Enhancing Prevention Pathways Towards Tribal Colorectal Health

 描述（由申请人提供）：美国印第安人/阿拉斯加原住民（AI/AN）在结直肠癌（CRC）相关的发病率、死亡率、诊断分期和生存率方面存在显著的健康不平等和差异。最近CRC发病率和死亡率的降低以及美国普通人群诊断分期和生存率的改善归因于常规筛查，及时切除息肉，早期发现以及及时和适当的治疗。AI/AN比非西班牙裔白人更不可能接受及时和风险和年龄适当的癌症筛查，包括推荐的CRC筛查。短期目标是测试连续实施的干预措施的有效性，这些干预措施旨在使用粪便免疫化学试验（FIT）加强每年的CRC筛查。系列实施是指提供常规筛查，而不管对先前邀请的反应如何，这与建议在50-75岁之间进行年度FIT测试的国家指导方针相一致。FIT是最合适的，因为根据共识指南，它是一种经批准的高灵敏度粪便潜血试验，每年提供一次，可在印度卫生服务和部落卫生机构提供筛查结肠镜检查的资源有限。我们将遵循所有积极的FIT结果，及时提供适当的诊断和治疗服务。我们通过测试干预措施来解决筛查差异，这些干预措施旨在使用FIT在西南部农村地区50-75岁的平均风险保留AI中加强年度CRC筛查。这些干预措施是有理论依据的，以证据为基础的，并按其强度分级。高强度干预将包括导航外展、邮寄FIT套件、教育材料和随访 提醒（研究组1）。中等强度干预将包括邮寄的FIT套件、教育材料和随访提醒（研究组2）。参考组（研究组3）将接受常规护理（筛选建议和诊所访视时的FIT套件）。我们将使用严格的研究方法来：（a）通过完成FIT套件来确定干预措施的有效性，以加强年度CRC筛查;（B）了解对行为改变重要的背景相关因素;（c）确定最具成本效益的策略，以加强常规CRC筛查;（d）制定计划，以告知可持续性和可扩展性。这是新墨西哥州大学、阿尔伯克基地区印第安人健康委员会（100%由印第安人拥有和经营）和西南部农村的六个普韦布洛部落之间的合作努力。该研究团队在与人工智能社区合作开展基于社区的参与性癌症预防研究方面拥有广泛而成功的历史。此外，研究团队认识到整合共同学习过程和参与基于信任的互利研究的价值。这项研究的结果可能会导致CRC筛查的立即增加，并最终减少经历癌症差异和健康不平等的AI中的CRC疾病负担。

 DESCRIPTION (provided by applicant): American Indians/Alaska Natives (AI/ANs) experience significant health inequities and disparities in colorectal cancer (CRC) related incidence, mortality, stage at diagnosis, and survival. Recent reductions in CRC incidence and mortality rates and improvements in stage at diagnosis and survival rates in the general U.S. population have been attributed to routine screening with prompt removal of polyps, early detection, and timely and appropriate treatment. AI/ANs are significantly less likely than non-Hispanic Whites to receive timely and risk- and age-appropriate cancer screenings, including recommended CRC screening. The short-term goal is to test the efficacy of serially implemented interventions designed to enhance annual CRC screening using the fecal immunochemical test (FIT). Serial implementation refers to offering routine screening, irrespective of response to an earlier invitation, in concordance with national guidelines which recommend annual FIT testing between ages 50-75. The FIT is most appropriate because, based on consensus guidelines, it is an approved, high sensitivity fecal occult blood test that is offered annually and is available in Indian Health Service and tribal health facilities where resources to provide screening colonoscopy are limited. We will follow all positive FIT results with timely and appropriate diagnostic and treatment services. We address screening disparities through the testing of interventions designed to enhance annual CRC screening using the FIT among average- risk, on-reservation AIs aged 50-75 in the rural Southwest. The interventions are theory-informed, evidence- based, and graded in their intensity. The high intensity intervention will include navigated outreach, a mailed FIT kit, educational material, and follow-up reminders (Study Group 1). The medium intensity intervention will include a mailed FIT kit, educational material, and follow-up reminders (Study Group 2). The reference group (Study Group 3) will receive usual care (screening recommendation and a FIT kit at a clinic visit). We will use rigorous research methods to: (a) determine the efficacy of interventions to enhance annual CRC screening through completion of the FIT kit; (b) understand contextually relevant factors important for behavior change; (c) identify the most cost-effective strategies to enhance routine CRC screening; and (d) develop plans to inform sustainability and scalability. This is a collaborative effort between the University of New Mexico, the Albuquerque Area Indian Health Board (100% Indian-owned and operated), and six Pueblo Tribes in the rural Southwest. The research team has an extensive and successful history of conducting community based participatory cancer prevention research in collaboration with AI communities. Moreover, the research team recognizes the value of integrating a co-learning process and engaging in trust-based mutually beneficial research. Findings from this research could lead to an immediate increase in CRC screening and ultimately reduce the CRC disease burden among AIs experiencing cancer disparities and health inequities.