Culturally Adapted Multilevel Decision Support Navigation Trial to Reduce Colorectal Cancer Disparity among At-Risk Asian American Primary Care Patients

项目摘要 癌症是亚裔美国人死亡的主要原因，结直肠癌（CRC）的死亡率是 在亚裔美国人的癌症死亡中排名第二。然而，最近的数据显示， 中国人和韩裔美国人（CKAs）的CRC筛查率显著低于 其他种族/民族。迄今为止，少数以社区为基础的研究报告了使用 单一水平（仅参与者水平）干预措施，以提高CKA中的CRC筛查率;然而， 人们对多层次（面向患者和面向提供者）干预措施的影响知之甚少， 初级保健环境中CKA患者的CRC筛查依从性此外，我们的初步 数据表明，在CKA中，医生的推荐是CRC筛查的最强促进者。 因此，本研究的主要目标是通过开展一项 确定多水平文化敏感决策影响的随机对照试验 对400名CKA初级保健患者进行CRC筛查依从性支持干预。先前 研究发现，通过决策支持和提供患者导航， 可以在不同的初级保健患者中增加CRC筛查。我们会从文化上改编现有的证据- 基于决策支持导航干预（CA-DSNI），并在200名CKA男性和200名 50至75岁的CKA妇女有资格接受CRC筛查。我们将从初级保健部门招募参与者， 医生（PCP）诊所。该研究旨在比较CA-DSNI和CA-DSNI之间的CRC筛查结果。 先进控制（AC）那些随机分配到AC的人将收到一本信息小册子， 验血包和邮寄提醒。那些被随机分配到CA-DSNI的人将获得AC 接收。此外，我们还将为参与者提供决策支持和导航联系， 使用基于理论的在线决策咨询计划制定个性化的筛选计划，与 参与者的PCP，并有PCP鼓励筛选参与者。使用结果数据 通过调查和病历审查收集，我们将：（1）确定总体CRC筛查依从性， CA-DSNI与AC;（2）测量CA-DSNI与AC中CRC筛选决策阶段的变化;以及（3） 评估CA-DSNI与AC中CRC筛查检测特异性（粪便血液检测与结肠镜检查）的依从性。 此外，我们还将评估干预措施的覆盖范围、有效性、采用、实施和维护 使用访谈数据。影响：本研究代表了将使用CA-DSNI的第一个实例 在初级保健实践环境中使用CKAs，以解决显著的癌症差异。随着日益增长的需求 提供语言和文化上胜任的护理，更多的决策支持，语言便利和导航 努力可以进入护理环境。因此，为目标人群准备好测试干预措施， 及时，医疗系统可能会受益于具有已知的和测试的CKA的多层次最佳实践。

PROJECT SUMMARY Cancer is the leading cause of death among Asian Americans, and mortality from colorectal cancer (CRC) is ranked as the second most common in cancer deaths among Asian Americans. However, recent data show that CRC screening rates are substantially lower for Chinese and Korean Americans (CKAs) compared with other racial/ethnic groups. To date, a small number of community-based studies have reported on the use of single level (participant level only) interventions to increase CRC screening rates among CKAs; however, very little is known about the impact of multi-level (patient-oriented and provider-oriented) interventions on CRC screening adherence among CKA patients in primary care setting. Furthermore, our preliminary data indicate physician's recommendation as the strongest facilitator of CRC screening among CKAs. Thus, the primary objective of the study is to address this important knowledge gap by conducting a randomized controlled trial to determine the impact of a multi-level culturally-sensitive decision support intervention on CRC screening adherence among 400 CKA primary care patients. Previous studies found that facilitating patient decision-making through decision support and providing patient navigation can increase CRC screening among diverse primary care patients. We will culturally adapt existing evidence- based decision support navigation intervention (CA-DSNI) and test its efficacy among 200 CKA men and 200 CKA women aged 50 to 75 eligible for CRC screening. We will recruit the participants from primary care physicians (PCPs) clinics. The study is designed to compare CRC screening outcomes between the CA-DSNI and the Advanced Control (AC). Those randomized to the AC will receive an informational booklet, a stool blood test kit and a reminder by mail. Those randomized to the CA-DSNI will receive everything the AC receives. Additionally, we will provide decision support and navigation contacts to participants, develop an individualized screening plan using a theory-based online Decision Counseling Program, share the plan with the participants' PCPs, and have PCPs to encourage the screening to participants. Using outcomes data collected by survey and medical record review, we will: (1) determine overall CRC screening adherence in the CA-DSNI vs. the AC; (2) measure change in CRC screening decision stage in the CA-DSNI vs. the AC; and (3) Assess CRC screening test-specific (stool blood test vs. colonoscopy) adherence in the CA-DSNI vs. the AC. Additionally, we will evaluate intervention reach, effectiveness, adoption, implementation, and maintenance using interview data. IMPACT: This study represents the first instance in which CA-DSNI will be used with CKAs in primary care practice settings to address a significant cancer disparity. With growing need for linguistically and culturally competent care, more decision support, language facilitation, and navigation efforts may come into care settings. Therefore, having tested interventions ready for the target population will be timely, and medical systems may benefit from having multilevel best practices known and tested for CKAs.