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

项目概要 癌症是亚裔美国人死亡的主要原因，结直肠癌 (CRC) 的死亡率 在亚裔美国人中癌症死亡中排名第二。然而，最新数据显示 与美国相比，华裔和韩裔美国人 (CKA) 的 CRC 筛查率要低得多 其他种族/族裔群体。迄今为止，少数基于社区的研究报告了使用 单一水平（仅限参与者水平）干预措施，以提高 CKA 中的 CRC 筛查率；然而，非常 关于多层次（以患者为导向和以提供者为导向）干预措施对健康的影响知之甚少。 初级保健机构中 CKA 患者的 CRC 筛查依从性。此外，我们初步 数据表明，医生的建议是 CKA 中 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研究来解决这一重要的知识差距。 随机对照试验，以确定多层次文化敏感决策的影响 支持对 400 名 CKA 初级保健患者的 CRC 筛查依从性进行干预。上一页 研究发现，通过决策支持和提供患者导航来促进患者决策 可以增加不同初级保健患者的 CRC 筛查。我们将在文化上调整现有的证据—— 基于决策支持导航干预 (CA-DSNI) 并在 200 名 CKA 男性和 200 名男性中测试其功效 50 至 75 岁的 CKA 女性有资格接受 CRC 筛查。我们将从初级保健中招募参与者 医生 (PCP) 诊所。该研究旨在比较 CA-DSNI 之间的 CRC 筛查结果 和高级控制（AC）。那些被随机分配到 AC 的人将收到一本信息手册、一张凳子 血液检测套件和邮件提醒。那些随机分配到 CA-DSNI 的人将收到 AC 中的所有内容 收到。此外，我们将为参与者提供决策支持和导航联系，制定 使用基于理论的在线决策咨询程序制定个性化筛查计划，与以下人员分享该计划 参与者的 PCP，并有 PCP 鼓励对参与者进行筛查。使用结果数据 通过调查和病历审查收集的信息，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 筛查决策阶段的变化；和（3） 评估 CA-DSNI 与 AC 中特定 CRC 筛查测试（粪便血液测试与结肠镜检查）的依从性。 此外，我们将评估干预措施的范围、有效性、采用、实施和维护 使用访谈数据。影响：这项研究是使用 CA-DSNI 的第一个实例 在初级保健实践环境中与 CKA 合作，以解决重大的癌症差异问题。随着需求的不断增长 提供具有语言和文化能力的护理、更多决策支持、语言便利和导航 努力可能会进入护理机构。因此，为目标人群准备好测试干预措施将 及时，医疗系统可能会受益于 CKA 已知和测试的多级最佳实践。

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.