Increasing Colorectal Cancer Screening in Alaska Native Men

摘要 阿拉斯加原住民男性的结直肠癌（CRC）发病率和死亡率高于美国任何其他种族或 族群。筛查可以预防CRC，并通过早期检测疾病来改善治疗结果， 但阿拉斯加原住民男性的CRC筛查率也很低。结肠镜检查是最准确的CRC筛查 方法和结果在最多年的生命保存。它只需要每10年重新筛选一次，但这是一个诊所- 这需要大量的准备工作。其他筛查选择包括家庭测试， 检测到便血，并要求每年重新筛查。最近，一种基于家庭的方法已经被 开发了检测粪便中指示CRC的DNA，并要求每3年重新筛查一次。现行指南 建议从45-50岁开始对平均风险的成年人进行CRC筛查，但风险较高的人应该 从年轻的时候开始许多干预措施已经制定，以促进CRC筛查。其中， 使用文本消息或其他电子健康信息来接触临床以外的人的干预措施 已经显示出改善CRC筛查的前景。在之前的研究中，我们的研究团队开发了一种 向中南部基金会的阿拉斯加土著人患者发送最多3条短信的干预措施 (SCF)阿拉斯加州安克雷奇的医疗保健系统。我们在一项随机对照试验中测试了干预措施， 2，386名阿拉斯加土著SCF患者，年龄40-75岁。该干预措施使妇女的CRC筛查增加了50%， 但对男性无效。在目前的实施研究中，我们提出了一种基于理论的方法， 为阿拉斯加土著男子量身定制现有的短信干预。我们将使用调查和焦点小组， SCF患者，以及与SCF医疗保健提供者的关键知情人访谈，以评估 优化阿拉斯加原住民男性的结直肠癌筛查。我们预计，修订将包括改变 短信的内容和频率，并推广家庭粪便DNA筛查， 结肠镜检查然后，我们将测试600名阿拉斯加土著男子年龄的定制干预的有效性 40-75人是SCF的活跃患者。合格的男性将从电子病历中识别， 以相等比例随机分配至干预或常规护理对照条件。主要结局是 在发送第一条短信后6个月内完成CRC筛查。次要结局包括 与筛选相关的临床结果和随访程序。所有数据将从电子 医疗记录，我们将获得直接招募患者的同意书。后续访谈将 评估患者对干预的反应。如果有效，这项研究对增加CRC筛查有意义。 来自其他种族和少数民族群体的男性，他们经历了CRC差异。

ABSTRACT Alaska Native men have higher colorectal cancer (CRC) incidence and mortality than any other US racial or ethnic group. Screening can prevent CRC and improve treatment outcomes by detecting disease in early stages, but Alaska Native men also have low CRC screening uptake. Colonoscopy is the most accurate CRC screening method and results in the most years of life saved. It only requires rescreening every 10 years, but it is a clinic- based procedure and needs extensive preparation. Other screening options include home-based tests that detect blood in the stool and require rescreening every year. More recently, a home-based method has been developed that tests stool for DNA indicative of CRC and requires rescreening every 3 years. Current guidelines recommend CRC screening for average risk adults starting between ages 45-50, but people at higher risk should start at younger ages. Many interventions have been developed to promote CRC screening. Among these, interventions that use text messaging or other electronic health messages to reach people outside of the clinical setting have shown promise for improving CRC screening. In a previous study, our research team developed an intervention that sends up to 3 text messages to Alaska Native people patients of the Southcentral Foundation (SCF) healthcare system in Anchorage, Alaska. We tested the intervention in a randomized controlled trial with 2,386 Alaska Native SCF patients ages 40-75. The intervention increased CRC screening by 50% in women, but it had no effect in men. In the current implementation study, we propose a theory-based approach to culturally tailor the existing text message intervention for Alaska Native men. We will use surveys and focus groups with SCF patients, and key informant interviews with SCF healthcare providers, to assess barriers and facilitators to optimize colorectal cancer screening in Alaska Native men. We anticipate that revisions will include changing the content and frequency of the text messages, and promoting home-based stool DNA screening in addition to colonoscopy. We will then test the effectiveness of the tailored intervention with 600 Alaska Native men ages 40-75 who are active patients at SCF. Eligible men will be identified from the electronic medical record and randomized in equal proportions to the intervention or usual care control conditions. The primary outcome is CRC screening completed within 6 months of sending the first text message. Secondary outcomes include clinical findings and follow-up procedures associated with screening. All data will be collected from the electronic medical record, and we will obtain a waiver of consent for direct patient recruitment. Follow-up interviews will assess patient response to the intervention. If effective, this study has implications for increasing CRC screening in men from other racial and ethnic minority groups who experience CRC disparities.