权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Optimal early colorectal cancer screening initiation

最佳的早期结直肠癌筛查启动

基本信息

批准号：
10526181
负责人：
Joshua Brian Demb
金额：
$ 11.69万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10526181
关键词：
Address Adult Advisory Committees Affect Age Age of Onset Alaska Native American American Indians Asian Americans Award Biometry Black Populations Black race California Cancer Burden Cancer Etiology Caring Cessation of life Colorectal Cancer Communities Complement County Data Decision Making Diagnosis Education Effectiveness Electronic Health Record Ensure Epidemiology Ethnic group Excision Future Gastroenterology Goals Health Disparities Research Health Services Research Health behavior Health system Hispanic Incidence Influentials Insurance Interview Knowledge Latino Population Malignant Neoplasms Medicaid Medical Mentorship Methodology Not Hispanic or Latino Outcome Participant Pathway interactions Patient risk Patients Phase Polyps Population Preventive service Provider Qualitative Research Quality of Care Randomized Randomized Controlled Trials Recommendation Research Research Methodology Research Personnel Research Support Research Training Risk Running Sample Size Screening for cancer Signal Transduction Surveys Testing Training Uninsured United States Universities Update age group cancer epidemiology cancer health disparity cancer type career career development colorectal cancer risk colorectal cancer screening comparative effectiveness trial early onset colorectal cancer early screening experience health disparity health equity low socioeconomic status mortality outreach pilot trial prevent racial and ethnic randomized trial recruit risk perception screening screening disparities screening policy screening program skills sociodemographic disparity sociodemographics treatment as usual trial comparing uptake

项目摘要

PROJECT SUMMARY Colorectal cancer (CRC) accounts for 8% of cancer incidence and 9% of cancer-related mortality in the United States (US). About 11% of CRC cases are diagnosed before age 50—known as early age onset CRC (EOCRC)—with incidence and mortality rates increasing 1.6% and 1% per year between 2005-2014, and an unequal burden among Asian, American Indian/Alaska Native, Black and Hispanic racial/ethnic groups and those with Medicaid or uninsured. The increasing EOCRC burden informed a US Preventive Services Task Force (USPSTF) recommendation to initiate CRC screening among average risk adults starting at age 45, rather than 50. This recommendation would expand CRC screening to 21 million Americans, with 4 million more turning 45 each year. There is a lack of evidence to inform how to optimize impact of CRC screening among adults ages 45-49. Specifically, there are three critical knowledge gaps: 1) we lack information regarding acceptability of CRC screening among those ages 45-49 and have not investigated factors that might influence CRC screening uptake among this newly eligible population, 2) there are concerns that CRC screening disparities that exist among adults ages ≥50 are likely to emerge in this younger age group without a targeted screening strategy and 3) it is unclear whether this age group will respond to current CRC screening practice or more active outreach. The central objective of this proposal is to develop a targeted CRC screening strategy among adults ages 45-49 to maximize screening uptake and prevent cancer disparities. Our study will recruit adults ages 45-49 receiving care within a large health system to answer these questions. First, we will characterize the acceptability of CRC screening by running a pilot trial to establish feasibility of a larger trial (Aim 1a) and conduct surveys and interviews regarding factors influencing CRC screening uptake (Aim 1b) to highlight effective strategies for implementing screening among adults ages 45-49. Next, we will use these pilot data to inform a randomized controlled trial of the comparative effectiveness of an active outreach strategy including mailed fecal immunochemical test versus usual care for optimizing uptake and preventing emergence of CRC screening disparities (Aim 2). This research plan is complemented by a training plan to enhance the applicant’s background in epidemiology and biostatistics, with new training in 1) randomized controlled trials methodology, 2) health behavior and medical decision making research, 3) health equity and disparities research and 4) survey and qualitative research methods. Our study will be the most comprehensive examination of early CRC screening initiation in the US to date and will provide context to the updated CRC screening policy and a potential framework for wider implementation of earlier CRC screening in adults ages 45-49. It also offers a high-quality career development opportunity to develop key skills to become a qualified independent investigator.

项目概要结直肠癌 (CRC) 占癌症发病率的 8%，占癌症相关死亡率的 9% 美国（US）。大约 11% 的 CRC 病例在 50 岁之前被诊断出来，称为早发性 CRC (EOCRC)——2005 年至 2014 年间，发病率和死亡率每年分别增加 1.6% 和 1%，亚裔、美洲印第安人/阿拉斯加原住民、黑人和西班牙裔种族/族裔群体之间的负担不平等，那些有医疗补助或没有保险的人。日益增加的 EOCRC 负担告知美国预防服务任务强制 (USPSTF) 建议从 45 岁开始对平均风险成年人启动 CRC 筛查，而不是 50。这项建议将把 CRC 筛查范围扩大到 2100 万美国人，其中 400 万每年有更多人年满 45 岁。缺乏证据来说明如何优化 CRC 筛查的影响 45-49 岁的成年人。具体来说，存在三个关键的知识差距：1）我们缺乏信息关于 45-49 岁人群对结直肠癌筛查的可接受性，尚未调查影响 CRC 筛查的因素可能会影响这一新符合资格人群的 CRC 筛查率，2) 有人担心 CRC 年龄 ≥ 50 岁的成年人中存在的筛查差异很可能会在这个较年轻的年龄组中出现，而无需经过有针对性的筛查策略，3) 目前尚不清楚该年龄组是否会对当前的 CRC 筛查做出反应实践或更积极的外展。该提案的中心目标是制定有针对性的 CRC 筛查针对 45-49 岁成年人的策略，以最大限度地提高筛查率并防止癌症差异。我们的研究将招募在大型卫生系统内接受护理的 45-49 岁成年人来回答这些问题。首先，我们将通过进行试点试验来确定更大规模试验的可行性，从而表征 CRC 筛查的可接受性（目标 1a）并就影响 CRC 筛查率的因素进行调查和访谈（目标 1b），以强调在 45-49 岁成年人中实施筛查的有效策略。接下来，我们将使用这些试点为随机对照试验提供有关积极外展策略的比较有效性的数据包括邮寄粪便免疫化学测试与常规护理的比较，以优化吸收并防止出现 CRC 筛查差异（目标 2）。该研究计划辅以培训计划，以增强申请人的流行病学和生物统计学背景，并接受过 1) 随机对照试验的新培训方法论，2) 健康行为和医疗决策研究，3) 健康公平和差异研究和4）调查和定性研究方法。我们的研究将是最全面的迄今为止，美国对早期 CRC 筛查启动情况进行了审查，并将为更新的 CRC 提供背景信息筛查政策和在成人中更广泛实施早期结直肠癌筛查的潜在框架 45-49。它还提供高质量的职业发展机会，培养关键技能，成为合格的人才独立调查员。