Optimal early colorectal cancer screening initiation

最佳的早期结直肠癌筛查启动

• 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
• 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

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.

项目摘要 结直肠癌（CRC）占8%的癌症发病率和9%的癌症相关死亡率， United States（US）.大约11%的CRC病例在50岁之前被诊断出来-被称为早发性CRC （EOCRC）-2005-2014年间，发病率和死亡率每年增加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/族裔群体之间的不平等负担， 有医疗补助或没有保险的人。不断增加的EOCRC负担告知美国预防服务任务 强制（USPSTF）建议从45岁开始在平均风险成人中启动CRC筛查， 而不是50。这项建议将扩大CRC筛查到2100万美国人，其中400万人 每年都有更多的人45岁。缺乏证据来告知如何优化CRC筛查的影响 在45-49岁的成年人中。具体来说，有三个关键的知识差距：1）我们缺乏信息 关于年龄在45-49岁之间的CRC筛查的可接受性，尚未调查 可能会影响新合格人群的CRC筛查，2）有人担心CRC 年龄≥50岁的成年人中存在的筛查差异可能会出现在这个年轻的年龄组中， 有针对性的筛查策略和3）尚不清楚该年龄组是否会对当前的CRC筛查有反应 实践或更积极的推广。该提案的中心目标是制定有针对性的CRC筛查 在45-49岁的成年人中采取战略，最大限度地提高筛查率，预防癌症差异。我们的研究将 招募45-49岁在大型卫生系统内接受护理的成年人回答这些问题。一是 通过开展一项试点试验来确定CRC筛查的可接受性，以确定大型试验的可行性 (Aim 1a）并就影响CRC筛查接受的因素进行调查和访谈（目标1b）， 强调在45-49岁的成年人中实施筛查的有效战略。接下来，我们将使用这些飞行员 为主动外展策略的比较有效性的随机对照试验提供数据 包括邮寄粪便免疫化学测试与常规护理，以优化吸收和预防出现 CRC筛查差异（目标2）。该研究计划由培训计划补充，以提高 申请人有流行病学和生物统计学的背景，在1）随机对照试验方面接受过新的培训 方法学; 2）健康行为与医疗决策研究; 3）健康公平与差异 研究方法;（4）调查与质的研究方法。我们的研究将是最全面的 检查迄今为止在美国启动的早期CRC筛查，并将为更新的CRC提供背景 筛查政策和在成年人中更广泛地实施早期CRC筛查的潜在框架 45-49.它还提供了一个高质量的职业发展机会，以发展关键技能，成为一个合格的 独立调查员