INCREASING COLORECTAL CANCER SCREENING

结肠和直肠腺癌是结肠癌患者死亡的主要原因。 癌症在美国，大多数权威机构现在建议， 为50岁以上的人提供结肠直肠癌筛查（CRC） 因为最近有证据表明筛查可以有效减少CRC mortality. 然而，患者对筛查的依从率 乙状结肠镜检查的推荐率较低， 解释这种有限的遵守情况或确定增加遵守的方法， 患者参与。 我们提出了一个随机试验来衡量教育的有效性， 视频提高了柔性乙状结肠镜筛查的依从性 （主要试验结果）。 受试者是已确定的初级保健患者 与初级保健有非紧急预约的人 医生。 将对600人进行分层抽样（性别/年龄）， 随机分配到干预或比较条件。 干预 受试者将被邮寄一个录像带，并随附书面材料 预约前的小册子。 强调以病人为中心 教育，并将利用榜样来讨论障碍， 动机 在访视期间，两种研究条件下的患者将 从以下机构收到关于CRC的标准化建议和印刷材料： 医生 主要试验结局是完成 推荐乙状结肠镜检查。 次要结局包括初始 接受建议，以及选定的知识、态度和 被假设为受视频影响的信念度量。 电话访谈将在基线（To）时进行， 预约（T1），并在初级保健后四个月内 访视期间，可以完成乙状结肠镜检查 （T2）。 视频的内容和格式将由焦点小组和 对马萨诸塞州代表性样本的随机数字拨号调查 50岁以上的居民。 调查将确定知识水平， 对CRC和乙状结肠镜检查的信念和态度; CRC筛查;并确定独立相关的因素 乙状结肠镜检查筛查意向和行为，包括个人 诱发因素以及促进和加强卫生系统的因素 以及其他潜在的中介因素。

Adenocarcinoma of the colon and rectum is a major cause of death from cancer in the United States and most authorities now recommend that persons over age 50 be offered screening for colorectal cancer (CRC) because of recent evidence that screening is effective in reducing CRC mortality. However, rates of patient adherence with screening sigmoidoscopy recommendations are low and little research has been done to explain this limited compliance or to identify methods for increasing patient participation. We propose a randomized trial to measure the efficacy of an educational video in increasing compliance with flexible sigmoidoscopy screening (primary trial outcome). Subjects are established primary care patients who have a scheduled non-urgent appointment with their primary care physician. A stratified sample (gender/age) of 600 people will be randomized to the intervention or comparison condition. Intervention subjects will be mailed a video cassette with accompanying written brochure prior to their appointment. It will emphasize patient-centered education and will utilize role models to discuss barriers and enhance motivation. During their visit, patients in both study conditions will receive a standardized recommendation on CRC and printed material from the physician. The primary trial outcome is completion of the recommended sigmoidoscopy. Secondary outcomes include initial acceptance of the recommendation, and selected knowledge, attitude and belief measures which are hypothesized to be influenced by the video. Telephone interviews will be conducted at baseline (To), directly after the appointment (T1), and within four months after the primary care visit during which period a sigmoidoscopy could have been completed (T2). The content and format of the video will be informed by focus groups and a random digit dial survey of a representative sample of Massachusetts residents over age 50. The survey will identify knowledge levels, beliefs, and attitudes about CRC and sigmoidoscopy; document rates of CRC screening; and identify factors independently related to sigmoidoscopy screening intention and behavior, including personal predisposing factors and enabling and reinforcing health system factors and other potential mediating factors.