CORE--ADHERENCE CORE

结直肠癌仍然是癌症死亡的第二大原因， 美国的辅助治疗的最新进展只是 开始影响5年生存率。因此，早期 特别是饮食和新的化学预防策略 代表着显著降低死亡率的最大希望 治疗这种疾病 临床试验的依从性是一个日益受到关注的领域， 部分费用用于开展社区临床试验。 越来越多的人希望确定那些可能 影响依从性，并易于改变，以及发展 提高临床试验依从性的方法。有证据 表明长期临床试验的依从性是可以实现的。 然而，维持长期变化的复杂性，特别是 饮食的变化应该得到承认。 坚持核心是一种服务资源，它汇集了专业知识， 支持这三个项目。受试者在这些临床 研究对象为40-80岁，有结直肠腺瘤病史 息肉核心的目标是：1。监测和评估依从性 学习程序，2。为护士提供 关于促进参与者遵守的准则、咨询和培训 研究方案，3.制定减少障碍的战略 与临床试验中的依从性问题相关，4.制定和 制作材料（如通讯）和实施程序（如 一般依从性干预），以提高参与者对 研究程序，5.开发、制作和分发各种书面材料 教育参与者了解潜在副作用的材料， 如何管理，6。优化受试者招募策略， 减少损耗，7.开发工具来识别行为 可能影响/预测流失和/或依从性的因素，以及8. 教育参与者了解癌症，其病因和预防， 尤其是结肠癌。 核心成果包括促进遵守， 一般依从性增强干预的有效性， 解决问题的补救性干预，为非遵守者， 预防、干预和生成关于问题的定性数据 大型临床试验参与者的经验，以及方法 来解决它们。

Colorectal cancer remains the second leading cause of cancer death in the United States. Recent advances in adjuvant therapy are just beginning to impact the 5-year survival rates. As a result, early detection and especially dietary and novel chemopreventive strategies represent the best hope to significantly decrease the mortality rates for this disease. Adherence to clinical trials is an area of increasing concern due in part to the cost involved in conducting community based clinical trials. There is increasing interest in identifying those factors that may affect adherence and are amenable to change, as well as developing methods to enhance adherence in clinical trials. There is evidence showing that adherence to long term clinical trials is achievable. However, the complexity of maintaining long term changes, particularly dietary changes should be recognized. The Adherence Core is a service resource which pools expertise and materials to support the three projects. Subjects in these clinical studies are 40-80 years old with a history of colorectal adenomatous polyps. The aims of the core are: 1. to monitor and evaluate adherence to study procedures, 2. to provide the nurse interveners with guidelines, consulting and training on promoting participant adherence to study protocols, 3. to develop strategies to reduce barriers associated with adherence problems in clinical trials, 4. to develop and produce materials (e.g. newsletters) and implement procedures (e.g. general adherence intervention) to enhance participant adherence to study procedures, 5. to develop, produce and distribute various written materials educating the participants about potential side effects and ways to manage them, 6. to optimize subject recruitment strategies to reduce attrition, 7. to develop instruments to identify behavioral factors that may influence/predict attrition and/or adherence, and 8. to educate participants about cancer, its etiology and prevention, with particular emphasis on colon cancer. Core outcomes include promotion of adherence, evaluation of the effectiveness of the General Adherence Enhancement intervention, the Problem-Solving remedial intervention for non-adherers, the Attrition Prevention intervention, and generation of qualitative data on problems experienced by participants in large clinical trials, as well as methods to solve them.