Interventions to Increase Colorectal Cancer Screening

结直肠癌(CRC)是美国第三大癌症死亡原因，大多数结直肠癌患者年龄在50岁或以上。前瞻性数据表明，每年一次的粪便潜血检测(FOBT)可以降低结直肠癌的死亡率。美国癌症协会建议每年进行一次FOBT检查，每5年进行一次柔性乙状结肠镜检查。这些测试的使用率非常低，从19%到39%不等，特别是在50岁或以上且最有可能患上这种疾病的人中。量身定制的干预措施显示，乳房X光检查的使用率显著增加，在结直肠癌筛查领域也可能有效。这项研究的目的是比较为增加FOBT和乙状结肠镜的使用而设计的定制干预和非定制干预的有效性，并确定其对行为认知阶段的影响。本研究的理论框架来源于健康信念和跨理论模型。在收集数据之前，将获得机构审查委员会的批准。这项研究中提出的所有工具之前都经过了信度和效度测试。训练有素的研究助理将联系总部设在中西部的健康维护组织(HMO)的成员，这些成员年龄在56岁或以上，并且在过去15个月内没有接受过FOBT。一旦资格标准得到验证，同意参与的人将随机分为三组：1)对照组，2)量身定制的印刷传播，3)非定制的印刷传播。基线数据将通过电话从600名HMO成员中抽样收集。干预措施将在基线访谈后2周邮寄，干预后访谈将在干预后2个月进行。干预组将对Fort或乙状结肠镜检查的几率进行Logistic回归分析。在双变量分析中p等于或等于0.20时显著的自变量将被输入到单独的Logistic回归模型中，以确定FOBT和乙状结肠镜使用的预测因素。结果将有助于测试在管理性医疗环境中增加FOBT和乙状结肠镜检查的量身定制的干预措施。

Colorectal cancer (CRC) is the third leading cause of cancer death in the United States with the majority of CRC diagnosed in those aged 50 or older. Prospective data indicate that annual fecal occult blood tests (FOBT) can decease mortality from CRC. The American Cancer Society recommends an annual FOBT and a flexible sigmoidoscopy every 5 years. Utilization of these tests is very low, ranging from 19% to 39%, especially among those who are 50 or older and most at risk for developing the disease. Tailored interventions have demonstrated significant increases in mammography use, and may be effective in the area of CRC screening as well. The purpose of this study is to compare the effectiveness of a tailored versus a non-tailored intervention designed to increase the use of FOBT and sigmoidoscopy, and to determine its effect on cognitive stage of behavior. The theoretical framework for this study was derived from the Health Belief and Transtheoretical Models. Institutional review board approval will be obtained before data collection. All instruments proposed in this study were previously tested for reliability and validity. Trained research assistants will contact members of a Midwest-based health maintenance organization (HMO), aged 56 or older and who have not had an FOBT in the last 15 months. Once eligibility criteria is verified, those who agree to participate with be randomized to one of three groups; 1) control, 2) tailored print communication, and 3) non- tailored print communication. Baseline data will be collected by telephone from a sample of 600 HMO members. Interventions will be mailed 2 weeks from the baseline interview, and post intervention interviews conducted 2 months from the intervention. Logistic regression will be conducted modeling the odds of having an FORT or sigmoidoscopy by intervention group. Those independent variables significant in bivariate analyses at p equal to or < .20 will be entered in to a separate logistic regression model to identify predictors of FOBT and sigmoidoscopy use. Results will be useful in testing tailored interventions to increase FOBT and sigmoidoscopy in managed care settings.