Increasing Colon Cancer Screening in Primary Care

美国癌症协会建议50岁或以上的男性和女性每五年进行一次粪便潜血检查(FOBT)和乙状结肠镜检查(FS)，以筛查结直肠癌(CRC)。推荐的其他结直肠癌筛查方案包括每隔5年进行一次钡灌肠X光(BE)或每10年进行一次结肠镜检查(CX)。对CRC筛查指南的遵从性很低。这项名为“增加初级保健中的结肠癌筛查”的拟议研究旨在开发和测试可用于提高结直肠癌筛查依从性的方法。研究参与者将是一家大型城市初级保健诊所(杰斐逊家庭医学协会)的男性和女性患者，他们的年龄在50岁到74岁之间，根据美国癌症协会的指南，他们患有结直肠癌的平均风险。在基线调查和基线图表审计完成后，1488名研究参与者将被随机分配到对照组、标准干预(SI)组、定制干预(TI)组或定制干预加电话(TIP)组。在为期两年的时间里，对照组将接受常规护理，而干预组将提供两次年度筛查干预。SI小组将收到一封标准的CRC筛查邀请函、一份CRC筛查工具包(一本教育小册子、一盘教育录像带和FOBT)和一封标准的提醒函。TI集团将收到一封量身定做的CRC筛查邀请函、一份CRC筛查试剂盒和一封量身定制的提醒函。在这里，为参与筛选决策阶段量身定做的教育信息将嵌入信件中。TIP小组将在TI集团接受同样的干预，外加一个定制的电话咨询电话，以在定制的筛选邀请信中放大教育信息。将管理中间点和终点调查，并完成终点图表审计以供研究(参与者。本研究的具体目的包括：(1)评估研究干预措施对筛查依从性的影响。(2)评估研究干预对筛查决策阶段的影响。(3)评估研究干预对明确的认知和心理社会变量的影响。(4)确定与筛查遵从性和决策阶段相关的变量。(5)评估与筛查依从性相关的干预成本效益。

ABSTRACT=The American Cancer Society recommends that men and women 50 or more years of age have a annual fecal occult blood test (FOBT) and a flexible sigmoidoscopy (FS) examination every five years to screen for colorectal cancer (CRC). Alternative CRC screening regimens that are recommended include having a barium enema X-ray (BE) at five- year intervals or a colonoscopy (CX) every 10 years. Compliance with CRC screening guidelines is low. The proposed study, Increasing Colon Cancer Screening in Primary Care, is intended to develop and test methods that may be used to increase CRC screening compliance. Study participants will be male and female patients of a large, urban primary care practice (Jefferson Family Medicine Associates), who are 50 to 74 years of age and are at average risk for CRC according to American Cancer Society guidelines. After a Baseline Survey and Baseline Chart Audit are completed, 1,488 study participants will be randomly assigned either to a Control Group, a Standard Intervention (SI) Group, a Tailored Intervention (TI) Group, or a Tailored Intervention plus Phone (TIP) Group. During a two-year period, the Control Group will receive usual care, while the intervention groups will be provided two annual screening interventions. The SI Group will receive a standard CRC screening invitation letter, a CRC screening kit (an educational booklet, and an educational videotape, and FOBTs), and a standard reminder letter. The TI Group will receive a tailored CRC screening invitation letter, a CRC screening kit, and a tailored reminder letter. Here, educational messages tailored to participant stage of decision making about screening will be embedded in the letters. The TIP Group will receive the same intervention at the TI Group, plus a tailored telephone counseling call to amplify educational messages in the tailored screening invitation letter. Midpoint and Endpoint Surveys will be administered and an Endpoint Chart Audit will be completed for study (participants. Specific aims of the study include the following: (1) Assess the impact of study interventions on screening compliance. (2) Assess the impact of study interventions on screening decision-making stage. (3) Assess the impact of study interventions on defined cognitive and psychosocial variables. (4) Identify variables associated with screening compliance and decision-making stage. (5) Evaluate intervention cost- effectiveness relative to screening compliance.