Promoting Colon Cancer Screening in At Risk Families

促进高危家庭的结肠癌筛查

• 批准号: 6522662
• 负责人: PAUL C SCHROY
• 金额: $ 15.18万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-30 至 2004-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6522662
• 关键词: adenoma; cancer risk; clinical research; clinical trials; colon neoplasms; computer assisted diagnosis; decision making; diagnosis design /evaluation; education evaluation /planning; endoscopy; family medicine; gastrointestinal imaging /visualization; human subject; medical education; neoplasm /cancer diagnosis; neoplasm /cancer education; preference; primary care physician; psychological aspect of cancer

DESCRIPTION (provided by applicant): Colorectal cancer is the second leading cause of cancer-related death in U.S. Screening rates among individuals at increased risk of the disease because of a family history colorectal cancer or adenomas are suboptimal. Preliminary studies highlight the need for novel strategies to increase both provider and patient awareness of familial risk factors, promote compliance with appropriate screening recommendations, and facilitate risk communication between providers, affected patients and at-risk family members. Accordingly, the specific aims described herein address each of these needs by proposing novel interventions targeted at providers, adenoma patients and at-risk relatives. Specific Aim #1 is to design, implement and evaluate an educational program for primary care housestaff and assess its impact on their knowledge, risk assessment and screening behavior. The educational program will incorporate both didactic and interactive teaching sessions as well as distribution of a colorectal cancer risk assessment "tool kit." The actual content of the sessions and "tool kit" will be defined during Year 1 using existing literature, focus groups and an expert panel. A randomized controlled trial will be conducted in Year 2 to evaluate the program's effectiveness. A pretest/post-test format will be used to assess knowledge, patient exit interviews will be used to assess risk assessment skills, and chart audit with feedback will be used to assess documentation and screening behavior. Specific Aim #2 is to evaluate the efficacy of an educational program aimed at promoting increased awareness about familial risk and notification of first-degree relatives among adenoma patients. The program employs a standardized computer-based educational intervention that is conducted at the "bedside" immediately post-polypectomy, followed by a tailored notification of risk and recommendations in the form of a personalized letter. A three-arm randomized trial comparing the dual intervention to the bedside computer-based intervention alone versus standard care will be conducted to assess the program's effectiveness. Telephone surveys will be used to assess patient knowledge and extent of communication to at-risk siblings. Specific Aim #3 is to explore patient preferences and the role of shared decision-making as a strategy for promoting compliance with colorectal cancer screening recommendations among individuals with a family history of colorectal adenomas or cancer. Structured interviews will be conducted to assess patient preferences for the five recommended screening strategies colorectal cancer screening strategies, identify factors influencing their choices, and determine the extent to which such patients wish to participate in tho decision-making process using a validated "decision aid" and "Colorectal Cancer Autonomy Index/Autonomy Preference Index."

描述（由申请人提供）：结直肠癌是第二大 美国癌症相关死亡原因筛查率 由于结肠直肠癌家族史而增加的疾病风险，或 腺瘤是次优的。 初步研究强调了新的需求 提高提供者和患者对家庭风险的认识的策略 因素，促进遵守适当的筛查建议，以及 促进提供者、受影响患者和风险患者之间的风险沟通 家庭成员 因此，本文所述的具体目标解决了每一个问题。 通过提出针对供应商的新干预措施， 患者和高危亲属。 具体目标#1是设计、实施和评估教育计划 并评估其对他们的知识，风险 评估和筛选行为。 教育计划将包括 教学和互动教学课程以及分发 结直肠癌风险评估“工具包。“实际内容的 课程和“工具包”将在第一年使用现有的 文献、焦点小组和专家小组。 一项随机对照试验 将在第二年进行，以评估该计划的有效性。 一 将使用测试前/测试后格式评估知识、患者退出 面试将用于评估风险评估技能，并与 反馈将用于评估文件和筛选行为。 具体目标#2是评估教育计划的有效性， 提高对家庭风险的认识， 腺瘤患者的一级亲属。 该方案采用了 标准化的基于计算机的教育干预，是在 息肉切除术后立即“床边”，然后是量身定制的通知， 风险和建议的形式个性化的信。 三臂 一项比较双重干预与基于床边计算机的 将进行单独干预与标准护理，以评估 计划有效性 电话调查将用于评估患者 与有风险的兄弟姐妹沟通的知识和程度。 具体目标#3是探索患者的偏好和共享的角色 决策作为促进结肠直肠癌治疗依从性的策略 在有家族史的个体中进行筛查的建议 结肠直肠腺瘤或癌症。 将进行结构化面试， 评估患者对五种推荐筛查策略的偏好 结直肠癌筛查策略，确定影响其的因素 选择，并确定这些患者希望参与的程度 在决策过程中使用经过验证的“决策辅助工具”， 结肠直肠癌自主指数/自主偏好指数。"