Colorectal Cancer Screening Among Patients Attending Ru*

描述（由申请人提供） 本研究计划的长期目标是改善PAR-02-042中结肠直肠癌（CRC）预防服务的提供和利用。本申请的目的是评估当前在忙碌繁忙的初级保健环境中CRC筛查的比率和模式，并确定医生和患者筛查的障碍/促进者。通过准确评估初级保健环境中CRC的预防性护理模式，这将为制定新的策略奠定基础，以改善CRC筛查和早期诊断，减少无法治疗的CRC。拟定的多方法研究旨在解决以下具体目标： 1.评估医生的分娩率和患者对CRC筛查的利用率。 2.确定患者依从或不依从结肠直肠筛查建议的原因以及他们选择特定检查的原因。 3.确定医生筛选或不筛选某些患者的原因以及为这些患者选择特定筛选方式的原因。 18名家庭医生将沿着随机抽取30名患者/医生，总计540名患者。患者将处于CRC的平均风险，年龄在55至80岁之间，主要生活在农村，卫生专业人员短缺地区。患者将完成一份详细的书面调查，内容涉及他们的健康状况、过去的CRC筛查试验、他们与医生就CRC筛查进行的讨论，并提供知情同意书，以审查他们过去的CRC筛查试验、当前药物和医疗状况的医疗记录。由于医生对患者进行聚类，因此将开发混合效应分层模型，以评估医生推荐筛选的预测因子和患者筛选依从性的预测因子。我们将使用定性方法采访医生，了解筛选/不筛选特定患者的原因。我们假设医生对影响CRC筛查可能性的患者特异性线索做出反应。以前的研究主要集中在医生是否同意已发表的指南及其自我报告的CRC筛查率，而没有阐明缺乏指南依从性的可能的患者特定原因（例如，合并症，健康状况，患者护理目标，社会经济地位，感知CRC风险，医疗保险）。需要患者特定的信息来帮助指导未来的干预措施。我们希望这种创新的方法产生新的重要信息，设计有效的干预措施，以提高CRC筛查率。

DESCRIPTION (provided by applicant) The long-term goal of this research program is to improve the delivery and utilization of preventive services for colorectal cancer (CRC) as in PAR-02-042. The objective of this application is to assess current rates and modalities of CRC screening in busy, primarily rural, primary care settings and to identify physician and patient barriers/facilitators to screening. By accurately assessing patterns of preventive care for CRC in the primary care setting, this will set the stage for developing new strategies to improve CRC screening and early diagnosis, reducing untreatable CRC. The proposed multimethod study is designed to address the following Specific Aims: 1. To assess physicians' rates of delivery and patients' rates of utilization of CRC screening. 2. To ascertain patients' reasons for compliance with or lack of compliance with colorectal screening recommendations and why they opted for particular tests. 3. To ascertain physicians' reasons for screening or not screening certain patients and why specific screening modalities were chosen for these patients. Eighteen family physicians will participate along with a random sample of 30 patients/physician for a total of 540 patients. Patients will be at average risk for CRC, ages 55 to 80 years, and primarily living in rural, health professional shortage areas. Patients will complete a detailed written survey regarding their health, past CRC screening tests, discussions they have had with their physician about CRC screening, and give Informed Consent for review of their medical record for past CRC screening tests, current medications, and medical conditions. Because of clustering of patients by physician, mixed effects hierarchical models will be developed to assess both predictors of physician recommendation for screening and predictors of patient compliance with screening. We will interview physicians using qualitative methods concerning reasons for screening/not screening specific patients. We hypothesize that physicians respond to patient-specific cues that affect the likelihood of CRC screening. Previous research has focused primarily on whether physicians agree with published guidelines and their self-reported rates of CRC screening, without elucidating possible patient-specific reasons for lack of guideline adherence (e.g. co-morbid conditions, health status, patient goals for care, socioeconomic status, perceived CRC risk, medical insurance). Patient-specific information is needed to help guide future interventions. We expect this innovative approach to yield new information of importance for designing effective interventions to improve the rate of CRC screening.