Colorectal Cancer Screening Among Patients Attending Ru*

描述(由申请人提供) 这项研究计划的长期目标是改进PAR-02-042中所述的结直肠癌(CRC)预防服务的交付和利用。这一应用程序的目的是评估当前繁忙的、主要是农村初级保健环境中结直肠癌筛查的比率和方式，并确定筛查的医生和患者障碍/促进者。通过准确评估初级保健环境中结直肠癌的预防护理模式，这将为制定新的战略，改进结直肠癌筛查和早期诊断，减少无法治疗的结直肠癌奠定基础。拟议的多方法研究旨在解决以下具体目标： 1.评估医生的接生率和患者对结直肠癌筛查的使用率。 2.确定病人遵从或不遵从结肠直肠检查建议的原因，以及他们选择进行特定检查的原因。 3.确定医生对某些病人进行筛查或不筛查的原因，以及为这些患者选择特定筛查方式的原因。 18名家庭医生将参与其中，随机抽样30名患者/医生，共540名患者。55岁至80岁的患者将面临患结直肠癌的平均风险，主要生活在农村卫生专业人员短缺的地区。患者将完成一份关于他们的健康、过去的CRC筛查测试、他们与医生就CRC筛查进行的讨论的详细书面调查，并在知情的情况下同意审查他们过去CRC筛查测试的医疗记录、当前的药物和医疗条件。由于按医生对患者进行聚类，将开发混合效应分层模型来评估医生推荐筛查的预测因素和患者对筛查的依从性的预测因素。我们将使用定性的方法采访医生，了解筛查/不筛查特定患者的原因。我们假设医生对影响结直肠癌筛查可能性的特定于患者的线索作出反应。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结直肠癌筛查率，而没有阐明不遵守指南的可能的患者特定原因(例如，共病情况、健康状况、患者的护理目标、社会经济状况、感知的结直肠癌风险、医疗保险)。需要特定于患者的信息来帮助指导未来的干预。我们期望这一创新方法将产生新的重要信息，以设计有效的干预措施，以提高结直肠癌筛查率。

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.