Colorectoral cancer screening decisions in primary care

描述（由申请人提供）： 当前结直肠癌预防工作的成功取决于筛查。然而，2000 年，美国只有不到一半的平均风险患者遵守筛查建议。帮助克服筛查障碍的其他研究已被认为是实现国家结直肠癌预防目标的重要一步。目前针对一般风险患者的筛查指南认可了 5 种选择：每年一次粪便隐血检测、每 5 年一次柔性乙状结肠镜检查、每 5 年一次年度粪便潜血检测和柔性乙状结肠镜检查、每 5 年一次双重造影钡剂灌肠以及每 10 年一次结肠镜检查。鼓励患者和医生比较各种选择的优缺点，并选择最适合患者个人偏好和情况的一种。几种健康行为理论的一个共同要素是，一个人对拟议干预措施的态度会影响他们的行为，而态度又直接受到干预措施的感知风险和益处的影响。这就提出了这样一个假设：有关初级保健决策者如何看待结直肠癌筛查测试的风险和益处的信息将有助于识别和克服筛查障碍。我们将使用层次分析法 (AHP)（一种多标准决策方法）来研究 650 名平均风险患者及其初级保健医生如何看待当前推荐的 5 种结直肠筛查方案的优缺点之间的权衡。患者和医生将来自纽约州罗彻斯特、阿拉巴马州伯明翰、印第安纳州印第安纳波利斯和阿拉巴马州基于实践的 CME 网络的不同初级保健机构。将使用描述性和多变量分析来分析数据，以实现 5 个具体目标：1）描述平均风险患者分配给决策标准的优先级范围，该决策标准描述当前推荐的五种结直肠癌筛查选项的优点和缺点； 2) 描述初级保健医生在为研究患者提出筛查建议时分配给相同决策标准的优先级范围； 3) 查看患者或医生的决策优先级是否与患者或医生的具体因素相关； 4) 比较患者和医生的优先事项； 5) 确定随后的结直肠癌筛查结果以及基于 AHP 的决策优先级评估的有效性和可接受性。

DESCRIPTION (provided by applicant): The success of current colorectal cancer prevention efforts depends on screening. In 2000, however, fewer than half of the average risk patients in the United States were in compliance with screening recommendations. Additional research to help overcome barriers to screening has been recognized as an important step toward meeting national colorectal cancer prevention goals. Current screening guidelines for average risk patients endorse 5 options: annual fecal occult blood tests, flexible sigmoidoscopy every 5 years, combined annual fecal occult blood tests and flexible sigmoidoscopy every 5 years, double contrast barium enema every 5 years, and colonoscopy every 10 years. Patients and physicians are encouraged to compare the options' pros and cons and select the one best suited for individual patient preferences and circumstances. A common element of several theories of health behavior is that a person's attitude toward a proposed intervention affects their behavior and that attitudes are directly influenced by an intervention's perceived risks and benefits. This raises the hypothesis that information about how primary care decision makers view the risks and benefits of colorectal cancer screening tests will help identify and overcome screening barriers. We will use the Analytic Hierarchy Process (AHP), a multi-criteria decision making method, to examine how 650 average risk patients and their primary care physicians view the trade-offs between the advantages and disadvantages of the 5 currently recommended colorectal screening options. The patients and physicians will be from diverse primary care settings in Rochester NY, Birmingham AL, Indianapolis IN, and the Alabama practice-based CME network. The data will be analyzed using descriptive and multivariable analysis to address 5 specific aims: 1) to describe the range of priorities average risk patients assign to decision criteria that describe strengths and weaknesses of the five currently recommended colorectal cancer screening options; 2) to describe the range of priorities primary care physicians assign to the same decision criteria when making screening recommendations for study patients; 3) to see if patient or physician decision priorities are associated with patient or physician specific factors ; 4) to compare patient and physician priorities; and 5) to determine subsequent colorectal cancer screening outcomes and the validity and acceptability of an AHP-based decision priority assessment.