Increasing Colorectal Cancer Screening for Patients with Multiple Morbidities

描述（由申请人提供）：总的来说，阿巴拉契亚和农村地区服务不足的居民，在预防和管理疾病的资源较少的情况下，经历了更高的多重发病率（MM）。一些研究人员推测，影响阿巴拉契亚人的癌症健康差异可能归因于多种发病率管理需求，这可能会使必要和有效的癌症筛查失去优先地位。在这项初步研究中，我们研究了多种疾病是否以及如何影响结直肠癌筛查率。我们的长期目标是将这种竞争时间和资源压力的不利情况转化为优势，通过在患有多种疾病的人更频繁的医疗互动中增加癌症筛查服务。由于MM发病率急剧上升，MM患者的癌症死亡率较高，以及疾病预防和管理的竞争需求，解决近四分之三的中老年人MM至关重要。我们的目标是通过三个研究活动来扩大我们对MM与结直肠癌（CRC）筛查之间关系的有限理解。首先，为了深入了解影响多种疾病患者CRC筛查行为模式的因素和环境，我们将对代表阿巴拉契亚地区不同做法的5名医疗服务提供者和40名患有两种或两种以上慢性疾病的患者进行深入访谈。这些访谈将提供两个最重要的卫生决策者——提供者和患者——基于当地的观点。其次，为了确保普遍性，我们将通过对阿巴拉契亚人进行分层代表性调查来评估与MM和CRC筛查行为相关的因素的影响。最后，在确定多种疾病背景下阻止CRC筛查的因素、环境和模式后，我们将举行焦点小组来验证我们的发现并讨论干预的最佳方向。最终，这些发现将导致以社区为基础的参与性干预R01的发展，这将利用那些患有多种疾病的人相对频繁的医疗就诊，最终将增加CRC筛查，改善实践协调，并减少癌症相关的死亡。公共卫生相关性：在美国，不断增长的中老年人口中，大多数患有多种疾病或多种慢性疾病。患有多种疾病通常会降低接受高效癌症预防的可能性，如结肠直肠癌筛查。该项目使用创新的方法来确定为什么患有多种疾病的人可能不太可能接受结直肠癌筛查的原因，并最终为阿巴拉契亚地区服务不足的农村健康差异人口制定一种文化上一致的干预措施，以增加对这种致命癌症的早期发现。

DESCRIPTION (provided by applicant): Appalachian and rural underserved residents, in general, experience higher rates of multiple morbidities (MM) with fewer resources to prevent and manage disease. Some researchers have speculated that the well-documented cancer health disparities affecting Appalachians may be attributable to multiple morbidity management demands which may deprioritize essential and efficacious cancer screenings. In this pilot study, we examine whether and how multiple morbidities affect colorectal cancer screening rates. Our long-term goal is to turn this disadvantageous situation of competing time and resource pressure into an advantage by increasing cancer screening services during the more frequent medical interactions of those with multiple morbidities. Addressing the nearly three-quarters of middle aged and older adults with MM is essential due to skyrocketing rates of MM, higher rates of cancer mortality among those with MM, and competing demands of disease prevention and management. We aim to expand our limited understanding of the association between MM and colorectal cancer (CRC) screening through three research activities. First, to obtain rich insights into the factors and circumstances that affect patterns of CRC screening behavior among those with multiple morbidities, in-depth interviews will be conducted with 5 health care providers representing diverse practices in Appalachia and with 40 patients who have two or more chronic diseases. These interviews will provide locally grounded perspectives from the two most salient health decision makers, providers and patients. Second, to insure generalizability, we will assess the impact of factors germane to both MM and CRC screening behavior by conducting a stratified representative survey of Appalachians. Finally, after identifying factors, circumstances, and patterns that prevent CRC screening in the context of multiple morbidities, we will hold focus groups to validate our findings and discuss optimal direction for interventions. Ultimately, these findings will lead to the development of a community-based participatory intervention R01 that will capitalize on the relatively frequent medical care visits of those with multiple morbidities and ultimately will increase CRC screening, improve practice coordination, and decrease cancer-associated deaths. PUBLIC HEALTH RELEVANCE: In the US, the majority of the ever-growing middle aged and older population has multiple morbidities or several chronic diseases. Having multiple morbidities generally decreases the likelihood of receiving highly effective cancer prevention, like colorectal cancer screening. This project uses innovative methods to determine the reasons why those with multiple morbidities may be less likely to get colorectal cancer screening and will eventually develop a culturally consistent intervention for the underserved rural health disparities population of Appalachia to increase early detection of this deadly cancer.