Evaluating a Preference-Tailored Intervention to Increase CRC Screening

描述(申请人提供)：结直肠癌(CRC)是一种重要的可预防的疾病，但CRC筛查率仍然很低。美国预防服务工作组和其他组织一直主张将患者的偏好纳入结直肠癌筛查决定，作为一种提高筛查依从性的机制。然而，这种为偏好量身定做的战略对重要结果的影响尚不清楚，包括筛查依从性和成本。这项拟议研究的广泛假设是，帮助符合条件的患者澄清他们的CRC筛查偏好将导致更多的依从性。该框架的概念是，偏好澄清将增加患者对筛查结直肠癌的重要因素的了解和认识。患者将更好地做好准备，与他们的提供者一起参与知情的决策过程。改善知情决策将减少决策冲突，增强接受筛查的意愿，并最终更好地遵守筛查。具体目标是：1)在两个地点的随机对照试验中，测试偏好定制(PT)与标准信息(SI)干预对提高初级保健患者CRC筛查依从性的有效性；2)评估干预对知情决策、筛查知识和态度、决策结果和接受筛查意图的影响；以及3)对PT干预增加CRC筛查进行成本效益分析。我们将在两个地点对PT和SI决策工具进行随机对照试验：密歇根州底特律的Henry Ford Health System和与旧金山大学有关联的旧金山社区卫生网络。这种干预是一种基于网络的决策工具，由P.I.与密歇根大学健康传播研究中心合作开发。275名符合条件的参与者(年龄50-79岁，目前没有结直肠癌筛查，没有结直肠癌个人或家族病史，预定的初级保健访问)将在每个研究地点登记，并在登录网站时随机接受PT或SI干预。参赛者将被鼓励在预约访问网站之前来到诊所。对于那些具有足够的互联网能力、计算机经验以及能够在初级保健预约前不超过24小时查看网站的人，将提供在家中查看网站的选项。偏好信息将通过计算机程序收集。参与者将在他们的初级保健访问后大约3天被召唤，以收集知情的决策措施。在他们访问12个月后，将从电子和纸质病历中收集遵守筛查的情况。与每个目标相关的假设将使用多水平建模进行测试，以控制提供者和场地之间的影响。总体假设是，在12个月的随访点，PT组的患者将有更高的CRC筛查依从率。成本效益分析将决定基于偏好的筛选策略是否具有成本效益。 公共卫生相关性：结直肠癌(CRC)筛查是一种重要的、可预防的疾病，但筛查率仍然很低。美国预防服务工作组和其他组织一直主张将患者的偏好纳入结直肠癌筛查决定。本申请概述了一项在两个地点进行的随机对照试验，以测试基于网络的、根据偏好定制的CRC筛查决策工具对提高筛查依从性的有效性。研究结果将与改进结直肠癌筛查的知情决策直接相关，该决策可应用于美国患者面临的大量偏好敏感的医疗决策。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is a significant and preventable disease, yet CRC screening rates remain low. Incorporating patient's preferences into CRC screening decisions has been advocated by the United States Preventive Services Task Force, and others, as a mechanism for increasing screening adherence. However the impact of such a preference-tailored strategy on important outcomes, including screening adherence and cost, is unknown. The broad hypothesis of the proposed study is that helping eligible patients clarify their CRC screening preferences will lead to increased adherence. The framework conceptualizes that preference clarification will increase the patient's knowledge and awareness of the factors that are important to him or her in getting screened for CRC. Patients will be better prepared to participate in an informed decision making process with their provider. Improving informed decision making will lead to reduced decisional conflict, a greater intention to get screened and, eventually, to better adherence with screening. The specific aims are: 1) To test the effectiveness of a preference-tailored (PT) vs. standard information (SI) intervention for increasing primary care patient's CRC screening adherence in a randomized controlled trial at two locations; 2) To assess the impact of the intervention on informed decision making, knowledge and attitudes toward screening, decisional outcomes, and intention to get screened; and 3) To conduct a cost effectiveness analysis of the PT intervention for increasing CRC screening. We will conduct a randomized controlled trial of the PT vs. SI decision tool at two locations; Henry Ford Health System in Detroit, Michigan and the San Francisco Community Health Network, affilated with the University of San Francisco. The intervention is a web-based decision tool that has been developed by the P.I. working with the Center for Health Communications Research at the University of Michigan. 275 eligible participants (age 50-79, not current with CRC screening, no personal or family history of CRC, scheduled primary care visit) will be enrolled at each study site and randomized to the PT or SI intervention at the time of log-in to the web-site. Particpants will be encouraged to come to the clinic location prior to their appointment to view the web-site. The option to view the web-site from home will be offered for those who have the adequate Internet capabilities, experience with computers, and the ability to view the site no more than 24 hours prior to their primary care appointment. Preference information will be collected through the computer program. Participants will be called approximately 3 days after their primary care visit to collect informed decision making measures. Adherence to screening will be collected from electronic and paper medical charts 12 months after their visit. Hypotheses related to each aim will be tested using multi-level modeling to control for between-provider and site effects. The overall hypothesis is that patients in the PT group will have higher rates of CRC screening adherence at the 12 month follow-up point. Cost effectiveness analysis will determine whether a preference-based screening strategy is cost effective. Public Health Relevance: Colorectal cancer (CRC) screening is a significant and preventable disease, yet screening rates remain low. Incorporating patient's preferences into CRC screening decisions has been advocated by the United States Preventive Services Task Force, and others. This application outlines a randomized controlled trial at two sites to test the effectiveness of a web-based, preference-tailored CRC screening decision tool for increasing screening adherence. The results will have direct relevance for improving informed decision making for CRC screening which can be applied to the multitude of preference-sensitive healthcare decisions faced by patients in the U.S.