Evaluating a Preference-Tailored Intervention to Increase CRC Screening

评估针对偏好的干预措施以加强 CRC 筛查

• 批准号: 7474125
• 负责人: SARAH T HAWLEY
• 金额: $ 65.27万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-06-09 至 2012-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7474125
• 关键词: Adherence; Adult; Advisory Committees; Advocate; Age; Appointment; Attitude; Awareness; Characteristics; Clinic; Clinical; Colorectal Cancer; Communication Research; Community Health Networks; Computers; Conflict (Psychology); Cost Effectiveness Analysis; Decision Making; Disease; Effectiveness; Electronics; Elements; Enrollment; Family history of; Feedback; Frequencies; Geographic Locations; Guidelines; Health Communication; Health system; Healthcare; Healthcare Systems; Home environment; Hour; Intention; Internet; Intervention; Knowledge; Lead; Link; Location; Malignant Neoplasms; Measures; Medical; Methodology; Methods; Michigan; Minority; Modeling; Online Systems; Outcome; Paper; Participant; Patient Preferences; Patients; Perception; Physicians; Pliability; Policy Maker; Population; Preventive; Primary Health Care; Process; Professional Organizations; Provider; Public Health; Quality Indicator; Randomized; Randomized Controlled Trials; Rate; Recommendation; Relative (related person); Reporting; Research; Role; San Francisco; Schedule; Screening procedure; Services; Site; Staging; Standards of Weights and Measures; Testing; Time; United States; Universities; Visit; Work; base; colorectal cancer screening; compliance behavior; computer program; cost; cost effective; day; eligible participant; experience; follow-up; improved; innovation; literacy; new technology; preference; satisfaction; theories; tool

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.

描述（申请人提供）：结直肠癌（CRC）是一种重要且可预防的疾病，但CRC的筛查率仍然很低。美国预防服务工作组（United States Preventive Services Task Force）和其他机构一直倡导将患者的偏好纳入CRC筛查决策，作为增加筛查依从性的一种机制。然而，这种偏好定制策略对包括筛查依从性和成本在内的重要结果的影响尚不清楚。该研究的广泛假设是，帮助符合条件的患者明确他们的CRC筛查偏好将增加依从性。该框架的概念是，偏好澄清将增加患者对他或她在CRC筛查中重要因素的认识和意识。患者将更好地准备参与一个知情的决策过程与他们的提供者。改善知情决策将减少决策冲突，提高接受筛查的意愿，并最终更好地坚持筛查。具体目的是：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）干预在提高初级保健患者CRC筛查依从性方面的有效性；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愿的影响；3)对PT干预增加CRC筛查的成本-效果进行分析。我们将在两个地点进行PT与SI决策工具的随机对照试验；密歇根州底特律的亨利福特健康系统和旧金山大学附属的旧金山社区健康网络。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。每个研究地点将招募275名符合条件的参与者（年龄50-79岁，目前没有CRC筛查，没有个人或家族CRC病史，预定的初级保健就诊），并在登录网站时随机分配到PT或SI干预组。我们鼓励参与者在预约前到诊所查看网站。对于那些有足够的上网能力，有电脑使用经验，并且能够在他们的初级保健预约前24小时内浏览网站的人，将提供在家浏览网站的选择。偏好信息将通过计算机程序收集。参与者将在初级保健访问后约3天被叫来收集知情决策措施。随访12个月后，将从电子和纸质病历中收集筛查依从性。与每个目标相关的假设将使用多级模型进行测试，以控制供应商之间和现场的影响。总体假设是PT组患者在12个月随访时CRC筛查依从性更高。成本效益分析将决定基于偏好的筛查策略是否具有成本效益。