PEER OUTREACH TO FACILITATE COLORECTAL CANCER SCREENING IN SAFETY NET CLINICS

描述（由申请人提供）：筛查是降低结直肠癌（CRC）发病率和死亡率的有效工具，但许多成年人没有在推荐的时间间隔内进行筛查。社会经济地位低的人或没有保险的人的筛查率不成比例地低，而CRC的发病率和死亡率较高。这一人群需要新的策略来提高对CRC的认识并促进筛查尝试。该项目的长期目标是开发有效的、可持续的和可传播的干预措施，以增加CRC筛查，降低发病率，提高服务不足人群的生存率。这些努力对于减少目前CRC的健康差距和减少人口中CRC的总体负担至关重要。本申请的主要目的是评估同行提供的外展干预措施的承诺，以增加有利于城市安全网诊所患者的CRC筛查的决策和完成。这项随机试验将测试与传统的基于打印的干预相比，同行提供的干预在促进CRC筛查方面的有效性。这项研究将在200名年龄在50岁至75岁之间，具有CRC平均风险的患者中进行。患者将在招募时在安全网诊所现场完成基线调查，并将随机分配至“同伴教练”或对照打印干预。我们的理论为基础的干预结合了从计划行为理论和实施意图理论的结构。同侪教练是社区成员谁是诊所雇用和培训，以帮助患者获得医疗保健。干预措施将包括三个外展咨询电话，以促进和促进CRC筛查。对照打印干预将包括三封邮件，其中包含有关CRC筛查的目标信息。我们将在基线后6个月对参与者进行随访电话调查。这项研究的主要结果是在基线后6个月完成任何可接受的CRC筛查（FOBT，乙状结肠镜检查，结肠镜检查），通过图表审查进行测量。第二个目的是进行过程评价，并证明干预安全网环境的可行性。R21的成功完成将为计划的全面R01干预试验的开发提供信息，以减少CRC筛查，发病率和生存率的差异。公共卫生相关性：结直肠癌（CRC）的早期发现与更好的生存率有关，但人口筛查率相对较低，特别是在低收入和无保险的人群中。我们的研究将检查使用同伴教练干预的效果，以提高安全网诊所的CRC筛查率。在美国，筛查的增加可能对CRC负担产生重大影响。

DESCRIPTION (provided by applicant): Screening is an effective tool for reducing both colorectal cancer (CRC) incidence and mortality, but many adults are not screened at recommended intervals. Persons of low socioeconomic status or who are uninsured have disproportionately lower rates of screening and higher rates of CRC incidence and mortality. Novel strategies are needed for this population to increase awareness of CRC and facilitate screening attempts. The long-term objectives of this project are to develop effective, sustainable, and disseminable interventions that will increase CRC screening, decrease incidence, and improve survival in underserved populations. Such efforts are critical to decreasing the current health disparities in CRC and reducing overall CRC burden in the population. The Primary Aim in this application is to assess the promise of a peer-delivered outreach intervention for increasing decisions favoring, and completion of, CRC screening among patients from urban safety-net clinics. This randomized trial will test the effectiveness of a peer-delivered intervention compared to a traditional print-based intervention for promoting CRC screening. This study will be conducted with 200 patients who are between the ages of 50 and 75 and at average-risk for CRC. Patients will complete a baseline survey on-site at the safety-net clinic at the time of recruitment and will be randomized to either a "peer coach" or a comparison print intervention. Our theory-based intervention incorporates constructs from the Theory of Planned Behavior and Implementation Intentions Theory. Peer Coaches are community members who are employed by the clinic and trained to help patients access healthcare. The intervention will consist of three outreach counseling calls to promote and facilitate CRC screening. The comparison print intervention will consist of three mailings with targeted information about CRC screening. We will conduct a follow-up telephone survey of participants at 6-months post baseline. The primary outcome of this study is completion of any acceptable CRC screen (FOBT, sigmoidoscopy, colonoscopy) at six-months after baseline, measured by chart review. A secondary aim is to conduct process evaluation and demonstrate feasibility for intervening in safety-net settings. Successful completion of this R21 will inform the development of a planned full-scale R01 intervention trial to reduce disparities in CRC screening, incidence, and survival. PUBLIC HEALTH RELEVANCE: Early detection of colorectal cancer (CRC) is associated with better survival, but population screening rates are relatively low, especially so in low income and uninsured persons. Our study will examine the effect of an intervention using peer coaches to increase CRC screening rates in safety-net clinics. Increases in screening can have a significant impact on CRC burden in the United States.