Colorectal Cancer Screening: A New Web-Based Decision-Making Strategy for Low-Lit

描述(由申请人提供)：预计将有近143,000名美国人被诊断为结直肠癌(CRC)，2013年约有51,000名美国人死于结直肠癌。这使CRC成为该国癌症死亡的第二大原因，也是确诊人数第三多的原因。早期诊断，预后良好，存活率接近90%。然而，如果及早发现这种疾病，预计的死亡人数大约是预期的3.5倍。出现差异的一个主要原因是没有遵守美国预防服务工作组(USPSTF)制定的筛查指南，该指南建议使用三种筛查方法之一对50岁至75岁的所有患者进行筛查：粪便潜血试验、弹性乙状结肠镜或结肠镜检查。在高危人群中，只有58.6%的人遵守了指导方针。在西班牙裔人口中，这一比例降至46.5%，与年龄和阶段匹配的人相比，他们的死亡率也更高。需要创新的战略来解决筛查率低的问题，特别是在拉美裔美国人中。这项建议的主要目标是制定、测试和确定针对低识字率拉美裔人口实施双语、文化定制和基于理论的决策支持干预措施的可行性，以促进在护理患者时做出高质量的知情决策，从而增加对结直肠癌筛查的接受。我们应用新的决策理论方法，依赖于非加性积分的概念，帮助患者做出与结直肠癌筛查相关的更知情的决定。由于信息学的无处不在和无处不在的性质，基于信息学的决策辅助系统是这种干预的理想载体。我们建议开发一个基于Web的、在触摸屏计算机上交付的开源软件。提供因地制宜和以理论为基础的关于儿童权利公约和筛查的教育。2)提供包含关键测试属性的交互式、明确的偏好澄清练习；3)根据个人喜好计算非相加度量，并为患者和治疗医生提供决策指南；以及将患者的决定直接与电子病历联系起来。我们建议从两个初级保健诊所招募140名西班牙裔患者和20名提供者，以试点和测试该软件的可用性，干预措施，收集有关将其整合到临床实践的可行性的数据，并获得关于其对筛查吸收、患者提供者互动和临床过程的潜在影响的信息。我们研究的中心假设是，在计算基础设施内基于适当的决策工具(例如，基于最近的决策理论研究)进行的干预将提高对高危人群，特别是拉美裔人口的认识，将促进决策过程，将产生更高的筛查率和对USPSTF关于结直肠癌的指导方针的总体遵守，并将导致更高的早期发现率，因此更高的实际生存率。该项目将为 开发一项R01赠款，进行多点干预，以提高全美拉美裔患者的CRC筛查率。

DESCRIPTION (provided by applicant): It is estimated that close to 143,000 Americans will be diagnosed with colorectal cancer (CRC) that about 51,000 Americans will die from CRC in 2013. This makes CRC the second leading cause of cancer deaths in the country, and the third most diagnosed. With early stage diagnosis, the outcome is favorable, and the survival rate is close to 90%. Yet, the predicted number of deaths is roughly 3.5 times more than anticipated were the disease detected early. A primary reason for the discrepancy is the lack of adherence to the screening guidelines set forth by the U.S. Preventive Services Task Force (USPSTF) which recommends screening for all patients between 50 and 75 years of age, using one of the three screening methods: Fecal Occult Blood Test, flexible sigmoidoscopy, or colonoscopy. Within the population at risk, only 58.6% adhere to the guidelines. The rate drops to 46.5% in the Hispanic population, who also suffer greater mortality compared to age and stage matched individuals. Innovative strategies are needed to address low screening rates in, in particular among Hispanics. The primary objective of this proposal is to develop, test and determine the feasibility of implementing a bilingual, culturally tailored and theory-based decision-support intervention targeting low literacy Hispanic populations, to facilitate high quality informed decision making at the point of care for patients, in order to increase the uptake of CRC screening. We apply new decision -theoretic methods relying on the concepts of non-additive integration, to help patients make better-informed decisions pertaining to CRC screening. Because of the ubiquitous and pervasive nature of informatics, an informatics-based decision aid system is an ideal vector for such an intervention. We propose to develop a web-based, open- source software delivered on touch screen computers which 1.) Provides culturally tailored and theory-based education on CRC and screening. 2) Provides an interactive, explicit preference clarification exercise incorporating key test attributes; 3.) Computes the non-additive measures based on individual preferences, and provides decision-making guidelines for the patient and the treating physician; and 4.) Links the patient's decision directly into the EMR. We propose to recruit 140 Hispanic patients and 20 providers from two primary care clinics in order to pilot and test the usability of the software, the intervention, gather data on the feasibility o integrating it into clinical practice and to garner information about its potential effect on screening uptake, patient provider interaction and clinic processes. The central hypothesis of our research is that an intervention based on proper decision-making tools (e.g. based on recent research in decision theory), within a computing infrastructure will increase the awareness of the population at risk, especially Hispanics, will facilitate the decision-making process, will yield a higher rate of screening and general adherence to USPSTF guidelines for CRC, and will lead to higher early detection rates, and thus higher actual survival rates. This project will provide vital information for the development of an R01 grant to conduct a multi- site intervention to improve CRC screening rates among Hispanic patients across the US.