Systems of Support (SOS) to Increase Colon Cancer Screening and Follow-up

描述（由申请人提供）：在美国，结直肠癌的终生风险超过5%，尽管最近发病率和死亡率下降，但结直肠癌仍然是癌症死亡的第二大原因。更好的治疗方法提高了生存率，但通过实现更高的摄取率和长期坚持结直肠癌筛查，可以更快地降低发病率和死亡率。减少结直肠癌支持系统（SOS）研究成功地推进了结直肠癌筛查。SOS是一项4组随机对照试验，利用电子健康记录数据和自动化系统逐步增加筛查支持。筛选患者（n=4675）被随机分配至（1）家庭护理，（2）自动化护理（自动邮寄和粪便潜血检测），（3）医疗助理的自动化+辅助护理（电话提醒和发送订单给医生签名），或（4）注册护士的自动化+辅助+导航护理（随访直至检测完成）。干预措施在第2年重复。与常规护理相比，干预患者在两个研究年内更有可能进行结直肠癌筛查，干预强度增加：家庭护理26.5%，自动化50.7%，辅助57.7%和导航64.4%（P<.001）。我们建议改善和继续SOS干预长达10年，并衡量其对长期依从性和结果的影响。我们将：1.确定与接受持续干预后仍对筛查依从性低或不依从相关的因素，并将这些发现应用于阶梯式干预，以增加筛查的接受率和长期依从性。2.评估SOS干预措施对长达10年的长期筛查依从性的有效性。3.描述SOS干预对结直肠癌相关费用和临床结局的影响。

DESCRIPTION (provided by applicant): The lifetime risk of colorectal cancer is over 5% in the United States where, despite recent declines in incidence and mortality, colorectal cancer remains the second highest cause of cancer death. Better treatments have improved survival rates, but morbidity and mortality could be more rapidly and cost-effectively reduced by achieving higher uptake and long-term adherence to colorectal cancer screening. The Systems of Support to Decrease Colorectal Cancer (SOS) study successfully advanced colorectal screening. SOS was a 4-arm randomized controlled trial that leveraged electronic health record data and automated systems to implement stepwise increases in screening support. Patients due for screening (n=4675) were randomized to (1) Usual Care, (2) Automated care (automated mailings and fecal occult blood tests), (3) automated plus assisted care from medical assistants (phone reminders and sending orders to physicians to sign), or (4) automated + assisted + navigated care from registered nurses (follow-up until test completion). Interventions were repeated in year 2. Compared to usual care, intervention patients were more likely to be current for colorectal cancer screening in both study years, with increases by intervention intensity: Usual Care 26.5%, Automated 50.7%, Assisted 57.7%, and Navigated 64.4% (P<.001). We propose to improve and continue SOS interventions up to 10 years and measure their effects on long-term adherence and outcomes. We will: 1. Identify factors related to low or non-adherence to screening despite receiving continued interventions and apply these findings to a stepped intervention to increase uptake and long-term adherence of screening. 2. Assess the effectiveness of the SOS interventions on long-term screening adherence up to 10 years. 3. Describe the impact of SOS interventions on colorectal cancer-related costs and clinical outcomes.