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

描述(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有所下降，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存活率，但通过实现更高的摄取率和长期坚持结直肠癌筛查，发病率和死亡率可能会更快、更具成本效益地降低。降低结直肠癌支持系统(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。应进行筛查的患者(n=4675)被随机分为(1)常规护理，(2)自动护理(自动邮寄和粪便潜血测试)，(3)由医疗助理提供的自动化+辅助护理(电话提醒并向医生发送命令签名)，或(4)由注册护士提供的自动化+辅助+导航护理(跟踪，直到测试完成)。干预措施在第二年重复。与常规护理相比，干预患者在两个研究年度都更有可能接受结直肠癌筛查，干预强度依次增加：常规护理26.5%，自动化50.7%，辅助57.7%，导航64.4%(P&lt；.001)。我们建议改进和延续SOS干预措施，最长可达10年，并衡量其对长期坚持和结果的影响。我们将：1.确定尽管接受持续干预但筛查依从性低或不坚持的相关因素，并将这些发现应用于阶段性干预，以增加筛查的接受度和长期依从性。2.评估SOS干预措施对长期坚持筛查的有效性，最长可达10年。3.描述SOS干预对结直肠癌相关成本和临床结果的影响。

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.