Improving CRC Screening for Diverse Hispanics in an Urban Primary Care Setting

描述(申请人提供)：结直肠癌(CRC)是西班牙裔女性和男性癌症死亡的第二大原因。与非西班牙裔白人相比，西班牙裔更有可能被诊断为更晚期的疾病，生存概率更低。降低西班牙裔结直肠癌死亡率的一个关键方法是提高结直肠癌筛查率，从而及早发现结直肠癌。为了解决筛查率低的问题，从而增加对结直肠癌的预防和早期发现，拟议的研究试图增加西班牙裔结直肠癌结肠镜检查。主要目的是调查旨在通过结肠镜在50岁及以上的西班牙裔不同群体中增加结直肠癌筛查的具有文化针对性的印刷教育干预的影响：a)他们参加结肠镜检查(无论他们是否接受结肠镜检查)和b)他们准备接受结肠镜检查的阶段。我们的长期研究平台(自1999年以来)通过与我们的社区咨询委员会(CAB)的持续会议征求他们的观点和关注，纳入了大量的社区意见。此外，我们还与主要社区成员进行持续磋商，以获得更多意见。这项研究将分为两个阶段。第一个将使用焦点小组方法，八个焦点小组由每组最多10名西班牙裔组成。我们的焦点小组成员将是当地居民，他们将增加我们对目标人群的障碍和促进者的了解。对焦点小组数据的定性分析还将确认，针对文化目标的印刷材料对讲英语和西班牙语的拉美裔人是相关和激励的，并提出任何必要的修订建议。第二阶段是在西奈山目前提供的最佳临床做法的背景下，对400名拉美裔进行随机临床试验(RCT)。有三个研究分支：1)最佳临床实践加上与文化相关的印刷材料，2)最佳临床实践加上标准印刷材料，以及3)单独的最佳临床实践。这三个部门将能够对增加印刷材料的情况进行调查，并比较与标准印刷材料有关的文化，以评估每种印刷格式的不同影响。这种比较控制了将标准印刷材料添加到最佳临床实践中的可能好处，并允许调查在标准材料之外，有针对性的和文化相关的材料的额外好处。此外，通过纳入社区的反馈，我们将能够清楚地了解这一快速增长的少数群体的好处，并能够向他们传播有针对性和与文化相关的材料。如果像假设的那样，添加具有文化针对性的印刷材料导致结肠镜检查的比率更高，并为接受结肠镜检查做好准备，那么这些材料就可以很容易地在治疗拉美裔的卫生保健机构中传播。第二阶段的结果还将表明，干预的影响是否受到社会人口、保健和社会文化因素的影响，以及哪些因素是积极的(例如，有利/有利因素、癌症宿命论)。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the 2nd leading cause of cancer death among Hispanic women and men. Hispanics are more likely to be diagnosed at more advanced disease stages compared to non-Hispanic Whites and have a lower probability of survival. A key way to decrease mortality from CRC among Hispanics is to increase rates of CRC screening and thereby early detection of CRC. To address low screening rates; thereby increasing the prevention and early detection of CRC, the proposed research seeks to increase CRC colonoscopy screening among Hispanics. The primary aim is to investigate the impact of a culturally targeted print educational intervention designed to increase CRC screening via colonoscopy in a diverse group of Hispanics 50 years of age and older on: a) their participation in colonoscopy (whether or not they undergo colonoscopy) and b) their stage of readiness to undergo colonoscopy. Our long standing (since 1999) research platform has included significant community input through ongoing meetings with our Community Advisory Board (CAB) soliciting their viewpoints and concerns. In addition, we consult with key community members on an ongoing basis for additional input. There will be two phases to the study. The first will use focus group methodology with eight focus groups comprised of up to 10 Hispanics in each group. Our focus group members will be local residents and add to our understanding of the barriers and facilitators of the targeted population. Qualitative analyses of the data from the focus group will also confirm that the culturally targeted print materials are relevant and motivating to English and Spanish speaking Hispanics as well as suggest any needed revisions. The second phase features a Randomized Clinical Trial (RCT) with 400 Hispanics conducted within the context of the best clinical practices currently provided at Mount Sinai. There are three study arms; 1) best clinical practices plus culturally relevant print materials, 2) best clinical practices plus standard print materials and 3) best clinical practices alone. These three arms will allow the investigation of the addition of print materials and the comparison of culturally relevant to standard print materials to assess the differential impact of each print format. This comparison controls for the possible benefit of adding standard print materials to best clinical practices and allows for investigation of the additional benefit of targeted and culturally relevant materials over and above that of standard materials. Further, by including feedback from the community, we will be able to clearly understand the benefits of, and be able to disseminate targeted and culturally relevant materials among this rapidly growing minority group. If, as hypothesized, the addition of the culturally targeted print materials leads to higher rates of colonoscopy and later stages of readiness to undergo colonoscopy, they can then be easily disseminated among health care settings treating Hispanics. The results from this second phase will also indicate if the impacts of the intervention are moderated by socio-demographic, health care and socio- cultural factors as well as what are the active ingredients (e.g., Pros/benefits, cancer fatalism).