Culturally Adapted Multilevel Decision Support Navigation Trial to Reduce Colorectal Cancer Disparity among At-Risk Asian American Primary Care Patients

适应文化的多层次决策支持导航试验，以减少高危亚裔美国初级保健患者中结直肠癌的差异

• 批准号: 9930467
• 负责人: SUNMIN LEE
• 金额: $ 68.43万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-26 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9930467
• 关键词: Culturally; Adapted; Multilevel; Decision; Support

PROJECT SUMMARY Cancer is the leading cause of death among Asian Americans, and mortality from colorectal cancer (CRC) is ranked as the second most common in cancer deaths among Asian Americans. However, recent data show that CRC screening rates are substantially lower for Chinese and Korean Americans (CKAs) compared with other racial/ethnic groups. To date, a small number of community-based studies have reported on the use of single level (participant level only) interventions to increase CRC screening rates among CKAs; however, very little is known about the impact of multi-level (patient-oriented and provider-oriented) interventions on CRC screening adherence among CKA patients in primary care setting. Furthermore, our preliminary data indicate physician's recommendation as the strongest facilitator of CRC screening among CKAs. Thus, the primary objective of the study is to address this important knowledge gap by conducting a randomized controlled trial to determine the impact of a multi-level culturally-sensitive decision support intervention on CRC screening adherence among 400 CKA primary care patients. Previous studies found that facilitating patient decision-making through decision support and providing patient navigation can increase CRC screening among diverse primary care patients. We will culturally adapt existing evidence- based decision support navigation intervention (CA-DSNI) and test its efficacy among 200 CKA men and 200 CKA women aged 50 to 75 eligible for CRC screening. We will recruit the participants from primary care physicians (PCPs) clinics. The study is designed to compare CRC screening outcomes between the CA-DSNI and the Advanced Control (AC). Those randomized to the AC will receive an informational booklet, a stool blood test kit and a reminder by mail. Those randomized to the CA-DSNI will receive everything the AC receives. Additionally, we will provide decision support and navigation contacts to participants, develop an individualized screening plan using a theory-based online Decision Counseling Program, share the plan with the participants' PCPs, and have PCPs to encourage the screening to participants. Using outcomes data collected by survey and medical record review, we will: (1) determine overall CRC screening adherence in the CA-DSNI vs. the AC; (2) measure change in CRC screening decision stage in the CA-DSNI vs. the AC; and (3) Assess CRC screening test-specific (stool blood test vs. colonoscopy) adherence in the CA-DSNI vs. the AC. Additionally, we will evaluate intervention reach, effectiveness, adoption, implementation, and maintenance using interview data. IMPACT: This study represents the first instance in which CA-DSNI will be used with CKAs in primary care practice settings to address a significant cancer disparity. With growing need for linguistically and culturally competent care, more decision support, language facilitation, and navigation efforts may come into care settings. Therefore, having tested interventions ready for the target population will be timely, and medical systems may benefit from having multilevel best practices known and tested for CKAs.

项目总结 癌症是亚裔美国人的主要死亡原因，结直肠癌的死亡率是 在亚裔美国人的癌症死亡中排名第二。然而，最近的数据显示， 中国人和韩裔美国人(CKA)的结直肠癌筛查率比 其他种族/民族群体。迄今为止，少数以社区为基础的研究报告了使用 单级(仅限参与者一级)干预措施，以提高CKA中的CRC筛查率；然而，非常 对于多层次(以患者为中心和以提供者为中心)干预措施的影响知之甚少 CKA患者在初级保健环境中接受CRC筛查的依从性。此外，我们初步的 数据表明，医生的推荐是CKA中结直肠癌筛查的最强有力的促进者。 因此，这项研究的主要目标是通过开展一项 确定多层次文化敏感决策影响的随机对照试验 对400名CKA初级保健患者CRC筛查依从性的支持干预。上一首 研究发现，通过决策支持和提供患者导航来促进患者决策 可以增加不同初级保健患者中的结直肠癌筛查。我们将在文化上修改现有的证据- 基于决策支持的导航干预(CA-DSNI)，并在200名CKA男性和200名男性中测试其效果 50岁至75岁的慢性阻塞性肺病妇女有资格接受CRC筛查。我们将从初级保健中心招募参与者 医生(PCP)诊所。这项研究旨在比较CA-DSNI和CA-DSNI之间的CRC筛查结果 和先进控制(AC)。那些被随机分配到AC的人将收到一本信息手册，一张凳子 验血试剂盒和邮寄的提醒。那些被随机分配到CA-DSNI的人将收到AC的所有信息 收到。此外，我们还将为参与者提供决策支持和导航联系，开发 使用基于理论的在线决策咨询计划的个性化筛选计划，与 参与者的PCP，并有PCP鼓励对参与者进行筛查。使用结果数据 通过调查和病历审查收集的资料，我们将：(1)确定总体结直肠癌筛查的遵守情况 CA-DSNI VS AC；(2)CA-DSNI VS AC中CRC筛选决策阶段的量度变化；以及(3) 在CA-DSNI和AC中评估CRC筛查试验的特异性(粪便血检和结肠镜检查)的依从性。 此外，我们还将评估干预范围、有效性、采用、实施和维护 使用访谈数据。影响：这项研究是第一次使用CA-DSNI 在初级保健实践环境中使用CKAS，以解决显著的癌症差异。随着需求的增长 对于语言和文化方面的称职关怀、更多的决策支持、语言便利化和导航 可能会在护理环境中做出努力。因此，在为目标人群准备好干预措施后， 要及时，医疗系统可能会受益于已知的多级最佳实践，并对其进行CKAS测试。