Strategies for Optimizing a Mailed FIT Program in Appalachia

优化阿巴拉契亚邮寄散客计划的策略

• 批准号: 10714728
• 负责人: MIRA L KATZ
• 金额: $ 58.43万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-28 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10714728
• 关键词: Address; Adult; Age; Appalachian Region; Cancer Etiology; Cessation of life; Characteristics; Colonoscopy; Colorectal Cancer; Communities; County; Diagnostic Reagent Kits; Education; Future; Geographic Locations; Health; Health Insurance; Home; Incidence; Instruction; Intervention; Malignant Neoplasms; Medical; Pamphlets; Participant; Patients; Persons; Population; Randomized; Recommendation; Research; Risk; Rural; Screening for cancer; Services; System; Telephone; Testing; Text; Text Messaging; Time; Transportation; Travel; United States; Visual; Woman; Work; barrier to care; cancer health disparity; colorectal cancer screening; comparative cost effectiveness; cost; cost effective; cost effectiveness; design; efficacy evaluation; evidence base; experience; health care availability; improved; innovation; interest; men; mortality; novel; outreach program; patient navigation; patient navigator; pilot test; programs; randomized trial; response; routine screening; screening; screening guidelines; user-friendly

PROJECT SUMMARY Colorectal cancer (CRC) is the third most common cancer among both men and women and the second leading cause of cancer deaths in the United States (US). CRC screening is now recommended for average- risk adults ages 45-75, yet many adults in the US are not within screening guidelines. One recommended CRC screening approach is annual completion of a fecal immunochemical test (FIT). FIT can be completed at home and sent/returned via mail, making mailed FIT programs a promising way to reach people and increase CRC screening. Such programs may be especially important for geographic regions with lower access to healthcare and lack of public transportation, such as the Appalachian region of the US. Mailed FIT programs have been shown to increase CRC screening, but typically fewer than half of participants in these programs who were sent a FIT returned a completed test. This indicates that mailed FIT programs can be greatly improved upon by addressing common barriers to FIT return. A key next step in this field of research is to identify strategies that can address these barriers and subsequently increase FIT return in mailed programs. Our study team will build on our past research and take this key next step. In doing so, we will partner with health centers in Appalachian counties that are located in a CRC “hotspot” within the US (i.e., clusters of counties with high CRC rates). The proposed study will involve a mailed FIT program (called “FIT Starts at 45”) that includes 500 participants from Appalachia who are underscreened and ages 45-74. We will determine the efficacy and cost-effectiveness of two potential strategies for increasing FIT return: FIT kit materials (enhanced FIT kit that includes a video brochure vs. standard FIT kit) and patient navigation (PN) delivery mode (text message PN vs. telephone PN). In a 2x2 between-subjects factorial randomized trial, each participant will be randomized to one of the following study groups: standard FIT kit plus telephone PN; standard FIT kit plus text message PN; enhanced FIT kit plus telephone PN; or enhanced FIT kit plus text message PN. The proposed study will be one of the most innovative and comprehensive mailed FIT programs to date in the US, with each study aim making a significant research contribution. Aim 1 will determine the efficacy of FIT kit materials and PN delivery mode on increasing FIT return. FIT return will be defined as return of a completed FIT by participants within six weeks of FIT distribution. Aim 2 will determine if efficacy differs across key characteristics of participants and their communities (i.e., moderation). Aim 3 will compare the cost- effectiveness of FIT kit materials and PN delivery mode on increasing FIT return. Results will be impactful by providing an evidence base that can help optimize the design, implementation, scalability, and sustainability of future mailed FIT programs, including our own efforts to disseminate the FIT Starts at 45 program.

项目总结 结直肠癌(CRC)是男性和女性的第三大常见癌症，排在第二位。 美国癌症死亡的主要原因。现在建议对以下人群进行CRC筛查- 年龄在45-75岁之间的高危成年人，但美国许多成年人不在筛查指南范围内。一种推荐的CRC 筛查方法是每年完成一次粪便免疫化学测试(FIT)。试穿可以在家中完成 并通过邮件发送/返回，使邮寄FIT计划成为接触人们和增加CRC的一种有希望的方式 放映。这类计划可能对医疗保健覆盖率较低的地理区域尤为重要 缺乏公共交通，比如美国的阿巴拉契亚地区。邮寄的Fit计划已经被 显示增加了CRC筛查，但通常不到这些计划参与者中的一半 发送了一次Fit，返回了一次完成的测试。这表明邮寄的FIT程序可以通过以下方式大大改进 解决适合退货的常见障碍。这一研究领域的关键下一步是确定 可以解决这些障碍，并随后增加邮寄程序中的FIT回报。 我们的研究团队将在过去研究的基础上，采取这一关键的下一步行动。在此过程中，我们将与 阿巴拉契亚地区位于美国CRC热点地区的医疗中心(即 儿童权利公约比率较高的县)。这项拟议的研究将涉及一项邮寄的FIT计划(名为“FIT从45岁开始”) 这包括来自阿巴拉契亚地区的500名参与者，他们的年龄在45-74岁之间，没有经过充分的筛查。我们将确定 提高FIT回报的两种潜在策略的效果和成本效益：FIT试剂盒材料(增强型 FIT工具包，包括视频手册与标准FIT工具包)和患者导航(PN)交付模式(文本 消息PN与电话PN)。在一项2x2受试者间析因随机试验中，每个参与者将 随机分为以下研究组之一：标准试剂盒+电话PN；标准试剂盒+文本 消息PN；增强的FIT套件+电话PN；或增强的FIT套件+文本消息PN。建议数 Study将是美国迄今为止最具创新性和最全面的邮寄Fit项目之一，每个项目 研究目的做出重大的研究贡献。目标1将确定FIT试剂盒材料和 PN递送模式对提高FIT回报的作用。FIT退货将定义为按以下方式退回已完成的FIT 参与者在配合度分配的六周内。目标2将确定不同关键字的疗效是否不同 参与者及其社区的特点(即适度性)。目标3将比较成本- FIT试剂盒材料和PN投放方式对提高FIT回报的效果。结果将受到以下方面的影响 提供证据基础，帮助优化设计、实施、可扩展性和可持续性 未来邮寄的FIT计划，包括我们自己传播FIT开始于45岁计划的努力。