Initiation of Colon Cancer Screening in Veterans

描述(申请人提供)：结直肠癌(CRC)是美国癌症死亡的第二大原因，风险随着年龄的增长而增加。结直肠癌筛查提供了早期发现和预防的可能性。对于那些中等风险的人，建议从50岁开始进行CRC。然而，CRCS检测的认知度和使用率很低。我们建议进行一项随机对照试验，以开发和测试阶梯式干预措施，以增加在具有全国代表性的、不同种族的男性和女性退伍军人样本中对CRCs的初始摄取。我们的具体目标是：(1)开发和预试循证循证的分步干预组件；(2)实施和评估分步干预的过程、有效性和成本效益，以提高50-年龄的男性和女性退伍军人的初始CRC；(3)分析预测变量与CRC启动之间的关联，以及每一步之后干预的中介和调节效果。在第一步中，我们将评估通过信件、电话或自动电话传递的基于理论的最小线索，并与仅进行调查的对照组进行比较，以确定这三种不同的传递渠道是否具有同等的效率和成本效益。最小的暗示是一种成本效益高的方法，它会促使那些更愿意改变的人采取行动，并且很容易在现实世界中传播。在步骤1中没有完成CRC的人将在步骤2中随机接受更密集的干预措施，以解决耐药性问题。在第二步中，我们将利用动机访谈的原则，确定基于理论的、量身定做的电话干预是否有效，当作为序贯干预过程的一部分时，早期采用者已被从人群中剔除。步骤2还将确定一种自动化的方法，即电话联系通信(TLC)，在促进启动合作伙伴关系方面是否与电话辅导员一样有效。步骤1和步骤2将共同处理鼓励完成《公约》所需的“剂量”这一重要问题。在每个步骤之后，我们将检查干预的调解和缓和效果，以确定完成的决定因素。癌症筛查干预研究要想对公众健康产生最广泛的影响，干预措施必须具有传播的潜力。我们设计我们的试验是为了让我们朝着具有外部有效性证据的可传播干预的目标前进。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the 2nd leading cause of cancer deaths in the US and risk increases with age. Colorectal cancer screening (CRCS) offers the possibility of both early detection and prevention. For those at average risk, CRCS beginning at age 50 is recommended. However, awareness and use of CRCS tests are low. We propose to conduct a randomized controlled trial to develop and test stepped interventions to increase initial uptake of CRCS in a nationally-representative, ethnically-diverse sample of male and female veterans. Our specific aims are to: (1) develop and pre-test stepped intervention components that are theory- and evidence-informed; (2) implement and evaluate the process, efficacy, and cost-effectiveness of stepped interventions to increase an initial CRCS among male and female veterans aged 50-64 years; and (3) analyze the association between predictor variables and CRCS initiation and the mediating and moderating effects of the interventions, after each step. In Step 1, we will evaluate a theory-based minimal cue delivered by a letter, telephone call, or automated telephone call compared with a survey-only control group to determine whether the 3 different delivery channels are equally efficacious and cost-effective. Minimal cues are a cost-effective method that prompts to action those more willing to change and are easy to disseminate in real-world settings. Persons who do not complete CRCS in Step 1 will be randomized in Step 2 to more intensive interventions that address resistance. In Step 2 we will determine whether a theory-based, tailored telephone intervention, using principles of Motivation Interviewing, is effective when delivered as part of a sequential intervention process in which early adopters have been removed from the population. Step 2 also will determine whether an automated approach, telephone-linked communication (TLC), is as effective as a telephone counselor in promoting initiation of CRCS. Steps 1 and 2 together will address the important issue of the "dose" needed to encourage completion of CRCS. After each step, we will examine the mediating and moderating effects of the intervention to identify determinants of completion. For cancer screening intervention research to have the broadest public health impact, interventions must have the potential for dissemination. We designed our trial to move us toward the goal of disseminable interventions with evidence of external validity.