Initiation of Colon Cancer Screening in Veterans

描述（由申请人提供）：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（CRCS）提供了早期发现和预防的可能性。对于那些处于平均风险的人，建议从50岁开始使用CRCS。然而，对CRCS测试的认识和使用率很低。我们建议进行一项随机对照试验，以开发和测试分步干预措施，以增加CRCS在全国代表性，种族多样性的男性和女性退伍军人样本中的初始摄入。我们的具体目标是：（1）开发和预测试理论和证据知情的阶梯式干预组件;（2）实施和评估阶梯式干预的过程，有效性和成本效益，以增加50-64岁男性和女性退伍军人的初始CRCS;（3）分析预测变量与CRCS启动之间的关系以及干预措施的中介和调节作用，每一步之后。在第一步中，我们将评估一个基于理论的最小提示，通过一封信，电话，或自动电话与一个调查的控制组相比，以确定是否3个不同的传递渠道是同样有效和具有成本效益。最小提示是一种具有成本效益的方法，可以促使那些更愿意改变的人采取行动，并且易于在现实世界中传播。在第1步中未完成CRCS的患者将在第2步中随机接受更强化的干预措施，以解决耐药性问题。在第二步中，我们将确定一个基于理论的，量身定制的电话干预，使用动机访谈的原则，是否是有效的，当交付作为一个连续的干预过程中，早期采用者已从人口中删除的一部分。第2步还将确定自动化方法，电话联系沟通（TLC），是否与电话咨询师一样有效，以促进CRCS的启动。步骤1和步骤2将共同解决鼓励完成社区登记册系统所需的“剂量”这一重要问题。在每一步之后，我们将检查干预的中介和调节作用，以确定完成的决定因素。为了使癌症筛查干预研究具有最广泛的公共卫生影响，干预措施必须具有传播的潜力。我们设计了我们的试验，以使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.