Participatory Research to Advance Colon Cancer Prevention

项目摘要/摘要： 在美国，结直肠癌是癌症死亡的第三大原因。考虑到这一点，这很麻烦 筛查率的标志是明显的差异，在美国生活了五年的拉丁裔 不到10年，没有保险的人费率最低。这些人通常在 超过1200个联邦合格的健康中心(FQHC)之一，为全国2100多万人提供服务。 虽然FQHC患者的结直肠癌筛查率令人非常担忧，但研究已经 在提高筛查率方面取得了成功。邮寄粪便免疫化学检测的程序(FIT) 为符合条件的患者提供象形文字说明的试剂盒报告了更高的筛查率。虽然新技术， 例如自动电话和短信，已经被探索用来提醒患者完成 在筛查方面，人们对它们在不同人群中的有效性知之甚少。此外，这样的节目往往 采用一刀切的方法，其有效性尚未在最不可能的子组中进行测试 接受筛选。为了解决这些问题，我们将与为我们的成功 停止CRC项目和其他社区利益相关者，以适应和传播直接邮件FIT和 提醒程序(提示)分两个阶段。在第一阶段，我们将设计和评估一个随机的 用于测试增加结直肠癌的系统、自动化和非自动化策略的对照试验 在具有不同患者群体的FQHC中进行筛查。在第二阶段，我们将评估该计划的传播情况 至11家诊所(估计符合年龄条件的患者人数约为22,000人)。拟议研究的设计和 评估将由RE-AIM框架指导，使用干预地图，并将涉及低收入者 以及由亚基马谷农民诊所提供服务的不同种族的患者。提示将是 首次试验顺序测试直邮结直肠癌筛查提醒的有效性 计划，然后将选定的最佳实践传播到FQHC网络内的其他诊所。提示将 应用新的和本地开发的战略，让利益相关者参与适应干预，定义 干预组件，并选择传播的最佳实践。如果审判成功，它将产生广泛的- 扩大实施类似计划的潜力，以减少癌症筛查差异。

PROJECT SUMMARY/ABSTRACT: Colorectal cancer is the third-leading cause of cancer death in the United States. This is troubling given that screening rates are marked by a pronounced disparity, with Latinos who have been in the United States for fewer than 10 years and the uninsured having the lowest rates. These individuals generally receive care at one of over 1,200 federally qualified health centers (FQHCs) that serve over 21 million persons nationwide. While colorectal cancer screening rates among FQHC patients are a cause for great concern, studies have demonstrated success for improving screening rates. Programs that mail fecal immunochemical testing (FIT) kits with pictograph instructions to eligible patients report higher screening rates. While new technologies, such as automated phone calls and text messages, have been explored to remind patients to complete screening, little is known about their effectiveness in diverse populations. Moreover, such programs often adopt a one-size fits all approach and their effectiveness has not been tested among subgroups least likely to be screened. To address these issues, we will work with the advisory board assembled for our successful STOP CRC project and additional community stakeholders to adapt and spread a direct-mail FIT and reminder program (PROMPT) in two phases. In Phase I, we will design and evaluate a randomized controlled trial to test systems-based, automated and non-automated strategies to increase colorectal cancer screening in an FQHC with diverse patient populations. In Phase II, we will assess the spread of the program to 11 clinics (estimated age-eligible patient population ~ 22,000). The proposed study's design and evaluation will be guided by the RE-AIM framework using intervention mapping and will involve low-income and ethnically diverse patients who are served by Yakima Valley Farmworkers Clinic. PROMPT will be the first trial to sequentially test the effectiveness of reminders to a direct-mail colorectal cancer screening program, then spread the selected best practice to additional clinics within the FQHC network. PROMPT will apply novel and locally develop strategies to engage stakeholders in adapting the intervetion, defining the intervention components, and selecting a best practice for spread. If the trial succeeds, it will have broad- scale implementation potential for a similar program to decrease cancer screening disparities.