Participatory Research to Advance Colon Cancer Prevention

项目总结/摘要： 结直肠癌是美国癌症死亡的第三大原因。这令人不安，因为 筛查率的特点是明显的差距，与拉丁美洲人谁一直在美国， 不到10年，没有保险的人的费率最低。这些人通常会在 超过1，200个联邦合格的健康中心之一，为全国2100多万人提供服务。 虽然结肠直肠癌患者的结肠直肠癌筛查率引起了极大的关注， 成功提高了筛查率。邮寄粪便免疫化学检测（FIT）的程序 向符合条件的患者提供的带有象形文字说明的工具包报告了更高的筛查率。虽然新技术， 例如自动电话和短信，已经被探索来提醒患者完成 筛查，很少有人知道他们在不同人群中的有效性。此外，这些方案往往 采用一刀切的方法，其有效性尚未在最不可能的亚组中进行测试 进行筛选为了解决这些问题，我们将与咨询委员会合作， 停止CRC项目和其他社区利益相关者，以适应和传播直邮FIT， 提示程序（PROMPT）分两个阶段。在第一阶段，我们将设计和评估一个随机的 对照试验，以测试基于系统的，自动化和非自动化的策略，以增加结直肠癌 在具有不同患者人群的CIMHC中进行筛查。在第二阶段，我们将评估该计划的传播情况， 11个诊所（估计符合年龄要求的患者人数约为22 000人）。研究的设计和 评估将以RE-AIM框架为指导，使用干预绘图，并将涉及低收入者 和种族多样化的病人谁是由亚基马谷农场工人诊所服务。PROMPT将是 第一次试验，顺序测试提醒的有效性，以直接邮件结直肠癌筛查 计划，然后将选定的最佳实践传播到CNOHC网络内的其他诊所。提示将 采用新的和当地制定的战略，使利益攸关方参与适应干预， 干预组成部分，并选择推广的最佳做法。如果审判成功，它将有广泛的- 规模实施类似计划的潜力，以减少癌症筛查的差距。

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.