Rural Community Support for Colonoscopy

项目总结/摘要 结直肠癌（CRC）是美国癌症死亡的第三大原因。 适当的筛查可以降低CRC死亡率。结肠镜检查，检测CRC的程序 对于粪便免疫化学试验（FIT）结果阳性的患者， 检测CRC，甚至可以通过切除癌前息肉来预防CRC。农村 低收入人群在结肠镜检查阳性后， 适应症，包括难以获得手术（缺乏当地提供者/旅行时间长）， 完成程序的社会经济障碍（难以请假， 儿童保育和交通，自付程序费用高），缺乏对 程序及其在CRC筛查和早期发现中的作用，以及对程序和 《儿童权利公约》。患者导航是提高结肠镜检查完成率的循证方法。 患者导航为患者准备和完成 结肠镜检查，并通过教育，动机性访谈，护理 协调和连接社区资源。患者导航的有效性 提高FIT阳性的低收入农村人群的结肠镜检查完成率 还没有被证明。本研究的总体目标是测试 患者导航计划，以提高农村低收入人群的结肠镜检查完成率 有阳性FIT结果的人群。该项目将通过伙伴关系实施 与农村卫生理事会和华盛顿社区卫生协会合作， 四个农村联邦合格的卫生中心（FATHCs）。干预将是 在包括600名患者的1型混合实施有效性研究中进行了评价 随机对照试验和全面的定量和定性数据收集， 更好地理解项目的实施和可持续性。这个项目是至关重要的， 提高我们对患者导航对增加结肠镜检查的有效性的认识 在这个患者群体中，以及为了了解可以支持长期 有效干预措施的实施和可持续性。

PROJECT SUMMARY/ABSTRACT Colorectal cancer (CRC) is the third leading cause of cancer death in the United States. Appropriate screening can reduce CRC mortality. Colonoscopy, a procedure to detect CRC early, is recommended for patients with a positive fecal immunochemical test (FIT) result to detect CRC and can even prevent CRC through the removal of pre-cancerous polyps. Rural and low-income populations face significant barriers to colonoscopy completion after positive FIT, including difficult access to the procedure (lack of local providers/long travel times), socioeconomic barriers to completing the procedure (difficulty getting time off work, arranging childcare and transportation, high out of pocket procedure costs), lack of knowledge about the procedure and its role in CRC screening and early detection, and fear of the procedure and of CRC. Patient navigation is an evidence-based approach to increasing colonoscopy completion. Patient navigation provides one-on-one support to patients preparing for and completing colonoscopy and addresses barriers through education, motivational interviewing, care coordination and connection to community resources. The effectiveness of patient navigation for increasing colonoscopy completion among low-income rural populations with positive FIT has not been demonstrated. The overall objective of this study is to test the effectiveness of a patient navigation program for increasing colonoscopy completion among rural, low-income populations who have had a positive FIT result. The project will be implemented in partnership with the Rural Health Council and the Washington Association for Community Health, and will engage four rural Federally Qualified Health Centers (FQHCs). The intervention will be evaluated in a type 1 hybrid implementation-effectiveness study that includes a 600-patient randomized controlled trial and comprehensive quantitative and qualitative data collection to better understand implementation and sustainability of the program. This project is critical in advancing our knowledge of the effectiveness of patient navigation for increasing colonoscopy in this patient population as well as for understanding factors that can support long term implementation and sustainability of effective interventions.