Monitoring Community Efforts to Increase Colorectal Cancer Screening in African Americans

项目摘要 非洲裔美国人在结直肠癌(CRC)发病率和死亡率方面继续存在差异 与美国其他种族/民族相比，坚持循证的结直肠癌筛查 建议可以缩小这些差距。以粪便为基础的结直肠癌筛查试验与 其他筛查方法包括方便和成本较低。然而，基于粪便的结直肠癌筛查通常 必须每年进行一次，筛查异常的个人必须能够访问并完成筛查 在大便检测呈阳性结果后进行结肠镜检查。没有保险或医疗保险不足的患者 医疗保险或面临财务或结构障碍可能需要社区的额外支持 健康中心(CHC)完成筛查结肠镜检查，CHC可能会面临安全保护的挑战 为这类患者提供结肠镜检查。现在测试教育计划(Tune-Up)是一项为期5年的行为计划 对45岁的非裔美国人的临床试验，他们是北佛罗里达州两家合作的CHC和 测试为期6周的创新性社区卫生顾问(CHA)干预是否可以增加大便为基础的CRC 筛查与通常的护理方法相比较。参与者在基线、3个月和9-12个月时接受调查 衡量初步研究结果，完成大便筛查。在这项后续监测研究中 现在建议，我们将重新建立与调整参与者的联系，并获得知情同意 检查CHA干预对随后的两次年度筛查是否有持续效果，以及是否 结果在纵向上是不同的。因此，我们提出了一个对时间敏感的建议，以评估重复的年度筛查 这个CHC患者队列。目标1将检验参与调整试验的CHC患者的假设 接受CHA干预的患者将显示出更高的坚持以大便为基础的CRC的可能性。 筛选比调整参与者谁已经被分配到通常护理研究组。目标2 拟议的研究将利用社区合作的参与性研究(CPPR)框架来探索社区健康中心 在北方非裔美国人患者中实施结直肠癌筛查教育干预的背景 佛罗里达。拟议的调整监测研究在解决持续性问题方面具有重要、创新和及时的意义 非裔美国人通过方便和方便的粪便在结直肠癌发病率和死亡率方面的差异- 根据USPSTF最近更新的建议进行筛查，以便在年龄开始筛查结直肠癌 45.此外，这项研究将使在挑战中监测结直肠癌预防性筛查计划成为可能 并将增加对决策因素之间关系的理解 以及在非裔美国人中进行结直肠癌筛查。这项研究计划也将提高研究能力 佛罗里达农工大学与卫生中心合作开展研究，并吸收研究生参与。

Project Summary African Americans continue to experience disparities for colorectal cancer (CRC) incidence and deaths compared to other racial/ethnic groups in the US and adherence with evidence-based CRC screening recommendations can reduce these disparities. Advantages of stool-based CRC screening tests compared to other screening methods include convenience and lower cost. However, stool-based CRC screening generally must be done annually and individuals who screen abnormally must be able to access and complete a screening colonoscopy following a positive result on a stool-based test. Patients who are uninsured or have inadequate health insurance or face financial or structural obstacles may require additional support from their community health center (CHC) to complete a screening colonoscopy, and CHCs may experience challenges securing access to colonoscopy for such patients. The Test Up Now Education Program (TUNE-UP) is a 5-year behavioral clinical trial for African Americans ages 45-64 who are patients at one of two partnering north Florida CHCs and tests whether an innovative 6-week community health advisor (CHA) intervention can increase stool-based CRC screening compared to a usual care approach. Participants are surveyed at baseline, 3-months and 9-12 months to measure the primary study outcome, completion of stool-based screening. In this follow-up monitoring study now being proposed, we will reestablish contact with TUNE-UP participants and obtain informed consent to examine if there was a sustained effect of the CHA intervention for two ensuing annual screenings and whether outcomes vary longitudinally. Thus, we present a time-sensitive proposal to assess repeat annual screening in this CHC patient cohort. Aim 1 will test the hypothesis that CHC patients who participated in the TUNE-UP trial and received the CHA intervention will show a higher likelihood of adherence with subsequent stool-based CRC screening than TUNE-UP participants who had been assigned to the usual care study group. Aim 2 of the proposed study will utilize a community-partnered participatory research (CPPR) framework to explore the CHC context for implementing CRC screening educational interventions among African American patients in north Florida. The proposed TUNE-UP Monitoring Study is significant, innovative and timely in addressing persistent disparities in CRC incidence and mortality among African Americans through convenient and accessible stool- based screening in the context of recently updated USPSTF recommendations to begin CRC screening at age 45. Additionally, this research will enable monitoring of CRC preventive screening programs amid the challenges of the Covid-19 pandemic and will increase understanding of the relationships between decision-making factors and CRC screening among African Americans. This research program will also improve the research capacity of Florida A&M University to conduct research in partnership with health centers and involve graduate students.