Monitoring Community Efforts to Increase Colorectal Cancer Screening in African Americans

项目摘要 非裔美国人继续经历结直肠癌（CRC）发病率和死亡率的差异 与美国其他种族/族裔群体相比，并坚持循证CRC筛查 建议可以减少这些差距。粪便为基础的CRC筛查测试相比， 其他筛选方法包括方便和较低的成本。然而，基于粪便的CRC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 粪便检测结果呈阳性后进行结肠镜检查。没有保险或没有足够医疗保险的患者 健康保险或面临财务或结构性障碍者可能需要社区提供额外支持 健康中心（CHC）完成筛查结肠镜检查，CHC可能会遇到挑战， 为这些患者提供结肠镜检查。测试现在教育计划（调整）是一个为期5年的行为 针对年龄在45-64岁之间的非裔美国人的临床试验，这些非裔美国人是两个合作的北佛罗里达社区卫生中心之一的患者， 测试创新的6周社区健康顾问（CHA）干预是否可以增加粪便CRC 与常规护理方法相比，参与者在基线、3个月和9-12个月时接受调查 为了衡量主要研究结果，完成基于粪便的筛查。在这项随访监测研究中， 现在，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干预是否对随后的两次年度筛查产生持续影响， 结果纵向不同。因此，我们提出了一个时间敏感的建议，以评估重复年度筛查， CHC患者队列。目的1将检验参与TUNE-UP试验的CHC患者 并且接受CHA干预的患者将显示出更高的可能性， 与那些被分配到常规护理研究组的TUNE-UP参与者相比，目标2 拟议的研究将利用社区合作参与式研究（CPPR）框架来探索CHC 在北方非洲裔美国人患者中实施CRC筛查教育干预的背景 佛罗里达。拟议的“调整”监测研究是重要的、创新的和及时的， 通过方便和可获得的粪便，非裔美国人之间CRC发病率和死亡率的差异- 在最近更新的USPSTF建议的背景下，开始CRC筛查， 45.此外，这项研究将使监测CRC预防性筛查计划中的挑战， 新冠肺炎大流行的影响，并将增加对决策因素之间关系的理解 和非裔美国人的CRC筛查。该研究计划还将提高研究能力 佛罗里达A&M大学与健康中心合作进行研究，并让研究生参与。

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.