Facilitating Risk-Appropriate Colorectal Cancer Testing

描述（由申请人提供）：风险适当的测试可以防止结肠癌死亡的显着比例，但参与这种测试太低。患者因素（对需求和获益的了解有限）和医生因素（次优建议）促成了这一问题。由于医生的建议是参与测试的最重要的预测因素，因此依赖初级保健医生来完成确定风险适当的测试模式和时间表的复杂任务。然而，个人和家庭的风险因素，确定哪些测试（S）和时间表是风险适当的一个给定的病人没有定期总结在初级保健记录，可以是耗时的收集和评估在访问期间。如果没有计算机干预的帮助来收集和分析个人和家庭风险信息，忙碌的医生不太可能为每个病人提出风险适当的检测建议。我们将测试一个易于使用的触摸屏电脑程序之前使用的初级保健预约。该计划基于信息-动机-行为技能模型，收集和评估风险数据，并为风险适当的测试提供患者量身定制的建议。我们开发的一个试点版本，并在初级保健环境中进行了试点测试，表明收集和综合必要的信息，以确定风险适当的测试和促进患者-医生讨论结肠癌检测以及该计划应适应的方式，以最大限度地提高临床效用是可行的。在调整该计划后，我们将在3个杜克普通内科诊所进行一项基于临床的随机试验，其中约有30,000名患者由28名医学博士就诊。入组患者将根据其医生分配至干预组或对照组。我们将确定该计划在多大程度上促进：1）患者参与风险适当的结直肠癌检测，由电子病历（EMR）审计记录; 2）患者收到风险适当的医生建议进行检测，由EMR审计记录; 3）患者参与风险适当的检测的意图和感知障碍的变化，由患者报告记录。通过提供一个单独定制的干预与初级保健访问相结合，该计划可以是一个有益的和非阻塞性的辅助临床护理。如果发现有效，它应该是高度可传播的，具有改善大规模人群结直肠癌预后的巨大潜力。

DESCRIPTION (provided by applicant): Risk-appropriate testing can prevent a significant proportion of colon cancer deaths, but participation in such testing is too low. Patient factors (limited knowledge about need and benefits) and physician factors (sub- optimal recommendations) contribute to this problem. Because physician recommendation is the most important predictor of participation in testing, primary-care doctors are relied upon for the complicated task of determining risk-appropriate testing modalities and schedules. However, personal and familial risk factors that determine which test(s) and schedules are risk-appropriate for a given patient are not routinely summarized in primary-care records and can be time-consuming to collect and evaluate during a visit. Without help from a computerized intervention to collect and analyze personal and familial risk information, it is unlikely that a busy physician will make a risk-appropriate testing recommendation for every patient. We will test an easy-to-use touch-screen computer program used prior to primary-care appointments. The program, based on the Information-Motivation-Behavioral skills model, collects and evaluates risk data and provides patient-tailored recommendations for risk-appropriate testing. A pilot version we developed and pilot tested in primary-care settings showed feasibly for gathering and synthesizing information necessary to determine risk-appropriate tests and facilitate patient-physician discussion about colon cancer testing as well as ways the program should be adapted to maximize clinical utility. After adapting the program, we will conduct a clinic-based randomized trial in 3 Duke General Internal Medicine practice sites in which approximately 30,000 patients are seen by 28 MDs. Enrolled patients will be assigned to intervention or comparison group according to their physician. We will determine extent to which the program facilitates: 1) patient participation in risk-appropriate colorectal cancer testing, documented by electronic medical record (EMR) audit; 2) patient receipt of risk-appropriate physician recommendation for testing, documented by EMR audit; and 3) changes in patients' intent and perceived barriers to participating in risk-appropriate testing, documented by patient report. By providing an individually tailored intervention in conjunction with the primary-care visit, the program can be a helpful and non-obstructive adjunct to clinical care. If found effective, it should be highly disseminable, with great potential for improving colorectal cancer outcomes in the population at large.