Improving CRC Screening for Diverse Hispanics in an Urban Primary Care Setting

描述（由申请人提供）：结直肠癌（CRC）是西班牙裔女性和男性癌症死亡的第二大原因。与非西班牙裔白人相比，西班牙裔白人更有可能在更晚期的疾病阶段被诊断出来，并且生存概率较低。降低西班牙裔CRC死亡率的一个关键方法是提高CRC筛查率，从而早期发现CRC。为了解决筛查率低的问题，从而增加CRC的预防和早期发现，拟议的研究旨在增加西班牙裔人的CRC结肠镜筛查。主要目的是调查文化针对性的印刷教育干预的影响，旨在通过结肠镜检查增加50岁及以上的西班牙裔不同群体的CRC筛查：a）他们参与结肠镜检查（无论他们是否接受结肠镜检查）和B）他们准备接受结肠镜检查的阶段。我们长期以来（自1999年以来）的研究平台包括通过与我们的社区咨询委员会（CAB）持续会议征求他们的观点和关注的重要社区投入。此外，我们会持续咨询主要社区成员，以获取额外意见。研究将分两个阶段进行。第一个将使用焦点小组方法，每组由最多10名西班牙裔人组成的8个焦点小组。我们的焦点小组成员将是当地居民，并增加我们对目标人群的障碍和促进因素的理解。对焦点小组数据的定性分析也将证实，有文化针对性的印刷材料对讲英语和西班牙语的西班牙裔人是相关的和有激励作用的，并提出任何必要的修订建议。第二阶段的特点是在西奈山目前提供的最佳临床实践的背景下进行了400名西班牙裔美国人的随机临床试验（RCT）。有三个研究组; 1）最佳临床实践加上文化相关的印刷材料，2）最佳临床实践加上标准印刷材料，3）单独的最佳临床实践。这三个分支将允许调查印刷材料的添加情况，并将文化相关性与标准印刷材料进行比较，以评估每种印刷格式的不同影响。该比较控制了将标准打印材料添加到最佳临床实践的可能受益，并允许研究目标和文化相关材料在标准材料之外的额外受益。此外，通过纳入社区的反馈，我们将能够清楚地了解这一迅速增长的少数群体的好处，并能够在这一迅速增长的少数群体中传播有针对性的和文化相关的材料。如果，正如假设的那样，增加有文化针对性的印刷材料会导致结肠镜检查的比率更高，并且在准备接受结肠镜检查的后期阶段，那么它们可以很容易地在治疗西班牙裔的医疗保健机构中传播。第二阶段的结果还将表明，干预措施的影响是否受到社会人口、卫生保健和社会文化因素的调节，以及哪些是有效成分（例如，优点/好处，癌症宿命论）。 公共卫生相关性：这项拟议的研究旨在调查文化针对性的印刷教育干预对西班牙裔通过结肠镜检查进行CRC筛查的比率及其通过结肠镜检查进行CRC筛查的准备情况的影响。如果正如预期的那样，与最佳临床实践加上标准材料或单独的最佳临床实践相比，在最佳临床实践中添加文化靶向材料会导致通过结肠镜检查进行CRC筛查的比率更高，并且更晚的准备接受结肠镜检查，然后，针对文化的印刷教育材料可以很容易地在这个快速增长的少数群体中传播，他们的CRC筛查率很低，他们的疾病在较晚的、较难治愈的阶段被发现。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the 2nd leading cause of cancer death among Hispanic women and men. Hispanics are more likely to be diagnosed at more advanced disease stages compared to non-Hispanic Whites and have a lower probability of survival. A key way to decrease mortality from CRC among Hispanics is to increase rates of CRC screening and thereby early detection of CRC. To address low screening rates; thereby increasing the prevention and early detection of CRC, the proposed research seeks to increase CRC colonoscopy screening among Hispanics. The primary aim is to investigate the impact of a culturally targeted print educational intervention designed to increase CRC screening via colonoscopy in a diverse group of Hispanics 50 years of age and older on: a) their participation in colonoscopy (whether or not they undergo colonoscopy) and b) their stage of readiness to undergo colonoscopy. Our long standing (since 1999) research platform has included significant community input through ongoing meetings with our Community Advisory Board (CAB) soliciting their viewpoints and concerns. In addition, we consult with key community members on an ongoing basis for additional input. There will be two phases to the study. The first will use focus group methodology with eight focus groups comprised of up to 10 Hispanics in each group. Our focus group members will be local residents and add to our understanding of the barriers and facilitators of the targeted population. Qualitative analyses of the data from the focus group will also confirm that the culturally targeted print materials are relevant and motivating to English and Spanish speaking Hispanics as well as suggest any needed revisions. The second phase features a Randomized Clinical Trial (RCT) with 400 Hispanics conducted within the context of the best clinical practices currently provided at Mount Sinai. There are three study arms; 1) best clinical practices plus culturally relevant print materials, 2) best clinical practices plus standard print materials and 3) best clinical practices alone. These three arms will allow the investigation of the addition of print materials and the comparison of culturally relevant to standard print materials to assess the differential impact of each print format. This comparison controls for the possible benefit of adding standard print materials to best clinical practices and allows for investigation of the additional benefit of targeted and culturally relevant materials over and above that of standard materials. Further, by including feedback from the community, we will be able to clearly understand the benefits of, and be able to disseminate targeted and culturally relevant materials among this rapidly growing minority group. If, as hypothesized, the addition of the culturally targeted print materials leads to higher rates of colonoscopy and later stages of readiness to undergo colonoscopy, they can then be easily disseminated among health care settings treating Hispanics. The results from this second phase will also indicate if the impacts of the intervention are moderated by socio-demographic, health care and socio- cultural factors as well as what are the active ingredients (e.g., Pros/benefits, cancer fatalism). PUBLIC HEALTH RELEVANCE: The proposed study seeks to investigate the impact of a culturally targeted print educational intervention on Hispanics rates of CRC screening via colonoscopy and their readiness to undergo CRC screening via colonoscopy. If, as expected, the addition of culturally targeted materials to best clinical practices as compared to best clinical practices plus standard materials or best clinical practices alone leads to higher rates of CRC screening via colonoscopy and later stage of readiness to undergo colonoscopy, then the culturally targeted print educational materials can be easily disseminated among this rapidly growing minority group who have low rates of CRC screening and whose disease is detected at later, less curable stages.