Rural Cancer Prevention Center __ Early Detection of Colorectal Cancer and Polyps

描述（由申请人提供）：本更新申请建议继续肯塔基州中华人民共和国大学的癌症预防计划，这是唯一一个致力于阿巴拉契亚农村癌症预防的中华人民共和国。在当地被称为农村癌症预防中心（RCPC），我们过去的重点是预防（通过接种疫苗）和早期发现宫颈癌。通过社会营销和有计划的推广，RCPC成功地利用了居住在经济最萧条的阿巴拉契亚（肯塔基州东南部）地区的农村人民的信任。拟议的更新提供了继续我们以社区为基础的癌症预防研究的计划，并将我们的计划扩展到阿巴拉契亚的其他地区，使用可持续的模式。此外，以前关于宫颈癌预防的研究为测试一种以社区为基础的结直肠癌（CRC）筛查的新方法奠定了坚实的基础。基于新的筛查技术，这种方法将是有效的，并可用于医疗权利被剥夺和服务不足的农村居民。拟议的计划有5个总目标（A-E）和一个具体的研究目标（F）：A）提供支持癌症预防的基础设施和行政服务; B）建立社区能力，积极参与社区预防癌症的伙伴关系; C）提供一个高效和有效的通信网络，将癌症预防活动联系在一起，传播健康信息; D）为州和地方机构提供培训和技术支持; E）评估（过程和成果）与目标A-D有关的所有计划活动;和F）开展应用预防研究项目，展示使用社区变革推动者促进每年结直肠癌（CRC）的广泛采用的价值通过粪便免疫化学试验（FIT）进行筛查，然后对筛查FIT阳性的患者进行结肠镜检查，并通过促进每年重复使用FIT的干预计划。所有六个目标都是相互关联的;然而，最终目标是一套高度集中的活动，分两个阶段进行：1）支持这一目标的方案将在第1-3年进行测试，2）为了使阿巴拉契亚其他农村州受益，将在第4-5年进行传播和实施活动。将在1-3年进行测试的项目包括：1）以社区为基础的干预，其特点是创新扩散模型，标准RCPC外展方法，以及使用非等效比较设计测试的医疗保健提供者的学术细节;当500个FIT样本返回干预卫生区时，该试验将结束，2）社会网络分析（N = 64），用于提供关于扩散模型中使用的有效变革推动者的关键特征的临时反馈，3）导航程序（基于目前针对宫颈癌的RCPC实践），将应用于检测FIT阳性的人（N = 60），以及4） 一项基于互联网的计划，旨在促进每年重复FIT筛查，采用随机对照试验设计进行测试（N = 220）。方案的设计将具有最佳的可持续性和传播/执行潜力。

DESCRIPTION (provided by applicant): This renewal application proposes to continue the cancer prevention programs of the University of Kentucky PRC, the only PRC dedicated to cancer prevention in rural Appalachia. Known locally as the Rural Cancer Prevention Center (RCPC), our past focus has been on the prevention (through vaccination) and early detection of cervical cancer. Through social marketing and planned outreach the RCPC has successfully leveraged the trust of rural people residing in the most economically depressed area of Appalachia (southeastern, KY). The proposed renewal offers plans to continue our community-based cancer prevention research, and to extend our programs to other regions of Appalachia, using sustainable models. Moreover, the previous research pertaining to cervical cancer prevention created a strong basis for testing a novel approach to community-based screening for colorectal cancer (CRC). Based on new screening technology, this approach will be effective and accessible to medically disenfranchised and under-served rural residents. The proposed plan has 5 general aims (A-E) and a specific research aim (F): A) Provide infrastructure and administrative services that support cancer prevention; B) Build community capacity and actively engage the community in partnerships for cancer prevention; C) Provide an efficient and effective communications network that ties cancer prevention activities together and disseminates health communication; D) Offer training and technical support to state and local agencies; E) Evaluate (process and outcome) all planned activities related to aims A-D; and F) Conduct an applied prevention research project that demonstrates the value of using community change agents to foster widespread adoption of annual colorectal cancer (CRC) screening with Fecal Immunochemical Test (FIT), followed by navigation to colonoscopy for those screening FIT-positive, and by an intervention program that promote annual repeat use of FIT. All six aims are inter-related; however, the final aim is a highly focused set of activities that occur in two phases: 1) the programs supporting this aim will be tested in Years 1-3, and 2) to benefit other rural Appalachian states, dissemination and implementation activities will be conducted in Years 4-5. Programs to be tested in Years 1-3 include 1) a community-based intervention featuring a Diffusion of Innovations model, standard RCPC outreach methods, and academic detailing for health care providers tested using a non-equivalent comparison design; this trial will end when 500 FIT specimens have been returned in the intervention health district, 2) a social network analysis (N = 64) used to provide interim feedback regarding key characteristics of effective change agents used in the diffusion model, 3) a navigation program (based on current RCPC practices for cervical cancer) that will be applied to people testing FIT-positive (N = 60), and 4) an internet-based program designed to foster annual repeat FIT screening tested using a randomized, controlled trial design (N = 220). Programs will be designed for optimal sustainability and dissemination/implementation potential.