Promoting Colorectal Cancer Screening in Rural Emergency Departments

描述(由申请人提供)：阿巴拉契亚肯塔基州农村人患有结直肠癌(CRC)的发病率和死亡率不成比例，CRC是癌症死亡的第二大原因。疾病控制中心估计，如果每个50岁及以上的人定期进行筛查，多达60%的CRC相关死亡是可以预防的。阿巴拉契亚地区的农村居民目前正在接受不太理想的筛查。建议的干预措施建立在我们成功的癌症预防项目：信念感动山脉：CBPR阿巴拉契亚健康和癌症预防计划以及在急诊科就诊的非裔美国女性中推广乳房X光检查。这两个项目都涉及业馀健康顾问(LHA)提供的激励性访谈干预措施，这些干预措施是根据文化定制的。我们建议在肯塔基州阿巴拉契亚农村地区的急诊科(ED)通过简短的激励性访谈，试行一种针对文化定制的干预措施，以促进结直肠癌筛查，以(1)评估干预措施在阿巴拉契亚农村地区的可行性；以及(2)评估干预措施对结直肠癌筛查和后续癌症筛查参与的感知障碍的影响。与我们目前的Faith Moves Mountain和推广乳房X光摄影计划一致，我们将培训精心挑选的社区成员(LHA)在参与者在急诊室等待非紧急护理或等待接受护理的家庭成员时进行简短的励志访谈。每个参与者将与LHA一起制定一份书面行动计划，以解决他们确定的筛查障碍。简短的干预将耗时约15分钟，并将在 教育署的私人地方。对照组参与者将接受标准护理急诊服务，其中包括识别医院提供的一般癌症筛查服务的小册子信息。结果措施将包括评估障碍和接受儿童权利公约筛查，并将在干预后三个月和六个月进行衡量。这一结果将作为评估促癌干预措施的多点农村ED临床试验的初步数据。

DESCRIPTION (provided by applicant): Rural Appalachian Kentuckians suffer a disproportionate incidence and mortality from colorectal cancer (CRC), the second leading cause of cancer death. The Centers for Disease Control estimate that as many as 60 percent of CRC related deaths could be prevented if everyone age 50 and older were screened regularly. Rural Appalachian residents are currently being screened at suboptimal rates. The proposed intervention builds on our successful cancer prevention projects: Faith Moves Mountains: A CBPR Appalachian Wellness and Cancer Prevention Program and Promoting Mammography among African American Women Visiting the Emergency Departments. Both projects involve lay health advisor (LHA) delivered motivational interviewing interventions that have been culturally tailored. We propose to pilot test a culturally tailored intervention using brief motivational interviewing by LHAs to promote CRC screenings in an emergency department (ED) serving rural Appalachian Kentucky in order to (1) evaluate the feasibility of the intervention in this rurl Appalachian setting; and (2) assess the effects of the intervention on perceived barriers to CRC screening and subsequent cancer screening engagement. Consistent with our current Faith Moves Mountains and Promoting Mammography projects, we will train carefully selected community members (LHAs) to deliver a brief motivational interview while participants wait for non-urgent care in the ED or wait with a family member who is receiving care. Each participant, in conjunction with the LHA, will develop a written plan of action that addresses their identified barriers to screening. The brief intervention will take about 15 minutes and will be delivered in a private area of the ED. Control group participants will receive standard-of-care ED services that include brochure information identifying general cancer screening services provided by the hospital. Outcome measures will include assessment of barriers and receipt of CRC screening and will be measured at three and six months post intervention. The results will serve as preliminary data for a multisite rural ED-based clinical trial evaluating the cancer promotion intervention.