Rural Community Support for Colonoscopy

项目摘要/摘要 结直肠癌(CRC)是美国癌症死亡的第三大原因。 适当的筛查可以降低结直肠癌的死亡率。结肠镜检查--一种检测结直肠癌的方法 对于粪便免疫化学试验(FIT)阳性的患者，建议及早使用 检测结直肠癌，甚至可以通过切除癌前息肉来预防结直肠癌。农村 低收入人群在结肠镜检查阳性后面临重大障碍 适合性，包括难以进入程序(缺乏当地供应商/旅行时间长)， 完成程序的社会经济障碍(难以获得休假时间、安排 儿童保育和交通，高额的自付手术费用)，缺乏关于 程序及其在结直肠癌筛查和早期发现中的作用，以及对该程序和对 CRC。患者导航是增加结肠镜检查完成率的循证方法。 患者导航为患者准备和完成提供一对一支持 结肠镜检查并通过教育、激励性访谈、护理解决障碍 协调和连接社区资源。患者导航的有效性 在低收入农村人口中提高结肠镜检查完成率 还没有被证明。这项研究的总体目标是测试一种 在农村低收入人群中提高结肠镜检查完成率的患者导航计划 具有正向匹配结果的人群。该项目将结成伙伴关系实施。 与农村卫生委员会和华盛顿社区卫生协会合作，并将 聘用四个具有联邦资格的农村卫生中心(FQHC)。干预措施将是 在一项包含600名患者的第一类混合实施效果研究中进行评估 随机对照试验和全面的定量和定性数据收集 更好地了解该计划的实施和可持续性。此项目在以下方面至关重要 提高我们对患者导航对增加结肠镜检查的有效性的认识 在这一患者群体中，以及理解可以支持长期 有效干预措施的实施和可持续性。

PROJECT SUMMARY/ABSTRACT Colorectal cancer (CRC) is the third leading cause of cancer death in the United States. Appropriate screening can reduce CRC mortality. Colonoscopy, a procedure to detect CRC early, is recommended for patients with a positive fecal immunochemical test (FIT) result to detect CRC and can even prevent CRC through the removal of pre-cancerous polyps. Rural and low-income populations face significant barriers to colonoscopy completion after positive FIT, including difficult access to the procedure (lack of local providers/long travel times), socioeconomic barriers to completing the procedure (difficulty getting time off work, arranging childcare and transportation, high out of pocket procedure costs), lack of knowledge about the procedure and its role in CRC screening and early detection, and fear of the procedure and of CRC. Patient navigation is an evidence-based approach to increasing colonoscopy completion. Patient navigation provides one-on-one support to patients preparing for and completing colonoscopy and addresses barriers through education, motivational interviewing, care coordination and connection to community resources. The effectiveness of patient navigation for increasing colonoscopy completion among low-income rural populations with positive FIT has not been demonstrated. The overall objective of this study is to test the effectiveness of a patient navigation program for increasing colonoscopy completion among rural, low-income populations who have had a positive FIT result. The project will be implemented in partnership with the Rural Health Council and the Washington Association for Community Health, and will engage four rural Federally Qualified Health Centers (FQHCs). The intervention will be evaluated in a type 1 hybrid implementation-effectiveness study that includes a 600-patient randomized controlled trial and comprehensive quantitative and qualitative data collection to better understand implementation and sustainability of the program. This project is critical in advancing our knowledge of the effectiveness of patient navigation for increasing colonoscopy in this patient population as well as for understanding factors that can support long term implementation and sustainability of effective interventions.