NEW STRATEGIES FOR COLORECTAL CANCER CONTROL

这个预防肿瘤学学术奖的目的是使保罗C Schroy III，医学博士获得有关新学科的额外培训 预防性肿瘤学，并启动以社区为基础的研究， 解决了结肠直肠癌预防领域的关键问题， 早期检测 博士Schroy的教育目标是1）获得公共卫生硕士学位 学位; 2）获得相关领域的多学科专业知识， 通过与各种赞助商的频繁互动， 顾问和共同调查员，以及3.）扩大参与正在进行的 波士顿大学医学中心的癌症预防活动， 像美国癌症协会和波士顿的 社区卫生、教育、研究和服务中心（CCHERS）。 博士Schroy的第一个研究目标是开发、实施一个评估 初级保健导向的社区结直肠癌模式 控制 该模型采用两层战略，包括：1） 现场实践为导向的供应商教育计划，其中包括两个 教学和乙状结肠镜检查培训，以提高提供者的依从性，以及2） 提供现场初级保健指导的结肠直肠检查服务。 该模型对提供者态度和实践模式的影响将是 在10个社区卫生中心进行评估，包括5个 干预和5个对照站点，使用准实验设计。 将监测和比较提供者的态度和做法模式 使用教育前后调查和乙状结肠镜检查预约时间表， 分别 博士Schroy的第二个研究目标是确定人口统计学， 筛查依从性的行为和/或心理社会决定因素 乙状结肠镜检查的种族/民族多样化的内城人口。 到 为了达到这个目标，计划是：1）安排焦点小组访谈， 选择NHC。 2)开发一个调查工具，利用从 焦点小组; 3）对转诊的患者进行扩大调查， 乙状结肠镜检查在选定的NHC，以评估的有效性和普遍性， 焦点小组数据;以及4）比较编译器的响应， 不遵守者识别歧视因素。 博士Schroy的第三个研究目标是进一步定义临床 p21 ras癌蛋白分子检测的作用。 他特别 计划1）确定p21 ras的患病率和/或类型 结肠直肠腺瘤/癌中的突变在种族之间是不同的， /种族多样化的高风险群体，以证明扩大人口的合理性 试验. 2)继续进行相关研究， p21 ras基因突变与乳腺癌临床病理的关系 腺瘤进展的决定因素，3）建立数据库， 评估p21 ras突变状态对以下方面的预测价值： 3年监测结肠镜检查的患者结局。

The purpose of this Preventive Oncology Academic Award is to enable Paul C Schroy III, M.D. to acquire additional training in new disciplines relevant to preventive oncology and to initiate community-based research that addresses critical issues in the area of colorectal cancer prevention and early detection. Dr. Schroy's educational goals are to 1) obtain a master of Public Health degree; 2) acquire multidisciplinary expertise in areas relevant to preventive oncology through frequent interactions with various sponsors, consultants and co-investigators, and 3.) expand participation in ongoing cancer prevention activities at Boston University Medical Center and outside organizations such as the American Cancer Society and Boston's Center for Community Health, Education, Research and Service (CCHERS). Dr. Schroy's first research objective is to develop, implement an evaluate a model for primary care-directed community-based colorectal cancer control. The model employs a two-tiered strategy which consists of 1) an on-site practice-oriented provider education program, which includes both didactic and sigmidoscopy training, to enhance provider compliance, and 2) provisions for on-site primary care directed colorectal screening services. The model's impact on provider attitudes and practice patterns will be evaluated at 10 Neighborhood Health Centers (NHCs), including 5 intervention and 5 control sites, using a quasi-experimental design. Provider attitudes and practice patterns will be monitored and compared using pre-post-educational surveys and sigmoidoscopy appointment schedules, respectively. Dr. Schroy's second research objective is to identify demographic, behavioral, and/or psychosocial determinants of compliance with screening sigmoidoscopy for racially/ethnically-diverse inner city populations. To achieve this goal, the plan is to: 1) arrange focus group interviews at select NHCs. 2) develop a survey instrument utilizing data derived from the focus groups; 3) conduct an expanded survey of patients referred for sigmoidoscopy at select NHCs to assess the validity and generalizability of the focus group data; and 4) compare responses from compliers and noncompliers to identify discriminating factors. Dr. Schroy's third research objective is to further define the clinical role of molecular testing for the p21ras oncoprotein. Specifically, he plans to 1) determine whether the prevalence and/or type of p21ras mutation(s) in colorectal adenomas/carcinomas varies among racially- /ethnically-diverse high-risk groups to justify expanded population testing. 2) continue ongoing correlative studies to define the relationship between p21ras mutational status and clinicopathologic determinants of adenoma progression, 3) establish a database from which to assess the predictive value of p21ras mutational status with respect to patient outcome at a 3-year surveillance colonoscopy.