REDUCING BARRIERS TO THE USE OF COLON CANCER SCREENING

纽约州立大学石溪分校（SUNYSB）提交的这项拟议研究的长期目标是提高50岁及以上女性和男性的结直肠癌筛查率（CRC）。该研究的具体目的是测试针对性电话咨询（TTC）和个体化继续医学教育在增加研究女性和男性CRC筛查方面的有效性。这些干预措施的成本效益也将被评估。SUNYSB项目将针对通过人口抽样电话调查确定的50-75岁的社区妇女和男子。女性和男性的样本将从长岛的五个研究社区中抽取。个体化的继续医学教育（CME）干预将仅限于研究人群中女性和男性的初级保健医生。SUNYSB项目将测试针对性电话咨询（TTC），针对个人接受结直肠癌筛查的准备阶段和他们使用筛查的障碍。针对他们的医生的个性化CME干预将包括邮寄材料、电话和办公室干预。办公室干预旨在改善办公室系统的使用、医生沟通和行为咨询，并培养办公室工作人员在FOBT指导、阅读和跟踪方面的技能。这些主要组成部分的辅助内容还将处理结直肠癌风险沟通和FOBT阳性后的完整诊断评估。该研究涉及一个因子设计，以测试TTC和CME单独应用和联合应用时对增加CRC使用率的相对影响。每个研究城镇的女性和男性将被随机分配到TTC或对照条件，并根据他们是否居住在CME干预县和对照县而被分配到CME干预组或对照组。干预前和干预后的电话调查将评估女性和男性对结直肠癌筛查的知识、信念和做法的变化。还将对医生进行干预前和干预后的调查和图表审计，以评估医生对结直肠癌筛查的知识、信念和实践的变化。研究的重点是如何激励参与CRC筛查的重要问题。

The long-term objective of the proposed research submitted by the State University of New York at Stony Brook (SUNYSB) is to increase the rates of colorectal cancer screening (CRC) among women and men aged 50 and older. The specific aims of the research are to test the effectiveness of Targeted Telephone Counseling (TTC) and individualized Continuing Medical Education in increasing CRC screening among study women and men. The cost- effectiveness of these interventions will also be assessed. The SUNYSB project will target community women and men aged 50-75 who are identified through population sample telephone surveys. The samples of women and men will be drawn from five study communities on Long Island. The individualized Continuing Medical Education (CME) intervention will be limited to the primary care physicians of women and men in the study population. The SUNYSB project will test Targeted Telephone Counseling (TTC) aimed at the individual's stage of readiness to adopt CRC screening and barriers to their utilization of screening. The individualized CME intervention aimed at their physicians will involve mailed materials, telephone and in-office interventions. The in-office intervention is designed to improve the use of office systems, physician communication and behavioral counseling, and to develop skills of office staff in FOBT instructions, readings and tracking. Adjuncts to these major components will also address CRC risk communication and complete diagnostic evaluation following a positive FOBT. The research involves a factorial design to test the relative effects of TTC and of CME when applied alone and in combination on increasing CRC use. Women and men in each study town with regular physicians will be randomized to the TTC or control condition, and assigned to a CME intervention or control group by virtue of whether or not they reside in a CME intervention vs control County. Pre-and post-intervention telephone surveys will assess changes in women's and men's knowledge, beliefs and practices relating to CRC screening. Pre-and post-intervention surveys of physicians and chart audits will also be conducted to evaluate changes in physician knowledge, beliefs and practices related to CRC screening. The research focuses on the important question of how to motivate participation in CRC screening.