INCREASING COLORECTAL CANCER SCREENING

结肠癌和直肠腺癌是死于 美国的癌症和大多数权威人士现在建议 为50岁以上的人提供结直肠癌(CRC)筛查 因为最近有证据表明筛查在减少CRC方面是有效的 死亡率。然而，患者对筛查的依从率 乙状结肠镜检查的建议很低，而且几乎没有进行过研究 解释这种有限的合规性或确定提高 病人参与。 我们提出了一项随机试验来衡量教育的有效性 提高灵活乙状结肠镜筛查合规性的视频 (初步试验结果)。研究对象为已确定的初级保健患者 他们的初级保健有一个预定的非紧急预约 医生。600人的分层样本(性别/年龄)将是 随机化到干预或比较条件。干预 受试者将被邮寄一盘录像带，并附有书面说明 在他们被任命之前的宣传册。它将强调以患者为中心 并将利用榜样讨论障碍和提高 动力。在访问期间，两种研究条件下的患者将 收到关于CRC和印刷品的标准化建议，来自 内科医生。初步试验结果是完成了 推荐乙状结肠镜检查。次要结果包括最初的 接受建议，以及选定的知识、态度和 被假设为受视频影响的信念测量。 电话采访将在基线(TO)进行，紧接着 预约(T1)，并在初级保健后四个月内 在哪段时间内可以完成乙状结肠镜检查 (T2)。 视频的内容和格式将由焦点小组和 马萨诸塞州代表性样本的随机数字拨号调查 50岁以上的居民。调查将确定知识水平， 对结直肠癌和乙状结肠镜检查的信念和态度 结直肠癌筛查；并找出独立相关的因素 乙状结肠镜检查的意向和行为，包括个人 致病因素和促进和加强卫生系统因素 以及其他潜在的中介因素。

Adenocarcinoma of the colon and rectum is a major cause of death from cancer in the United States and most authorities now recommend that persons over age 50 be offered screening for colorectal cancer (CRC) because of recent evidence that screening is effective in reducing CRC mortality. However, rates of patient adherence with screening sigmoidoscopy recommendations are low and little research has been done to explain this limited compliance or to identify methods for increasing patient participation. We propose a randomized trial to measure the efficacy of an educational video in increasing compliance with flexible sigmoidoscopy screening (primary trial outcome). Subjects are established primary care patients who have a scheduled non-urgent appointment with their primary care physician. A stratified sample (gender/age) of 600 people will be randomized to the intervention or comparison condition. Intervention subjects will be mailed a video cassette with accompanying written brochure prior to their appointment. It will emphasize patient-centered education and will utilize role models to discuss barriers and enhance motivation. During their visit, patients in both study conditions will receive a standardized recommendation on CRC and printed material from the physician. The primary trial outcome is completion of the recommended sigmoidoscopy. Secondary outcomes include initial acceptance of the recommendation, and selected knowledge, attitude and belief measures which are hypothesized to be influenced by the video. Telephone interviews will be conducted at baseline (To), directly after the appointment (T1), and within four months after the primary care visit during which period a sigmoidoscopy could have been completed (T2). The content and format of the video will be informed by focus groups and a random digit dial survey of a representative sample of Massachusetts residents over age 50. The survey will identify knowledge levels, beliefs, and attitudes about CRC and sigmoidoscopy; document rates of CRC screening; and identify factors independently related to sigmoidoscopy screening intention and behavior, including personal predisposing factors and enabling and reinforcing health system factors and other potential mediating factors.