Colorectal Cancer Screening and the NetLET Intervention

随着互联网的兴起和电子邮件的使用，电子通信有可能改变医学文化、医患关系和预防性保健的提供。少数民族和社会经济地位较低的人通过公共图书馆访问互联网和电子邮件。许多人寻求健康信息。这些变化为提供预防性医疗保健带来了新的可能性，特别是在与加密技术和电子病历相结合的情况下。我们可以通过电子邮件将电子病历中的个人信息直接发送给家里、工作单位或公共图书馆的患者，而不是通过电脑生成提醒并在下次预约时将其邮寄给患者。此外，我们可以定制我们在个人层面上提供的教育信息。我们可以采用电子商务开发的“大规模定制”模式，在大众市场规模上向个体患者提供有关筛查的定制信息。在本提案中，我们将以结直肠癌筛查为例来证明这些可能性。电子病历中的个人信息和结直肠癌筛查的定制教育信息将通过名为“NetLET”的交互式互联网信件传递给患者。我们的目标是：1)开发被称为NetLET（互联网信件）的电子干预，并证明它可以在初级保健内科实践和城市公共图书馆系统中对医生和患者实施；2)与标准邮寄信件相比，对NetLET'S对遵守结直肠癌筛查指南的影响进行试点评估，为未来随机对照试验的设计提供信息；3)与标准邮寄信件相比，评估NetLET对结直肠癌筛查兴趣和知识的影响，为未来大型临床试验的设计提供信息。这项研究将招募220名患者，并将他们随机分为干预组和对照组，按性别“私人”（如：男性）分层。家庭，工作)或“公共”访问电子邮件。“公众”访问将通过休斯顿公共图书馆系统和哈里斯县公共图书馆系统。干预组患者接受NetLET；在控制患者时，通过邮件定制一封私人信件。这项试点研究将评估NetLET对结直肠癌筛查依从性的影响，并将确定“公众”获得干预措施的障碍。这一建议将导致研究，将检查电子干预如何促进知情决策和提供预防性卫生保健的方式，加强全科医患关系。

With the rise of the Internet and the use of e-mail, electronic communication has the potential to transform the culture of medicine, the physician-patient relationship, and the delivery of preventive health care. Minorities and people in lower socioeconomic groups are accessing the Internet and e-mail through public libraries. Many seek health information. These changes bring new possibilities to the delivery of preventive health care, especially when coupled with encryption technology and an electronic medical record. Instead of generating reminders by computer and mailing them to patients when their next screening appointment is due, we can electronically mail a reminder with personal information directly from the electronic medical record to patients at home, at work, or at the public library. Additionally, we can customize educational information that we deliver at an individual level. We can adapt "mass customization," a model developed by electronic businesses, to deliver customized information about screening to individual patients on a mass market scale. In this proposal we will use the example of colorectal cancer screening to demonstrate these possibilities. Personal information from the electronic medical record and customized educational information about colorectal cancer screening will be delivered to patients through an interactive Internet letter called the "NetLET." We aim to: 1) develop the electronic intervention called the NetLET (interNet LETter) and to demonstrate that it can be feasibly implemented with physicians and patients in a primary care internal medicine practice and city public library system; 2) conduct a pilot evaluation of the NetLET'S effect on adherence to colorectal cancer screening guidelines compared to a standard mailed letter to inform the design of a future randomized controlled trial; 3) Assess the effect of the NetLET on interest in and knowledge about colorectal cancer screening compared to a standard mailed letter to inform the design of a future large clinical trial. This study will recruit 220 patients and randomize them into intervention and control groups, stratified by gender 'private' (eg. home, work) or 'public' access to e-mail. 'Public' access will be through the Houston Public Library System and the Harris County Public Library systems. Patients in the intervention group will receive the NetLET; patients in the control, a customized personal letter by mail. This pilot study will assess the effect of the NetLET on colorectal cancer screening compliance and will determine barriers to 'public' access to the intervention. This proposal will lead to studies that will examine how electronic interventions can promote informed decision-making and deliver preventive health care in ways that strengthen the generalist physician-patient relationship.