Interventions to Increase Colorectal Cancer Screening

结直肠癌（CRC）是美国癌症死亡的第三大原因，大多数结直肠癌患者年龄在50岁或以上。前瞻性数据表明，每年进行粪便隐血检查（FOBT）可以降低结直肠癌的死亡率。美国癌症协会建议每年做一次FOBT，每5年做一次乙状结肠镜检查。这些检测的使用率非常低，从19%到39%不等，特别是在50岁或以上、患此病风险最高的人群中。量身定制的干预措施已显示出乳房x光检查使用的显著增加，并且可能在结直肠癌筛查领域也有效。本研究的目的是比较定制干预与非定制干预的有效性，以增加FOBT和乙状结肠镜的使用，并确定其对行为认知阶段的影响。本研究的理论框架来源于健康信念和跨理论模型。数据收集前需获得机构审查委员会的批准。本研究中提出的所有工具都经过了信度和效度测试。受过训练的研究助理将联系中西部健康维护组织（HMO）的成员，年龄在56岁或以上，并且在过去15个月内没有做过FOBT。一旦资格标准得到验证，同意参与的人将被随机分为三组之一；1)控制，2)定制印刷传播，3)非定制印刷传播。基线数据将通过电话从600名卫生组织成员样本中收集。干预措施将在基线访谈后两周邮寄，干预后访谈在干预后两个月进行。将对干预组接受FORT或乙状结肠镜检查的几率进行Logistic回归建模。那些在双变量分析中p =或< .20显著的自变量将被输入到一个单独的逻辑回归模型中，以确定FOBT和乙状结肠镜使用的预测因子。结果将有助于测试量身定制的干预措施，以增加管理医疗机构的FOBT和乙状结肠镜检查。

Colorectal cancer (CRC) is the third leading cause of cancer death in the United States with the majority of CRC diagnosed in those aged 50 or older. Prospective data indicate that annual fecal occult blood tests (FOBT) can decease mortality from CRC. The American Cancer Society recommends an annual FOBT and a flexible sigmoidoscopy every 5 years. Utilization of these tests is very low, ranging from 19% to 39%, especially among those who are 50 or older and most at risk for developing the disease. Tailored interventions have demonstrated significant increases in mammography use, and may be effective in the area of CRC screening as well. The purpose of this study is to compare the effectiveness of a tailored versus a non-tailored intervention designed to increase the use of FOBT and sigmoidoscopy, and to determine its effect on cognitive stage of behavior. The theoretical framework for this study was derived from the Health Belief and Transtheoretical Models. Institutional review board approval will be obtained before data collection. All instruments proposed in this study were previously tested for reliability and validity. Trained research assistants will contact members of a Midwest-based health maintenance organization (HMO), aged 56 or older and who have not had an FOBT in the last 15 months. Once eligibility criteria is verified, those who agree to participate with be randomized to one of three groups; 1) control, 2) tailored print communication, and 3) non- tailored print communication. Baseline data will be collected by telephone from a sample of 600 HMO members. Interventions will be mailed 2 weeks from the baseline interview, and post intervention interviews conducted 2 months from the intervention. Logistic regression will be conducted modeling the odds of having an FORT or sigmoidoscopy by intervention group. Those independent variables significant in bivariate analyses at p equal to or < .20 will be entered in to a separate logistic regression model to identify predictors of FOBT and sigmoidoscopy use. Results will be useful in testing tailored interventions to increase FOBT and sigmoidoscopy in managed care settings.