Promoting Colon Cancer Screening in At Risk Families

简介(申请人提供)：结直肠癌居第二位 美国癌症相关死亡原因筛查率 因有结直肠癌家族史或 腺瘤是不理想的。初步研究强调了小说的必要性 提高提供者和患者对家庭风险的认识的策略 因素，促进遵守适当的筛查建议，以及 促进提供者、受影响患者和高危人群之间的风险沟通 家庭成员。因此，这里描述的具体目标解决了每个目标 通过提出针对提供者、腺瘤的新干预措施来满足这些需求 患者和高危亲属。 具体目标#1是设计、实施和评估教育项目 并评估其对其知识、风险的影响 评估和筛选行为。该教育计划将包括 授课和互动教学课程，以及分发 结直肠癌风险评估工具包。的实际内容 课程和“工具包”将在第一年使用现有的 文献、焦点小组和专家小组。一项随机对照试验 将在第二年进行，以评估该计划的有效性。一个 将使用测试前/测试后的形式评估知识、患者退出 面谈将用于评估风险评估技能，并将审计与 反馈将用于评估文档和筛选行为。 具体目标#2是评估一个教育项目的效果 促进提高对家庭风险的认识和通知 腺瘤患者的一级亲属。该计划采用了一个 标准化的基于计算机的教育干预，在 息肉切除术后立即“床边”，然后是量身定做的通知 以个性化信函的形式提供风险和建议。一只三臂 双重干预与床边计算机干预的随机对照试验 将进行单独干预和标准护理，以评估 计划的有效性。将使用电话调查来评估患者 与处于危险中的兄弟姐妹交流的知识和程度。 具体目标#3是探索患者的偏好和共享的作用 将决策作为促进结直肠癌患者依从性的战略 有家族史的人中的筛查建议 结直肠腺瘤或癌症。将进行结构化面谈，以 评估患者对五种推荐筛查策略的偏好 结直肠癌筛查策略，确定影响其筛查的因素 选择，并确定这些患者希望参与的程度 在这一决策过程中，使用有效的“决策辅助工具”和 “结直肠癌自主指数/自主偏好指数。”

DESCRIPTION (provided by applicant): Colorectal cancer is the second leading cause of cancer-related death in U.S. Screening rates among individuals at increased risk of the disease because of a family history colorectal cancer or adenomas are suboptimal. Preliminary studies highlight the need for novel strategies to increase both provider and patient awareness of familial risk factors, promote compliance with appropriate screening recommendations, and facilitate risk communication between providers, affected patients and at-risk family members. Accordingly, the specific aims described herein address each of these needs by proposing novel interventions targeted at providers, adenoma patients and at-risk relatives. Specific Aim #1 is to design, implement and evaluate an educational program for primary care housestaff and assess its impact on their knowledge, risk assessment and screening behavior. The educational program will incorporate both didactic and interactive teaching sessions as well as distribution of a colorectal cancer risk assessment "tool kit." The actual content of the sessions and "tool kit" will be defined during Year 1 using existing literature, focus groups and an expert panel. A randomized controlled trial will be conducted in Year 2 to evaluate the program's effectiveness. A pretest/post-test format will be used to assess knowledge, patient exit interviews will be used to assess risk assessment skills, and chart audit with feedback will be used to assess documentation and screening behavior. Specific Aim #2 is to evaluate the efficacy of an educational program aimed at promoting increased awareness about familial risk and notification of first-degree relatives among adenoma patients. The program employs a standardized computer-based educational intervention that is conducted at the "bedside" immediately post-polypectomy, followed by a tailored notification of risk and recommendations in the form of a personalized letter. A three-arm randomized trial comparing the dual intervention to the bedside computer-based intervention alone versus standard care will be conducted to assess the program's effectiveness. Telephone surveys will be used to assess patient knowledge and extent of communication to at-risk siblings. Specific Aim #3 is to explore patient preferences and the role of shared decision-making as a strategy for promoting compliance with colorectal cancer screening recommendations among individuals with a family history of colorectal adenomas or cancer. Structured interviews will be conducted to assess patient preferences for the five recommended screening strategies colorectal cancer screening strategies, identify factors influencing their choices, and determine the extent to which such patients wish to participate in tho decision-making process using a validated "decision aid" and "Colorectal Cancer Autonomy Index/Autonomy Preference Index."