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、医患关系和预防保健的提供。少数族裔和社会经济地位较低的人正在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。我们不是通过计算机生成提醒，并在患者下一次筛查预约到期时将其邮寄给患者，而是可以直接从电子病历向家中、办公室或公共图书馆的患者发送带有个人信息的电子提醒。此外，我们还可以定制我们在个人层面提供的教育信息。我们可以采用“大规模定制”，这是一种由电子商务开发的模式，可以在大众市场规模上向个别患者提供定制的筛查信息。在这项提案中，我们将使用结直肠癌筛查的例子来演示这些可能性。电子病历中的个人信息和关于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)开发名为Netlet(网信)的电子干预措施，并证明它可以在初级保健内科诊所和城市公共图书馆系统的医生和患者中实施；2)与标准邮寄信件相比，对Netlet在遵守结直肠癌筛查指南方面的效果进行中试评估，以便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对结直肠癌筛查的兴趣和知识的影响，以便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，按性别分层。家庭、工作)或“公共”访问电子邮件。公众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进行访问。干预组患者将收到Netlet；对照组患者将收到定制的邮寄私人信件。这项初步研究将评估Netlet对结直肠癌筛查依从性的影响，并将确定“公众”获得干预的障碍。这项提议将导致进行研究，研究电子干预如何能够促进知情的决策，并以加强多面手医患关系的方式提供预防性保健。

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.