Tailored Interactive Intervention to Increase CRC Screen

描述（由申请人提供）：结直肠癌（CRC）是美国癌症死亡的第二大原因，CRC风险随着年龄的增长而增加。大多数组织建议，对于那些处于平均风险的人，筛查应该在50岁开始。结直肠癌筛查（CRCS）具有成本效益，并提供了早期发现和预防的可能性。然而，每一项CRCS测试的使用率都很低，近年来也没有大幅增加。显然，需要采取干预措施增加筛查。这个为期5年的研究项目的主要目标是在休斯顿的多专业初级保健实践中进行一项前瞻性随机试验，采用量身定制的基于计算机的交互式干预措施，以提高50-64岁患者的CRCS完成率。德克萨斯州。将招募基于性别和既往筛选史的分层随机样本。主要结局将是在干预后6个月内完成任何CRCS测试（遵循ACS指南）。次要目标是增加对预测CRCS完成的因素的理解，并评估干预的成本效益。将使用跨理论（变革阶段）模式来指导干预措施的制定。为了实现我们的具体目标，我们将使用干预映射，一个系统的健康促进计划规划的框架，结合理论和经验证据，以确定行为的决定因素，制定干预目标，并选择干预的方法和策略。干预将在患者就诊前立即通过安装在诊所患者教育中心的个人电脑进行。这将是一个互动式视听节目，专门针对参与者在一系列变量方面的状况，包括参与社区康复服务的准备程度。交互式程序将生成一份由患者确定的问题和关注点清单，可用于启动与医生关于CRCS的讨论。将纳入两个比较组：无接触对照组和在临床访视前即刻接受通用印刷CRCS教育材料的对照组。所有三个组都将在诊所访视前在病历中提供医生提醒。将在实施干预后6个月进行电话随访和病历审查，以确定CRCS的完成情况。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the 2nd leading cause of cancer deaths in the U.S. and CRC risk increases with age. Most organizations suggest that, for those at average risk screening should be initiated at age 50. Colorectal cancer screening (CRCS) is cost-effective and offers the possibility of early detection as well as prevention. However, the use of every CRCS test is low and has not increased substantially in recent years. Clearly, interventions to increase screening are needed. The primary goal of this 5-year research project is to conduct a prospective randomized trial of a tailored interactive computer-based intervention to increase patient completion of CRCS among patients aged 50-64 years in a multi-specialty primary care practice in Houston, TX. A stratified random sample based on sex and prior screening history will be recruited. The primary outcome will be completion of any CRCS test (following ACS guidelines) within 6 months of the intervention. Secondary goals are to increase understanding of factors that predict completion of CRCS and to assess the cost-effectiveness of the intervention. The transtheoretical (stages of change) model will be used to guide intervention development. To implement our specific aims we will use Intervention Mapping, a framework for systematic health promotion program planning that incorporates theory and empiric evidence to identify determinants of a behavior, develop intervention objectives, and select methods and strategies for an intervention. The intervention will be delivered immediately prior to a patient's clinic visit via a personal computer installed in the clinic's Patient Education Center. It will be an interactive audiovisual program tailored to a participant's status on a series of variables including readiness to engage in CRCS. The interactive program will generate a checklist of questions and concerns identified by the patient that can be used to initiate a discussion about CRCS with the physician. Two comparison groups will be included: a no-contact control group and a control group who receive generic printed CRCS educational materials immediately prior to their clinic visit. All three groups will involve the provision of a physician reminder placed in the medical chart prior to the clinic visit. Telephone follow-up and medical record review will be conducted 6 months after delivery of the intervention to ascertain completion of CRCS.