Patient-Guided Tools to Promote Colon Cancer Screening

结直肠癌（CRC）是美国癌症相关死亡的第二大原因，不幸的是，过去和现在的努力都未能将CRC筛查提高到NCI 2000的目标，即50-70岁人群的50%。在初级保健中促进结直肠癌筛查的典型干预措施是零星的，缺乏一种机制来实现医生、患者和实践的联合参与。虽然追踪系统对确保患者遵守其他类型的癌症筛查（例如pap）很有用，但很少用于结直肠癌筛查。本随机对照试验将评估一种多层次干预，旨在(1)激活提供者、患者和医生之间的决策过程，(2)确保筛查决策的贯彻执行。300名年龄在50-70岁之间的患者将有资格在科罗拉多研究网络的10家诊所中安排一次健康维护访问。在访问之前，干预患者将在掌上电脑上观看交互式教育模块。该模块将解决患者在决定是否进行结直肠癌筛查时所考虑的已知问题，例如结直肠癌的患病率和易感性以及与筛查相关的成本和疼痛。看完程序后，患者将把电脑带到他们的临床医生那里，她/他将把患者的筛查决定输入到跟踪程序中。诊所发出的提醒信将帮助患者记住要坚持到底。干预组和对照组都将收到一份邮寄的教育小册子，但对照组将不再接受进一步的干预。我们的主要目的是测试多层次干预的有效性，以提高12个月的CRC筛查率（接受筛查的人数）。其次，我们将使用混合方法来描述那些影响干预成分是否以及如何在初级保健中实施的实践、提供者和患者因素。本研究将证明基于初级保健实践的研究网络可以收集和系统地评估CRC筛查交付、利用和短期结果的数据。结果将表明干预的可行性和效用，也将阐明影响患者决定遵守初级保健提供者关于CRC筛查的建议的因素。此外，这种教育和跟踪方法并非CRC所特有，可以为提高其他类型癌症的筛查率提供机会。

DESCRIPTION (provided by applicant) Colorectal cancer (CRC) is the second leading cause of cancer related death in the U.S. Unfortunately, past and current efforts have failed to increase CRC screening to the NCI 2000 goal of 50% of people aged 50-70. Typical interventions to promote CRC screening in primary care are sporadic and lack a mechanism to achieve the combined involvement of the physician, patient, and practice. While tracking systems are useful for ensuring patient compliance with other types of cancer screening (e.g. Paps), they are rarely used for CRC screening. This randomized controlled trial will evaluate a multi-level intervention designed to (1) activate the decision-making process between the provider, patient, and practice, and (2) ensure follow through with screening decision. 300 patients between the age of 50-70 who schedule a health maintenance visit in one of l0 practices in the Colorado Research Network will be eligible. Just before their visit, intervention patients will view an interactive educational module on a handheld computer. The module will address the known issues that patients consider when making a decision about CRC screening, such as prevalence of and vulnerability to CRC and the cost and pain associated with screening. After viewing the program, patients will take the computer to their clinician, where she/he will enter the patient's screening decision into a tracking program. Reminder letters sent by the practice will help patients remember to follow through with their decision. Both the intervention group and a comparison group will receive a mailed educational brochure, but the comparison group will receive no further intervention. Our primary aim is to test the effectiveness of a multi-level intervention to improve 12 month rates of (number of people who receive) CRC screening. Secondarily, we will use mixed methods to describe those practice, provider, and patient factors that influence whether and how the intervention components are implemented in primary care. This study will demonstrate that a primary care practice-based research network can gather and systematically assess data on CRC screening delivery, utilization, and short-term outcomes. The results will indicate the feasibility and utility of the intervention and will also shed light on the factors that influence patient decisions to comply with primary care providers' recommendations regarding CRC screening. Furthermore, this method of education and tracking is not specific to CRC and could provide opportunities for increasing screening rates for other types of cancer.