Tailored Messaging in Colorectal Cancer Screening

说明(申请人提供)筛查可以减轻结直肠癌(CRC)的负担，但在初级保健中仍未得到充分利用。在拟议的研究中，将使用定制的信息来鼓励FOBT和内窥镜筛查，这些做法是特拉华州克里斯蒂娜护理卫生系统的14个初级保健实践的一部分。采用准实验前测-后测设计，我们将为完成基线调查的患者提供定制的筛查干预或TSI(定制的筛查试剂盒、定制的电话和定制的提醒信)。参与者将收到一份试剂盒，其中包含一封定制的CRC筛查邀请函和两页定制的信息页面，这些页面反映了他们对筛查FOBT和灵活的信号检查以及筛查决策阶段的看法。还将包括一本关于CRC筛查的信息手册和带有说明的FOBT卡片。在试剂盒邮寄10天后，一名训练有素的护士教育人员将为患者量身定做一个电话。在电话会议期间，护士教育人员将确认收到邮寄的材料，核实当前的决策阶段，审查发送量身定制的信息，确定当前的决策阶段，鼓励决策阶段的积极行动，提供与决策阶段相关的定制信息，解释FOBT和内窥镜筛查涉及的步骤，并提出安排内窥镜筛查的计划。对于没有报告他们已经决定筛查的患者，护士教育人员将建议他们与他们的初级保健医生讨论筛查问题。在30天内，将向未进行筛查或未安排筛查的患者及其主治医生发送一封量身定制的提醒信。这封信将提供目前量身定做的信息，鼓励在决策阶段采取积极行动，并建议医生和患者讨论筛查。将进行终点调查，并进行终点图表审计。研究的主要目的是：1.确定干预对结直肠癌筛查利用的影响；2.确定筛查决策阶段的干预影响；3.确定干预对患者筛查感知的影响。

DESCRIPTION (provided by applicant) Screening can reduce the colorectal cancer (CRC) burden but remains underutilized in primary care. In the proposed study, tailored messaging will be used to encourage FOBT and endoscopic screening in 14 primary care practices that are part of the Christiana Care Health System in Delaware. Using a quasi-experimental pretest-posttest design, we will deliver a Tailored Screening Intervention or TSI (a tailored screening kit, a tailored telephone call, and a tailored reminder letter) to patients who complete a Baseline Survey. Participants will be sent a kit containing a tailored CRC screening invitation letter and two tailored message pages that reflect their perceptions about screening FOBT and flexible sigrnoidoscopy and screening decision stage. An informational booklet on CRC screening and FOBT cards with instructions will also be included. A trained nurse educator will deliver a tailored telephone call to patients 10 days after the kit is mailed. During the call, the nurse educator will confirm receipt of mailed materials, verify current decision stage, review deliver tailored messages, determine current decision stage, encourage positive movement in decision stage, provide tailored messages keyed to decision stage, explain steps involved in FOBT and endoscopy screening, and offer to schedule endoscopy screening. For patients who do not report that they have decided to screen, the nurse educator will recommend that they discuss screening with their primary care physician. At 30 days, a tailored reminder letter will be sent to patients who have not screened or who have not scheduled screening and to their primary physician. The letter will provide current tailored messages, encourage positive movement in decision stage, and suggest physician-patient discussion of screening. An Endpoint Survey will be administered and an Endpoint Chart Audit will be conducted. Primary study aims are to: 1. Determine intervention impact on CRC screening utilization, 2. Determine intervention impact on screening decision stage, and 3. Determine intervention impact on patient perceptions about screening.