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来说，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，每项CRCS检测的使用率都很低，近年来并没有大幅增加。显然，加强筛查的干预措施是必要的。这项为期5年的研究项目的主要目标是开展一项前瞻性随机试验，通过定制的交互式计算机干预来提高德克萨斯州休斯顿多专业初级保健实践中50-64岁患者的CRCS完成率。将招募基于性别和先前筛查史的分层随机样本。主要结果将是在干预后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。跨理论（变化阶段）模型将用于指导干预的发展。为了实现我们的具体目标，我们将使用干预映射，这是一个系统健康促进计划规划的框架，结合理论和经验证据来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。干预将通过安装在诊所患者教育中心的个人电脑在患者就诊之前立即送达。这将是一个互动式视听节目，根据参与者在一系列变量上的状态量身定制，包括参与CRCS的准备情况。互动项目将生成一份由患者确定的问题和关注的清单，可用于与医生就CRCS进行讨论。将包括两个比较组：无接触对照组和对照组，他们在诊所就诊前立即收到通用印刷的CRCS教育材料。所有这三个小组都将在门诊就诊前在病历表上提供医生提醒。将在干预措施实施6个月后进行电话随访和医疗记录审查，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.