Tailored Interactive Intervention to Increase CRC Screen

简介(申请人提供)：结直肠癌(CRC)是美国癌症死亡的第二大原因，而且CRC的风险随着年龄的增长而增加。大多数组织建议，对于中等风险人群，筛查应该在50岁时开始。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检测的使用率都很低，近年来也没有大幅增加。显然，需要采取干预措施来增加筛查。这项为期5年的研究项目的主要目标是在德克萨斯州休斯敦的一家多专科初级保健诊所进行一项基于计算机的定制交互式干预的前瞻性随机试验，以提高50-年龄段患者完成CRCS的比例。将根据性别和既往筛查史进行分层随机抽样。主要结果将是在干预后6个月内完成任何CRCS测试(遵循美国癌症学会指南)。次要目标是增加对预测完成社区卫生控制的因素的了解，并评估干预措施的成本效益。跨理论(变化阶段)模型将被用来指导干预发展。为了实现我们的特定目标，我们将使用干预地图，这是一个系统的健康促进计划规划框架，结合了理论和经验证据，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。干预措施将在患者就诊前通过安装在诊所患者教育中心的个人计算机进行。这将是一个互动视听计划，根据参与者在一系列变量上的状态而量身定做，包括参与CRC的准备情况。该互动程序将生成一份由患者确定的问题和顾虑的核对表，可用于启动与医生关于CRC的讨论。将包括两个对照组：非接触性控制组和控制组，他们在就诊前立即接受通用印刷的CRCs教育材料。所有这三个小组都将在诊所就诊前在病历上放置医生提醒。在实施干预措施6个月后，将进行电话随访和病历审查，以确定社区康复中心的完成情况。

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.