Colorectal Cancer Screening Behavior in the VA Populatio

描述(申请人提供)：背景：结直肠癌是美国癌症死亡的第二大原因。尽管有已证实的疗效和指南建议，结直肠癌筛查率仍然很低。 目的：本研究是开发和验证结直肠癌筛查行为问卷(CRCSBQ)以测量结直肠癌筛查参与度的下一步工作。这项研究的长期目标是为开发一种在多个环境和人群中具有已知有效性的癌症筛查措施资源做出贡献。 方法：第一阶段：CRCSBQ将在两个不同地理位置的退伍军人事务部(VA)机构的患者样本(总共32人)中进行认知测试。患者将来自初级保健诊所，年龄在50岁以上，包括高加索人和非裔美国人，无论男女。第二阶段：CRCSBQ和人口统计学问卷将在两个地点向200名(总共)初级保健患者进行测试。此外，病历数据将从退伍军人管理局电子病历、非退伍军人病历和联邦医疗保险索赔数据(65岁以上的患者)中提取。调查问卷的回答将与病历数据进行比较。我们将计算CRCSBQ的符合率、相对敏感度、特异度和报告与记录比率的点估计和95%可信区间，以根据美国癌症协会指南与医疗记录审查相比较来检测当前的结直肠癌筛查状态。我们将使用Logistic回归分析来探索可能与结直肠癌筛查自我报告和病历之间的一致性相关的患者因素。 重要性：准确测量结直肠癌筛查行为是研究低筛查率问题的关键第一步。在退伍军人管理局初级保健诊所跟踪的退伍军人代表了验证新工具的理想人群。退伍军人医疗保健系统是美国最大的综合医疗保健系统。有一个全面的电子记录，其中包括所有住院和门诊护理在任何退伍军人医疗中心。退伍军人群体是多样化的，包括来自不同年龄组、种族和少数民族的代表，以及来自较低社会经济背景和较低教育水平的相当大比例的个人。

DESCRIPTION (provided by applicant): Background:Colorectal cancer is the second leading cause of Cancer death in the United States. In spite of demonstrated efficacy and guideline recommendations, colorectal cancer screening rates are low. Purpose: This study is the next step in development and validation of new instrument, the Colorectal Cancer Screening Behavior Questionnaire (CRCSBQ) to measure colorectal cancer screening participation. The long- term goal of this study is to contribute to the development of a resource of cancer screening measures with known validity across multiple settings and populations. Methods: Phase 1: The CRCSBQ will undergo cognitive testing in a sample of patients (32 total) at two geographically diverse Veterans Affairs (VA) facilities. Patients will be from the primary care clinics, over age 50 and include Caucasians and African-Americans of both genders. Phase 2: The CRCSBQ and a demographics questionnaire will be administered to 200 (total) primary care patients at the 2 sites. In addition, medical record data will abstracted from the VA electronic medical record, non-VA medical records and Medicare claims data (patients older than 65). The questionnaire responses will be compared to the medical record data. We will calculate point estimates and 95% confidence intervals for the concordance, relative sensitivity, specificity and report-to-records ratio of the CRCSBQ to detect current colorectal cancer screening status by the American Cancer Society guidelines compared to the medical record review. We will use logistic regression analysis to explore patient factors that may be associated with agreement between self-report and medical records for colorectal cancer screening. Importance: Accurate measurement of colorectal cancer screening behavior is the essential first step in studying the problem of low screening rates. Veterans followed at VA primary care clinics represent the ideal population in which to validate the new instrument. The VA health care system is the largest integrated healthcare system in the United States. There is a comprehensive electronic record which includes all inpatient and outpatient care at any VA medical center. The VA population is diverse and includes representation from a range of age groups, racial and ethnic minorities and a substantial proportion of individuals from lower socioeconomic backgrounds and lower educational levels.