Storytelling to Promote Colorectal Screening in Primary Care Clinics

描述(由申请人提供)： 许多关于风险沟通的研究都探讨了普通公众对数字风险信息的解释和行动能力。相比之下，社区项目通常使用非专业教育人员，他们分享个人故事来传达有关风险的信息。我们提出了一项随机对照试验来检验讲故事(ST)和日常护理(DC)对结直肠癌筛查(CRC)转诊患者依从性的影响。要比较的干预措施是两种不同的模式，ST或DC，用于传达CRC风险和当患者来诊所就诊和转诊时提供的风险降低。低收入，主要是联邦医疗保险/医疗补助资助的诊所的患者将被随机分为两组，接受两步干预。步骤1通过视频在转诊癌之前进行，介绍(A)ST：关于一个具有各种癌症相关危险和健康行为和筛查模式的家庭的文化丰富的故事，教授结直肠癌风险的要素；或(B)UC：风险评估工具，用于提供相同的结直肠癌风险信息，但具有关于相对风险评级的个人反馈。研究双方的患者都会收到关于降低和预防结直肠癌风险的讨论，以及完成第一步的CRCS指南。患者继续他们预定的访问临床医生(带提示卡)，接受转诊，并在前台安排推荐的CRC。干预的第二步包括接收有关指定的CRCS程序和准备的信息，如(A)ST：个人故事或(B)UC：局部讲义回顾。我们将随机选择600名患者进行筛查(每组300人)。我们有初步数据表明，从提供者那里获得约90%的遵从性，以便使用提示卡转介患者进行筛查是可行的。另一项初步研究显示，与UC相比，ST对筛查意向的影响更大。主要假设：在低收入，主要是联邦医疗保险/医疗补助资助的诊所环境中，患者在接受ST风格的风险沟通和随访时，比那些接受UC沟通和随访的患者更遵守CRCS转诊。第二假设：暴露于ST的患者比暴露于UC的患者更有可能表达筛查意图。对故事的识别和参与以及对威胁、恐惧和压力的看法将作为调解人进行评估。这一发现可能会为CRC提供有效的初级保健实践干预。

DESCRIPTION (provided by applicant): Much of the research on risk communication has addressed the lay public's ability to interpret and act on numeric risk information. In contrast, community programs often use lay educators who share personal stories to convey information about risk. We propose a randomized, controlled trial to examine effects of Storytelling (ST) versus a Usual Care (DC), numeric form of communication on patient compliance for colorectal cancer screening (CRCS) referrals. The interventions to be compared are two distinct modalities, ST or DC, for conveying CRC risk and risk reduction delivered when a patient comes in for a clinic visit and referral. Patients in low-income, primarily Medicare/Medicaid funded clinics due for CRCS will be randomized to one of two groups to receive a two-step intervention. Step 1 is delivered prior to CRCS referral via video, presenting either (a) ST: a culturally rich story about a family with various cancer-related risky and healthy behaviors and screening patterns, teaching elements of CRC risk, or (b) UC: a risk assessment tool for providing the same CRC risk information, but with individual feedback on ratings of relative risk. Patients in both arms of study receive a discussion of CRC risk reduction and prevention and CRCS guidelines to complete Step 1. Patients proceed to their scheduled visit with a clinician (with reminder card), receive a referral, and schedule the recommended CRCS at front desk, Step 2 of the intervention includes receiving information about the prescribed CRCS procedure and prep, either as (a) ST: a personal story or (b) UC: a review of topical handouts. We will randomize 600 patients referred for screening (300 each arm). We have preliminary data demonstrating feasibility of gaining approximately 90% compliance from providers to refer patients for screening using a reminder card. An additional preliminary study shows a trend for greater impact on intent to screen using ST compared to UC. Main Hypothesis: In a low-income, primarily Medicare/Medicaid-funded clinic setting, patients will comply more with a CRCS referral when exposed to ST style of risk communication and follow-up than those exposed to UC communication and follow-up. Secondary Hypothesis: Patients exposed to ST will be more likely to express intent to screen than those exposed to UC. Identification and engagement with the story and perceptions of threat, fear and stress will be assessed as mediators. Findings will potentially inform effective primary care practice interventions for CRCS.