Facilitating Risk-Appropriate Colorectal Cancer Testing

描述（由申请人提供）：适当的风险检测可以预防很大比例的结肠癌死亡，但参与此类检测的人数太少。患者因素（对需求和益处的了解有限）和医生因素（不理想的建议）导致了这个问题。因为医生的建议是参与检测的最重要的预测因素，初级保健医生被依赖于确定风险适当的检测方式和时间表的复杂任务。然而，个人和家族风险因素决定了哪些检查和时间表对特定患者来说是风险适宜的，这些因素并没有常规地总结在初级保健记录中，而且在就诊期间收集和评估可能很耗时。如果没有计算机干预来收集和分析个人和家庭风险信息的帮助，忙碌的医生不太可能为每个病人提供适合风险的检测建议。我们将测试在初级保健预约之前使用的易于使用的触摸屏电脑程序。该项目以信息-动机-行为技能模型为基础，收集和评估风险数据，并为患者提供适合风险的检测建议。我们开发了一个试点版本，并在初级保健机构进行了试点测试，结果表明，收集和综合必要的信息是可行的，这些信息可以确定风险适宜的测试，促进患者与医生就结肠癌测试进行讨论，以及如何调整该项目以最大限度地发挥临床效用。在调整项目后，我们将在3个杜克综合内科诊所进行一项基于临床的随机试验，其中28名医学博士约有30,000名患者。入选的患者将根据医生的意见被分配到干预组或对照组。我们将确定该计划在多大程度上促进：1)患者参与风险适当的结直肠癌检测，并通过电子病历（EMR）审计记录；2)患者收到适合风险的医生建议进行检测，并由电子病历审核记录；3)患者参与风险适宜检测的意图和感知障碍的变化，由患者报告记录。通过提供与初级保健访问相结合的个性化干预，该计划可以成为临床护理的有益和非阻塞性辅助。如果发现有效，它应该是高度可推广的，具有很大的潜力，可以改善结直肠癌在整个人群中的预后。

DESCRIPTION (provided by applicant): Risk-appropriate testing can prevent a significant proportion of colon cancer deaths, but participation in such testing is too low. Patient factors (limited knowledge about need and benefits) and physician factors (sub- optimal recommendations) contribute to this problem. Because physician recommendation is the most important predictor of participation in testing, primary-care doctors are relied upon for the complicated task of determining risk-appropriate testing modalities and schedules. However, personal and familial risk factors that determine which test(s) and schedules are risk-appropriate for a given patient are not routinely summarized in primary-care records and can be time-consuming to collect and evaluate during a visit. Without help from a computerized intervention to collect and analyze personal and familial risk information, it is unlikely that a busy physician will make a risk-appropriate testing recommendation for every patient. We will test an easy-to-use touch-screen computer program used prior to primary-care appointments. The program, based on the Information-Motivation-Behavioral skills model, collects and evaluates risk data and provides patient-tailored recommendations for risk-appropriate testing. A pilot version we developed and pilot tested in primary-care settings showed feasibly for gathering and synthesizing information necessary to determine risk-appropriate tests and facilitate patient-physician discussion about colon cancer testing as well as ways the program should be adapted to maximize clinical utility. After adapting the program, we will conduct a clinic-based randomized trial in 3 Duke General Internal Medicine practice sites in which approximately 30,000 patients are seen by 28 MDs. Enrolled patients will be assigned to intervention or comparison group according to their physician. We will determine extent to which the program facilitates: 1) patient participation in risk-appropriate colorectal cancer testing, documented by electronic medical record (EMR) audit; 2) patient receipt of risk-appropriate physician recommendation for testing, documented by EMR audit; and 3) changes in patients' intent and perceived barriers to participating in risk-appropriate testing, documented by patient report. By providing an individually tailored intervention in conjunction with the primary-care visit, the program can be a helpful and non-obstructive adjunct to clinical care. If found effective, it should be highly disseminable, with great potential for improving colorectal cancer outcomes in the population at large.