Increasing Colorectal Cancer Screening for Patients with Multiple Morbidities

描述(由申请人提供)：一般来说，阿巴拉契亚和农村服务不足的居民患多发性疾病的比率较高，用于预防和管理疾病的资源较少。一些研究人员推测，影响阿巴拉契亚地区的癌症健康差异可能是由于多种发病率管理要求造成的，这可能会剥夺必要和有效的癌症筛查的价值。在这项初步研究中，我们研究了多种疾病是否以及如何影响结直肠癌筛查率。我们的长期目标是通过在患有多种疾病的患者更频繁的医疗互动期间增加癌症筛查服务，将这种竞争时间和资源压力的不利情况转化为优势。由于多发性骨髓瘤发病率飙升，多发性骨髓瘤患者的癌症死亡率更高，以及疾病预防和管理的相互竞争的需求，解决近四分之三的中老年人多发性骨髓瘤至关重要。我们的目标是通过三个研究活动扩大我们对多发性骨髓瘤和结直肠癌(CRC)筛查之间关系的有限了解。首先，为了深入了解在患有多种疾病的人群中影响结直肠癌筛查行为模式的因素和环境，将对代表阿巴拉契亚不同做法的5名医疗保健提供者和40名患有两种或两种以上慢性病的患者进行深入访谈。这些访谈将提供两位最重要的卫生决策者--提供者和患者--的本地观点。其次，为了确保概括性，我们将通过对阿巴拉契亚地区进行分层代表性调查，评估与MM和CRC筛查行为相关的因素的影响。最后，在确定了在多种疾病背景下阻碍结直肠癌筛查的因素、情况和模式后，我们将召开焦点小组来验证我们的发现并讨论最佳干预方向。最终，这些发现将导致基于社区的参与式干预R01的开发，该干预将利用患有多种疾病的人相对频繁的医疗访问，最终将增加CRC筛查，改善实践协调，并减少与癌症相关的死亡。与公共卫生相关：在美国，不断增长的中老年人口中，大多数人患有多种疾病或几种慢性病。患有多种疾病通常会降低接受高效癌症预防的可能性，比如结直肠癌筛查。该项目使用创新的方法来确定那些患有多种疾病的人为什么不太可能接受结直肠癌筛查的原因，并最终将为阿巴拉契亚地区未得到充分服务的农村健康差距人口制定一种文化上一致的干预措施，以增加这种致命癌症的早期发现。

DESCRIPTION (provided by applicant): Appalachian and rural underserved residents, in general, experience higher rates of multiple morbidities (MM) with fewer resources to prevent and manage disease. Some researchers have speculated that the well-documented cancer health disparities affecting Appalachians may be attributable to multiple morbidity management demands which may deprioritize essential and efficacious cancer screenings. In this pilot study, we examine whether and how multiple morbidities affect colorectal cancer screening rates. Our long-term goal is to turn this disadvantageous situation of competing time and resource pressure into an advantage by increasing cancer screening services during the more frequent medical interactions of those with multiple morbidities. Addressing the nearly three-quarters of middle aged and older adults with MM is essential due to skyrocketing rates of MM, higher rates of cancer mortality among those with MM, and competing demands of disease prevention and management. We aim to expand our limited understanding of the association between MM and colorectal cancer (CRC) screening through three research activities. First, to obtain rich insights into the factors and circumstances that affect patterns of CRC screening behavior among those with multiple morbidities, in-depth interviews will be conducted with 5 health care providers representing diverse practices in Appalachia and with 40 patients who have two or more chronic diseases. These interviews will provide locally grounded perspectives from the two most salient health decision makers, providers and patients. Second, to insure generalizability, we will assess the impact of factors germane to both MM and CRC screening behavior by conducting a stratified representative survey of Appalachians. Finally, after identifying factors, circumstances, and patterns that prevent CRC screening in the context of multiple morbidities, we will hold focus groups to validate our findings and discuss optimal direction for interventions. Ultimately, these findings will lead to the development of a community-based participatory intervention R01 that will capitalize on the relatively frequent medical care visits of those with multiple morbidities and ultimately will increase CRC screening, improve practice coordination, and decrease cancer-associated deaths. PUBLIC HEALTH RELEVANCE: In the US, the majority of the ever-growing middle aged and older population has multiple morbidities or several chronic diseases. Having multiple morbidities generally decreases the likelihood of receiving highly effective cancer prevention, like colorectal cancer screening. This project uses innovative methods to determine the reasons why those with multiple morbidities may be less likely to get colorectal cancer screening and will eventually develop a culturally consistent intervention for the underserved rural health disparities population of Appalachia to increase early detection of this deadly cancer.