PEER OUTREACH TO FACILITATE COLORECTAL CANCER SCREENING IN SAFETY NET CLINICS

描述(由申请人提供)：筛查是降低结直肠癌(CRC)发病率和死亡率的有效工具，但许多成年人没有按推荐的间隔进行筛查。社会经济地位低的人或没有保险的人筛查率低得不成比例，而CRC发病率和死亡率则高得不成比例。这一人群需要新的战略来提高对CRC的认识，并为筛查尝试提供便利。该项目的长期目标是开发有效、可持续和可传播的干预措施，以增加结直肠癌筛查，降低发病率，并提高服务不足人群的存活率。这些努力对于减少儿童权利公约目前的健康差距和减少人口中儿童权利委员会的总体负担至关重要。这项应用的主要目的是评估同行提供的外展干预措施的前景，以增加城市安全网诊所患者中有利于和完成结直肠癌筛查的决定。这项随机试验将测试与传统的基于印刷品的干预相比，同行提供的干预在促进结直肠癌筛查方面的有效性。这项研究将对200名年龄在50岁到75岁之间、具有结直肠癌中等风险的患者进行。患者将在招募时在安全网诊所现场完成基线调查，并将被随机分配到“同行教练”或比较印记干预。我们的基于理论的干预结合了计划行为理论和实施意向理论的结构。同伴教练是受雇于诊所的社区成员，他们接受过帮助患者获得医疗保健的培训。这项干预将包括三个外展咨询电话，以促进和促进结直肠癌筛查。比较印刷干预将由三封邮件组成，其中包含关于结直肠癌筛查的目标信息。我们将在基线后6个月对参与者进行后续电话调查。这项研究的主要结果是在基线后6个月完成任何可接受的结直肠癌筛查(FOBT、乙状结肠镜、结肠镜检查)，通过图表回顾来衡量。第二个目标是进行过程评估，并证明干预安全网环境的可行性。R21的成功完成将有助于开发一项计划中的全面R01干预试验，以减少结直肠癌筛查、发病率和存活率方面的差异。公共卫生相关性：早期发现结直肠癌(CRC)与更好的生存相关，但人群筛查率相对较低，特别是在低收入和未参保的人中。我们的研究将检验使用同伴教练来提高安全网诊所结直肠癌筛查率的干预效果。筛查的增加可能会对美国的CRC负担产生重大影响。

DESCRIPTION (provided by applicant): Screening is an effective tool for reducing both colorectal cancer (CRC) incidence and mortality, but many adults are not screened at recommended intervals. Persons of low socioeconomic status or who are uninsured have disproportionately lower rates of screening and higher rates of CRC incidence and mortality. Novel strategies are needed for this population to increase awareness of CRC and facilitate screening attempts. The long-term objectives of this project are to develop effective, sustainable, and disseminable interventions that will increase CRC screening, decrease incidence, and improve survival in underserved populations. Such efforts are critical to decreasing the current health disparities in CRC and reducing overall CRC burden in the population. The Primary Aim in this application is to assess the promise of a peer-delivered outreach intervention for increasing decisions favoring, and completion of, CRC screening among patients from urban safety-net clinics. This randomized trial will test the effectiveness of a peer-delivered intervention compared to a traditional print-based intervention for promoting CRC screening. This study will be conducted with 200 patients who are between the ages of 50 and 75 and at average-risk for CRC. Patients will complete a baseline survey on-site at the safety-net clinic at the time of recruitment and will be randomized to either a "peer coach" or a comparison print intervention. Our theory-based intervention incorporates constructs from the Theory of Planned Behavior and Implementation Intentions Theory. Peer Coaches are community members who are employed by the clinic and trained to help patients access healthcare. The intervention will consist of three outreach counseling calls to promote and facilitate CRC screening. The comparison print intervention will consist of three mailings with targeted information about CRC screening. We will conduct a follow-up telephone survey of participants at 6-months post baseline. The primary outcome of this study is completion of any acceptable CRC screen (FOBT, sigmoidoscopy, colonoscopy) at six-months after baseline, measured by chart review. A secondary aim is to conduct process evaluation and demonstrate feasibility for intervening in safety-net settings. Successful completion of this R21 will inform the development of a planned full-scale R01 intervention trial to reduce disparities in CRC screening, incidence, and survival. PUBLIC HEALTH RELEVANCE: Early detection of colorectal cancer (CRC) is associated with better survival, but population screening rates are relatively low, especially so in low income and uninsured persons. Our study will examine the effect of an intervention using peer coaches to increase CRC screening rates in safety-net clinics. Increases in screening can have a significant impact on CRC burden in the United States.