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强调了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者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，以检查讲故事（ST）与家庭护理（DC）的效果，数字形式的沟通对患者依从性的结直肠癌筛查（CRCS）转诊。要比较的干预措施是两种不同的模式，ST或DC，用于传达CRC风险和降低风险，当患者来诊所就诊和转诊时。在低收入，主要是医疗保险/医疗补助资助的诊所，由于CRCS的患者将被随机分为两组之一，接受两步干预。步骤1在CRCS转诊之前通过视频进行，呈现（a）ST：关于具有各种癌症相关风险和健康行为以及筛查模式的家庭的文化丰富的故事，CRC风险的教学元素，或（B）UC：提供相同CRC风险信息的风险评估工具，但对相对风险评级提供个人反馈。研究两组的患者均接受CRC风险降低和预防以及CRCS指南的讨论，以完成步骤1。患者继续与临床医生（带提醒卡）进行计划访视，接受转诊，并在前台安排推荐的CRCS，干预的第2步包括接收有关处方CRCS程序和准备的信息，如（a）ST：个人故事或（B）UC：局部讲义的审查。我们将随机分配600例转诊患者进行筛选（每组300例）。我们有初步的数据表明，从供应商那里获得大约90%的依从性是可行的，可以使用提醒卡将患者转诊进行筛查。另一项初步研究显示，与UC相比，ST对筛查意图的影响更大。主要假设：在低收入，主要是医疗保险/医疗补助资助的诊所设置，患者将遵守CRCS转诊时，暴露于ST风格的风险沟通和随访比那些暴露于UC沟通和随访。次要假设：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。对故事的认同和参与以及对威胁、恐惧和压力的感知将作为中介进行评估。研究结果可能会为CRCS提供有效的初级保健实践干预措施。

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.