Initiation of Colon Cancer Screening in Veterans

描述（由申请人提供）：结直肠癌（CRC）是美国癌症死亡的第二大原因，其风险随着年龄的增长而增加。结直肠癌筛查（CRCS）提供了早期发现和预防的可能性。对于那些处于平均风险的人，建议从50岁开始进行CRCS。然而，对CRCS检测的认识和使用都很低。我们建议进行一项随机对照试验，以开发和测试阶梯式干预措施，以提高全国代表性，种族多样化的男性和女性退伍军人对CRCS的初步吸收。我们的具体目标是：(1)开发和预测试基于理论和证据的阶梯式干预组件；(2)实施并评估阶梯式干预措施的流程、效果和成本效益，以提高50-64岁男女退伍军人的初始CRCS；(3)分析预测变量与CRCS启动的关系以及各干预措施的中介和调节作用。在第1步中，我们将评估基于理论的通过信件、电话或自动电话传递的最小线索，并与仅进行调查的对照组进行比较，以确定这3种不同的传递渠道是否同样有效和具有成本效益。最小提示是一种经济有效的方法，可以促使那些更愿意改变的人采取行动，并且易于在现实环境中传播。在步骤1中未完成CRCS的患者将在步骤2中随机分配到更强化的干预措施中，以解决耐药性问题。在第2步中，我们将确定一个基于理论的，量身定制的电话干预，使用动机访谈的原则，当作为一个顺序干预过程的一部分，早期采用者已经从人群中移除时，是否有效。第二步还将确定一种自动化的方法，即电话联系沟通（TLC），是否与电话咨询师一样有效地促进CRCS的启动。步骤1和步骤2将共同解决鼓励完成CRCS所需的“剂量”这一重要问题。在每个步骤之后，我们将检查干预的中介和调节效应，以确定完成的决定因素。为了使癌症筛查干预研究产生最广泛的公共卫生影响，干预措施必须具有传播的潜力。我们设计了我们的试验，使我们朝着具有外部有效性证据的可传播干预措施的目标迈进。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the 2nd leading cause of cancer deaths in the US and risk increases with age. Colorectal cancer screening (CRCS) offers the possibility of both early detection and prevention. For those at average risk, CRCS beginning at age 50 is recommended. However, awareness and use of CRCS tests are low. We propose to conduct a randomized controlled trial to develop and test stepped interventions to increase initial uptake of CRCS in a nationally-representative, ethnically-diverse sample of male and female veterans. Our specific aims are to: (1) develop and pre-test stepped intervention components that are theory- and evidence-informed; (2) implement and evaluate the process, efficacy, and cost-effectiveness of stepped interventions to increase an initial CRCS among male and female veterans aged 50-64 years; and (3) analyze the association between predictor variables and CRCS initiation and the mediating and moderating effects of the interventions, after each step. In Step 1, we will evaluate a theory-based minimal cue delivered by a letter, telephone call, or automated telephone call compared with a survey-only control group to determine whether the 3 different delivery channels are equally efficacious and cost-effective. Minimal cues are a cost-effective method that prompts to action those more willing to change and are easy to disseminate in real-world settings. Persons who do not complete CRCS in Step 1 will be randomized in Step 2 to more intensive interventions that address resistance. In Step 2 we will determine whether a theory-based, tailored telephone intervention, using principles of Motivation Interviewing, is effective when delivered as part of a sequential intervention process in which early adopters have been removed from the population. Step 2 also will determine whether an automated approach, telephone-linked communication (TLC), is as effective as a telephone counselor in promoting initiation of CRCS. Steps 1 and 2 together will address the important issue of the "dose" needed to encourage completion of CRCS. After each step, we will examine the mediating and moderating effects of the intervention to identify determinants of completion. For cancer screening intervention research to have the broadest public health impact, interventions must have the potential for dissemination. We designed our trial to move us toward the goal of disseminable interventions with evidence of external validity.