Cervical Cancer Screening in Homeless Women: A Discrete Choice Experiment

描述（由申请人提供）：宫颈癌是少数几种可预防的癌症之一，但在美国每年仍有4,000多人死亡。预防和早期发现可以成功地根除这种疾病，如果全民都这样做的话。在美国，大多数新的宫颈癌病例都是从未接受过筛查或很少接受筛查的女性。虽然美国的大多数妇女都接受了宫颈癌筛查，但仍有一部分人未接受筛查或筛查不足，并有患宫颈癌的风险。无家可归的妇女是宫颈癌仍然造成死亡的群体之一。 无家可归妇女接受宫颈癌筛查的人数远远少于所有妇女，甚至少于贫穷的有住房妇女。美国无家可归的妇女人数正在增加，除非开发出有效的方法来预防新的病例，否则这些妇女将导致更多的宫颈癌病例。这项研究将确定宫颈癌筛查的具体健康和非健康方面，这些方面对无家可归的妇女很重要，以便进行筛查。研究结果将导致设计无家可归者特异性宫颈癌筛查干预措施，以增加这一独特人群的早期发现，并防止未来发生这种疾病。 拟议的研究将采用一种创新的决策分析方法来研究宫颈癌筛查背景下的个人选择。该方法使用问卷来收集人们在面对对决策重要的不同因素组合时会做出的选择的数据。在这项研究中，我们将首先确定无家可归妇女宫颈癌筛查决策的相关健康和非健康因素，如费用、进行检测的地点、进行检测的提供者等。 这些信息有助于制定调查，包括不同的筛选方案，其中包括这些要素的不同组合。被招募参加调查的无家可归妇女将在成对的不同筛选方案组合中进行选择，以证明她们的决策优先事项。由此产生的调查数据将进行分析，把每个元素的重要性是如何在我们的研究中选择所有无家可归的妇女进行筛选的数字估计。 研究结果将为筛选干预措施的设计提供信息，这些干预措施可以为这一特定人群实现最高的筛选率。无家可归妇女的偏好可能不同于有住房的贫穷妇女或其他收入的妇女等。这种研究方法允许根据特定群体的偏好和愿望制定战略，以最大限度地提高利益结果（在这种情况下，筛选）。作为一项探索性资助，我们的研究结果将用于开发筛选干预措施，用于随后的对照试验测试。这项研究将有助于NCI通过早期发现疾病来实现癌症控制和预防的目标。

DESCRIPTION (provided by applicant): Cervical cancer is one of the few preventable forms of cancer, yet it still causes over 4,000 deaths in the US each year. Prevention and early detection could successfully eradicate the disease if practiced by the entire population. Most of the new cases of cervical cancer in the US are in women who have never been screened or have been screened infrequently. While most women in the US are screened for cervical cancer, pockets of the population remain unscreened or under-screened and are at risk of the disease. Homeless women are one of these pockets where cervical cancer still exerts a toll. Homeless women are screened for cervical cancer far less than all women, and even less than poor, housed women. The number of homeless women in the US is increasing, and these women will contribute more cases of cervical cancer unless effective methods to prevent new cases are developed. This research will identify the specific health and non-health aspects of cervical cancer screening that are important to homeless women in order to be screened. The study results will lead to the design of homeless-specific cervical cancer screening interventions to increase early detection among this unique population, and to prevent future cases of this disease. The proposed study will apply an innovative method of decision analysis to study individual choice in the context of cervical cancer screening. The approach uses a questionnaire to collect data on the choices people would make when faced with different combinations of factors that are important to a decision. For this study, we will first determine the relevant healh and non-health factors for the cervical cancer screening decision for homeless women, such as cost, location where the test is performed, the provider performing the test, etc. We will use this information to develop a survey including different screening scenarios that include these elements in different combinations. Homeless women recruited to the survey will choose between pairs of different combinations of screening scenarios to demonstrate their decision priorities. The resulting survey data will be analyzed to put numerical estimates on how important each element is to the choice to be screened for all homeless women in our study. The study findings will inform the design of screening interventions that can achieve the highest rate of screening for this particular population. What is preferred for homeless women may be different than that for housed, poor women, or for women of other incomes, etc. This research method allows strategies to be tailored to the preferences and desires of a particular group, to maximize the outcome of interest (in this case, screening). As an exploratory grant, our findings will be used to develop screening interventions for subsequent testing in controlled trials. This research will contribute to the NCI goal of cancer control and prevention, through early detection of disease.