Cervical Cancer Screening in Homeless Women: A Discrete Choice Experiment

描述（由申请人提供）：子宫颈癌是为数不多的可预防的癌症之一，但在美国每年仍有超过4000人死于子宫颈癌。如果所有人都采取预防和早期发现措施，就可以成功地根除这种疾病。在美国，大多数宫颈癌新病例是从未接受过筛查或很少接受筛查的妇女。虽然美国大多数妇女都接受了宫颈癌筛查，但仍有一小部分人未接受筛查或筛查不足，面临着患宫颈癌的风险。无家可归的妇女是宫颈癌仍然造成死亡的人群之一。无家可归的妇女接受子宫颈癌筛查的人数远远少于所有妇女，甚至少于贫穷的有房妇女。在美国，无家可归的妇女人数正在增加，如果没有有效的预防新病例的方法，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进行筛查很重要。研究结果将导致设计针对无家可归者的宫颈癌筛查干预措施，以增加对这一独特人群的早期发现，并预防这种疾病的未来病例。建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。该方法使用问卷调查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，我们将首先确定与无家可归妇女宫颈癌筛查决定相关的健康和非健康因素，如费用、进行检测的地点、进行检测的提供者等。我们将使用这个

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. PUBLIC HEALTH RELEVANCE: This research addresses cancer screening behavior in an under-screened population, homeless women. Our study will identify the relevant health and non-health decision factors that explain whether homeless women seek screening for cervical cancer, through a decision analytic method that examines choice. The ultimate goal of the research is to reduce cervical cancer morbidity and mortality among homeless women, and prevent cervical cancer in the US.