Colorectal Cancer Screening: A New Web-Based Decision-Making Strategy for Low-Lit

描述（由申请人提供）：据估计，2013年将有近143,000名美国人被诊断为结直肠癌（CRC），约51,000名美国人将死于结直肠癌。这使得结直肠癌成为该国癌症死亡的第二大原因，也是第三大确诊原因。在早期诊断的情况下，预后良好，生存率接近90%。然而，预测的死亡人数大约是早期发现这种疾病的3.5倍。造成这种差异的主要原因是缺乏对美国预防服务工作组（USPSTF）提出的筛查指南的遵守，该指南建议对50至75岁之间的所有患者进行筛查，使用三种筛查方法之一：粪便隐血检查、乙状结肠镜检查或结肠镜检查。在高危人群中，只有58.6%的人遵守了指南。在西班牙裔人群中，这一比例降至46.5%，与年龄和阶段匹配的人相比，他们的死亡率也更高。需要创新的策略来解决低筛查率，特别是在西班牙裔。本提案的主要目的是开发、测试和确定针对低识字率西班牙裔人群实施双语、文化定制和基于理论的决策支持干预的可行性，以促进患者在护理点的高质量知情决策，从而增加CRC筛查的吸收。我们应用新的决策理论方法依赖于非加性整合的概念，以帮助患者做出更明智的决策有关CRC筛查。由于信息学的无所不在和无处不在的性质，基于信息学的决策辅助系统是这种干预的理想载体。我们建议开发一种基于网络的、开放源代码的软件，交付给触摸屏计算机。提供基于文化和理论的CRC和筛查教育。2)提供包含关键测试属性的交互式、明确的偏好澄清练习；3)。计算基于个体偏好的非加性度量，并为患者和治疗医师提供决策指导；和4)。将病人的决定直接连接到电子病历。我们建议从两家初级保健诊所招募140名西班牙裔患者和20名提供者，以试点和测试软件的可用性，干预措施，收集将其整合到临床实践中的可行性数据，并收集有关其对筛查吸收，患者提供者互动和临床流程的潜在影响的信息。我们研究的中心假设是，在计算基础设施中，基于适当决策工具（例如基于决策理论的最新研究）的干预将提高对高危人群（特别是西班牙裔）的认识，将促进决策过程，将产生更高的筛查率和对USPSTF CRC指南的普遍遵守，并将导致更高的早期检出率，从而提高实际存活率。这个项目将为…提供重要的信息

DESCRIPTION (provided by applicant): It is estimated that close to 143,000 Americans will be diagnosed with colorectal cancer (CRC) that about 51,000 Americans will die from CRC in 2013. This makes CRC the second leading cause of cancer deaths in the country, and the third most diagnosed. With early stage diagnosis, the outcome is favorable, and the survival rate is close to 90%. Yet, the predicted number of deaths is roughly 3.5 times more than anticipated were the disease detected early. A primary reason for the discrepancy is the lack of adherence to the screening guidelines set forth by the U.S. Preventive Services Task Force (USPSTF) which recommends screening for all patients between 50 and 75 years of age, using one of the three screening methods: Fecal Occult Blood Test, flexible sigmoidoscopy, or colonoscopy. Within the population at risk, only 58.6% adhere to the guidelines. The rate drops to 46.5% in the Hispanic population, who also suffer greater mortality compared to age and stage matched individuals. Innovative strategies are needed to address low screening rates in, in particular among Hispanics. The primary objective of this proposal is to develop, test and determine the feasibility of implementing a bilingual, culturally tailored and theory-based decision-support intervention targeting low literacy Hispanic populations, to facilitate high quality informed decision making at the point of care for patients, in order to increase the uptake of CRC screening. We apply new decision -theoretic methods relying on the concepts of non-additive integration, to help patients make better-informed decisions pertaining to CRC screening. Because of the ubiquitous and pervasive nature of informatics, an informatics-based decision aid system is an ideal vector for such an intervention. We propose to develop a web-based, open- source software delivered on touch screen computers which 1.) Provides culturally tailored and theory-based education on CRC and screening. 2) Provides an interactive, explicit preference clarification exercise incorporating key test attributes; 3.) Computes the non-additive measures based on individual preferences, and provides decision-making guidelines for the patient and the treating physician; and 4.) Links the patient's decision directly into the EMR. We propose to recruit 140 Hispanic patients and 20 providers from two primary care clinics in order to pilot and test the usability of the software, the intervention, gather data on the feasibility o integrating it into clinical practice and to garner information about its potential effect on screening uptake, patient provider interaction and clinic processes. The central hypothesis of our research is that an intervention based on proper decision-making tools (e.g. based on recent research in decision theory), within a computing infrastructure will increase the awareness of the population at risk, especially Hispanics, will facilitate the decision-making process, will yield a higher rate of screening and general adherence to USPSTF guidelines for CRC, and will lead to higher early detection rates, and thus higher actual survival rates. This project will provide vital information for the development of an R01 grant to conduct a multi- site intervention to improve CRC screening rates among Hispanic patients across the US.