Increasing Colorectal Cancer Screening for Patients with Multiple Morbidities

描述（由申请人提供）：阿巴拉契亚和农村服务不足的居民，一般来说，经历更高的多发性疾病（MM）的发病率，更少的资源来预防和管理疾病。一些研究人员推测，影响阿巴拉契亚山脉的有据可查的癌症健康差异可能归因于多种发病率管理需求，这些需求可能会降低必要和有效的癌症筛查的优先级。在这项初步研究中，我们研究了多种疾病是否以及如何影响结直肠癌筛查率。我们的长期目标是通过在患有多种疾病的人更频繁的医疗互动期间增加癌症筛查服务，将这种竞争时间和资源压力的不利情况转化为优势。解决近四分之三的中老年MM患者的问题至关重要，因为MM的发病率飙升，MM患者的癌症死亡率较高，以及疾病预防和管理的竞争需求。我们的目标是通过三项研究活动扩大我们对MM和结直肠癌（CRC）筛查之间关系的有限理解。首先，为了深入了解影响多发性疾病患者CRC筛查行为模式的因素和情况，将对代表阿巴拉契亚不同实践的5名医疗保健提供者和40名患有两种或两种以上慢性疾病的患者进行深入访谈。这些访谈将从两个最突出的卫生决策者，提供者和患者提供当地接地的观点。其次，为了确保普遍性，我们将通过对阿巴拉契亚山脉进行分层代表性调查，评估与MM和CRC筛查行为密切相关的因素的影响。最后，在确定了在多种发病率的背景下阻止CRC筛查的因素、情况和模式后，我们将举行焦点小组会议，以验证我们的研究结果，并讨论干预措施的最佳方向。最终，这些发现将导致开发一种基于社区的参与性干预措施R01，该干预措施将利用患有多种疾病的患者相对频繁的医疗保健访问，并最终增加CRC筛查，改善实践协调，并减少癌症相关死亡。公共卫生相关性：在美国，不断增长的中年和老年人口中的大多数患有多种疾病或多种慢性疾病。患有多种疾病通常会降低接受高效癌症预防的可能性，如结肠直肠癌筛查。该项目使用创新的方法来确定为什么患有多种疾病的人可能不太可能接受结肠直肠癌筛查，并最终为阿巴拉契亚农村健康差距人口制定文化上一致的干预措施，以增加这种致命癌症的早期发现。

DESCRIPTION (provided by applicant): Appalachian and rural underserved residents, in general, experience higher rates of multiple morbidities (MM) with fewer resources to prevent and manage disease. Some researchers have speculated that the well-documented cancer health disparities affecting Appalachians may be attributable to multiple morbidity management demands which may deprioritize essential and efficacious cancer screenings. In this pilot study, we examine whether and how multiple morbidities affect colorectal cancer screening rates. Our long-term goal is to turn this disadvantageous situation of competing time and resource pressure into an advantage by increasing cancer screening services during the more frequent medical interactions of those with multiple morbidities. Addressing the nearly three-quarters of middle aged and older adults with MM is essential due to skyrocketing rates of MM, higher rates of cancer mortality among those with MM, and competing demands of disease prevention and management. We aim to expand our limited understanding of the association between MM and colorectal cancer (CRC) screening through three research activities. First, to obtain rich insights into the factors and circumstances that affect patterns of CRC screening behavior among those with multiple morbidities, in-depth interviews will be conducted with 5 health care providers representing diverse practices in Appalachia and with 40 patients who have two or more chronic diseases. These interviews will provide locally grounded perspectives from the two most salient health decision makers, providers and patients. Second, to insure generalizability, we will assess the impact of factors germane to both MM and CRC screening behavior by conducting a stratified representative survey of Appalachians. Finally, after identifying factors, circumstances, and patterns that prevent CRC screening in the context of multiple morbidities, we will hold focus groups to validate our findings and discuss optimal direction for interventions. Ultimately, these findings will lead to the development of a community-based participatory intervention R01 that will capitalize on the relatively frequent medical care visits of those with multiple morbidities and ultimately will increase CRC screening, improve practice coordination, and decrease cancer-associated deaths. PUBLIC HEALTH RELEVANCE: In the US, the majority of the ever-growing middle aged and older population has multiple morbidities or several chronic diseases. Having multiple morbidities generally decreases the likelihood of receiving highly effective cancer prevention, like colorectal cancer screening. This project uses innovative methods to determine the reasons why those with multiple morbidities may be less likely to get colorectal cancer screening and will eventually develop a culturally consistent intervention for the underserved rural health disparities population of Appalachia to increase early detection of this deadly cancer.