Increasing Colorectal Cancer Screening in African Americans: Tailoring and MI

非裔美国人(AAs)的结直肠癌(CRC)死亡率比白人高43%。一 缩小这种差距的策略是增加早期发现。种族差异存在于决定因素中 筛查行为。例如，美国医学会可能更喜欢“医生主导”的沟通方式。 与白人相比，他们可能更依赖于家人而不是他们的医生。 通过量身定做干预措施来解释这些差异可以显著加强干预 功效。激励性访谈(ML)可能进一步有助于减少对结直肠癌筛查的抵抗力。建议数 随机试验将测试三种日益强化的干预措施，以增加再生障碍性贫血患者的CRC筛查 综合医疗保健系统(亨利福特健康系统-HF)的成员。成人AA，平均为CRC 风险但不符合USPSTF筛查建议的50-80岁的人将被随机分为三组 小组：1)基本定制：三份与儿童权利公约有关的通讯，根据年龄、性别、健康情况单独定制 病史和以前的结直肠癌筛查。2)增强裁剪：基本裁剪加上筛选偏好、种族 身份、沟通风格和动机倾向。3)增强剪裁+ml：增强 由训练有素的健康教育者使用ML定制外加一次电话咨询联系。组1将收到一个 打印干预针对HF电子病历(EMR)中已有的变量单独定制。组别2 &3将收到针对需要新数据收集的其他变量量身定做的打印干预。集团化 3增加了干预强度，包括单个毫升电话联系。在我们之前的CECCR研究中， 我们发现，为种族认同和动机倾向量身定做是可行的，而且对于可识别的 亚群，有效。大约1400名受试者将使用高频电子病历进行登记。主要结果是 在1年后的测试中，将由高频计算机化记录确定为CRC筛查状态。分析将是 执行以确定干预措施的成本效益。在整个研究过程中，我们将与 在HF的临床、文化能力和管理领导能力，以最大限度地提高HF采用的可能性 如果这些量身定制的计划被发现是有效的，还有其他一些计划。

Colorectal Cancer (CRC) mortality rates are 43% higher among African Americans (AAs) than whites. One strategy to reduce this disparity is to increase early detection. Ethnic differences exist in the determinants of screening behavior. For example, AAs may be more likely to prefer a "physician-dominated" communication style around CRC screening than whites and they may be more likely to rely on family than their physicians. Accounting for these differences through tailoring interventions could significantly potentiate intervention efficacy. Motivational Interviewing (Ml) may further help reduce resistance to CRC screening. The proposed randomized trial will test three increasingly intensive interventions to increase CRC screening among AA members of an integrated health care system (Henry Ford Health System - HF). Adult AAs, of average CRC risk but not meeting USPSTF recommendations for screening, ages 50-80 will be randomized to one of three groups: 1) Basic Tailoring: Three CRC-related newsletters, individually-tailored on age, gender, health history, and prior CRC screening. 2) Enhanced Tailoring: Basic tailoring PLUS screening preferences, ethnic identity, communication style and motivational predisposition. 3) Enhanced Tailoring PLUS Ml: Enhanced tailoring PLUS one telephone counseling contact by trained health educators using Ml. Group 1 will receive a print intervention individually tailored on variables already in the HF electronic medical record (EMR). Groups 2 & 3 will receive a print intervention tailored on additional variables that necessitate new data collection. Group 3 adds intervention intensity with the inclusion of a single Ml telephone contact. In our prior CECCR studies, we found tailoring on ethnic identity and motivational predisposition was feasible, and for identifiable subgroups, efficacious. Approximately 1,400 subjects will be enrolled using the HF EMR. The primary outcome will be CRC screening status at 1-year posttest determined by HF computerized records. Analyses will be performed to determine the cost-effectiveness of the interventions. Throughout the study, we will work with the clinical, cultural competence, and administrative leadership at HF to maximize the likelihood of adoption by HF and others should the tailored programs be found to be effective.