Participatory Research to Advance Colon Cancer Prevention

 描述(申请人提供)：结直肠癌是美国癌症死亡的第三大原因。这是令人不安的，因为筛查率的特点是明显的差异，在美国居住不到10年的拉丁裔，而没有保险的人的筛查率最低。这些人通常在1200多个联邦合格的健康中心(FQHC)接受治疗，这些中心为全国2100多万人提供服务。虽然FQHC患者的结直肠癌筛查率是一个非常令人担忧的原因，但研究表明，提高筛查率是成功的。向符合条件的患者邮寄带有象形文字说明的粪便免疫化学检测(FIT)试剂盒的项目报告筛查率较高。虽然已经探索了自动电话和短信等新技术来提醒患者完成筛查，但人们对它们在不同人群中的有效性知之甚少。此外，此类计划通常采用一刀切的方法，其有效性尚未在最不可能接受筛查的子组中进行测试。为了解决这些问题，我们将与为我们成功的Stop CRC项目组建的顾问委员会以及其他社区利益相关者合作，分两个阶段调整和传播直接邮件适配和提醒计划(Prompt)。在第一阶段，我们将设计和评估一项随机对照试验，以测试基于系统、自动化和非自动化的策略，以增加在具有不同患者群体的FQHC中进行结直肠癌筛查。在第二阶段，我们将评估该计划在11家诊所的推广情况(估计符合年龄条件的患者人数约为22,000人)。拟议研究的设计和评估将以RE-AIM框架为指导，使用干预地图，并将涉及由亚基马谷农民诊所提供服务的低收入和种族多样化的患者。Prompt将是第一个按顺序测试直邮结直肠癌筛查计划提醒的有效性的试验，然后将选定的最佳实践传播到FQHC网络内的其他诊所。PROMPT将应用新的和当地制定的战略，让利益攸关方参与调整干预措施，确定干预措施的组成部分，并选择传播的最佳做法。如果试验成功，它将为类似计划的广泛实施提供潜力，以减少癌症筛查差距。

 DESCRIPTION (provided by applicant): Colorectal cancer is the third-leading cause of cancer death in the United States. This is troubling given that screening rates are marked by a pronounced disparity, with Latinos who have been in the United States for fewer than 10 years and the uninsured having the lowest rates. These individuals generally receive care at one of over 1,200 federally qualified health centers (FQHCs) that serve over 21 million persons nationwide. While colorectal cancer screening rates among FQHC patients are a cause for great concern, studies have demonstrated success for improving screening rates. Programs that mail fecal immunochemical testing (FIT) kits with pictograph instructions to eligible patients report higher screening rates. While new technologies, such as automated phone calls and text messages, have been explored to remind patients to complete screening, little is known about their effectiveness in diverse populations. Moreover, such programs often adopt a one-size fits all approach and their effectiveness has not been tested among subgroups least likely to be screened. To address these issues, we will work with the advisory board assembled for our successful STOP CRC project and additional community stakeholders to adapt and spread a direct-mail FIT and reminder program (PROMPT) in two phases. In Phase I, we will design and evaluate a randomized controlled trial to test systems-based, automated and non-automated strategies to increase colorectal cancer screening in an FQHC with diverse patient populations. In Phase II, we will assess the spread of the program to 11 clinics (estimated age-eligible patient population ~ 22,000). The proposed study's design and evaluation will be guided by the RE-AIM framework using intervention mapping and will involve low-income and ethnically diverse patients who are served by Yakima Valley Farmworkers Clinic. PROMPT will be the first trial to sequentially test the effectiveness of reminders to a direct-mail colorectal cancer screening program, then spread the selected best practice to additional clinics within the FQHC network. PROMPT will apply novel and locally develop strategies to engage stakeholders in adapting the intervention, defining the intervention components, and selecting a best practice for spread. If the trial succeeds, it will have broad-scale implementation potential for a similar program to decrease cancer screening disparities.