NEW STRATEGIES FOR COLORECTAL CANCER CONTROL

这个预防肿瘤学学术奖的目的是使Paul C Schroy III，M.D.将获得相关新学科的额外培训 到预防肿瘤学，并启动基于社区的研究 解决结直肠癌预防和治疗领域的关键问题 及早发现。 施罗伊博士的教育目标是1)获得公共卫生硕士学位 学位；2)获得与以下领域相关的多学科专业知识 通过与不同赞助商的频繁互动预防肿瘤学， 咨询人和联合调查员，以及3.)扩大对持续发展的参与 波士顿大学医学中心癌症预防活动和 外部组织，如美国癌症协会和波士顿 社区卫生、教育、研究和服务中心(CCHERS)。 施罗伊博士的第一个研究目标是开发、实施一项评估 以初级保健为导向的社区结直肠癌模型 控制力。该模型采用了两层策略，包括1)和 以实践为导向的现场培训计划，包括 授课和乙状结肠镜检查培训，以提高提供者的合规性，以及2) 提供现场初级保健指导的结直肠筛查服务。 该模式对提供商态度和实践模式的影响将是 在10个社区卫生中心(NHCS)进行评估，其中包括5个 干预点和5个对照点，采用准实验设计。 供应商的态度和实践模式将被监控和比较 使用教育前调查和乙状结肠镜检查预约时间表， 分别进行了分析。 施罗伊博士的第二个研究目标是确定人口统计学， 筛查依从性的行为和/或心理社会决定因素 乙状结肠镜检查适用于不同种族/民族的市中心人群。至 为实现这一目标，计划是：1)安排焦点小组采访 选择NHCS。2)利用以下来源的数据开发调查工具 焦点小组；3)对转介的患者进行扩大调查 乙状结肠镜检查在选定的NHC评估的有效性和泛化 焦点组数据；以及4)比较来自编译器和 非编译者，以识别区别因素。 施罗伊博士的第三个研究目标是进一步定义临床 P21ras癌蛋白分子检测的作用。具体来说，他 计划1)确定p21ras的患病率和/或类型 结直肠腺瘤/癌中的突变(S)在不同种族之间存在差异- /种族多样化的高危群体，以证明扩大人口规模是合理的 测试。2)继续进行相关研究，以确定 P21ras基因突变状态与临床病理的关系 腺瘤进展的决定因素，3)建立一个数据库，从中 评估p21ras基因突变状态对乳腺癌的预测价值 3年监测结肠镜检查的患者结果。

The purpose of this Preventive Oncology Academic Award is to enable Paul C Schroy III, M.D. to acquire additional training in new disciplines relevant to preventive oncology and to initiate community-based research that addresses critical issues in the area of colorectal cancer prevention and early detection. Dr. Schroy's educational goals are to 1) obtain a master of Public Health degree; 2) acquire multidisciplinary expertise in areas relevant to preventive oncology through frequent interactions with various sponsors, consultants and co-investigators, and 3.) expand participation in ongoing cancer prevention activities at Boston University Medical Center and outside organizations such as the American Cancer Society and Boston's Center for Community Health, Education, Research and Service (CCHERS). Dr. Schroy's first research objective is to develop, implement an evaluate a model for primary care-directed community-based colorectal cancer control. The model employs a two-tiered strategy which consists of 1) an on-site practice-oriented provider education program, which includes both didactic and sigmidoscopy training, to enhance provider compliance, and 2) provisions for on-site primary care directed colorectal screening services. The model's impact on provider attitudes and practice patterns will be evaluated at 10 Neighborhood Health Centers (NHCs), including 5 intervention and 5 control sites, using a quasi-experimental design. Provider attitudes and practice patterns will be monitored and compared using pre-post-educational surveys and sigmoidoscopy appointment schedules, respectively. Dr. Schroy's second research objective is to identify demographic, behavioral, and/or psychosocial determinants of compliance with screening sigmoidoscopy for racially/ethnically-diverse inner city populations. To achieve this goal, the plan is to: 1) arrange focus group interviews at select NHCs. 2) develop a survey instrument utilizing data derived from the focus groups; 3) conduct an expanded survey of patients referred for sigmoidoscopy at select NHCs to assess the validity and generalizability of the focus group data; and 4) compare responses from compliers and noncompliers to identify discriminating factors. Dr. Schroy's third research objective is to further define the clinical role of molecular testing for the p21ras oncoprotein. Specifically, he plans to 1) determine whether the prevalence and/or type of p21ras mutation(s) in colorectal adenomas/carcinomas varies among racially- /ethnically-diverse high-risk groups to justify expanded population testing. 2) continue ongoing correlative studies to define the relationship between p21ras mutational status and clinicopathologic determinants of adenoma progression, 3) establish a database from which to assess the predictive value of p21ras mutational status with respect to patient outcome at a 3-year surveillance colonoscopy.