Enhancing Colorectal Cancer Screening in Primary Care

描述（由申请人提供）：结直肠癌（CRC）是美国第三大癌症类型，也是癌症死亡的第三大原因。俄亥俄州的CRC死亡率高于平均水平。我们的研究人群还将包括少数民族和老年人，因为这些群体的CRC发病率和死亡率更高。本研究的目的是在俄亥俄州立大学初级保健网络的12个初级保健诊所中测试一项计划，以改善50岁以上男性和女性患者的CRC筛查。本研究将采用医师调查、焦点小组和社区咨询委员会来确定干预措施的内容。五个理论模型构成了本研究的理论框架——健康信念模型、社会网络模型、少数群体健康和传播模型、第三部分和跨理论模型。干预计划将在临床和患者层面进行，并将在随机分组设计中进行测试。6家诊所将接受由诊所和患者导向干预组成的干预计划，6家诊所将随机接受常规护理。临床干预部分由提供者、系统和候诊室活动组成。个人定向干预部分在临床定向干预部分12个月后开始，将包括三个阶段，针对尚未接受筛查的患者：(1)量身定制的医生信函、易于阅读的CRC教育材料和FOBT信息表和卡片；(2)对收到信函后3个月内未完成结直肠癌筛查的患者进行随访电话障碍咨询；(3)非专业健康顾问（LH/l）对接受前两次干预后3个月内未完成结直肠癌筛查的患者进行亲自家访。我们将对干预措施进行过程评估，以确定实施过程中存在的问题，并确定每个组成部分成功执行的程度。通过对我们12家诊所的医疗记录进行两次独立的横断面分析，以及对随机选择的1128名患者进行测试前和测试后的访谈，对该计划的总体评估将确定该计划在增加50岁以上男性和女性CRC筛查方面的有效性。我们还将研究干预的组成部分如何与用于激励CRC筛查完成的理论框架相关。如果成功，这个项目可以很容易地被初级保健实践和诊所使用，以改善结直肠癌筛查。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the third leading type of cancer and the third leading cause of cancer death in the United States. Ohio has higher than average rates of CRC mortality. Our study population will also include minority and older individuals as these groups have higher CRC incidence and mortality rates. The goal of this study is to test a program to improve CRC screening among male and female patients over the age of 50 in 12 primary care clinics of The Ohio State University Primary Care Network. This study will use physician surveys, focus groups and a community advisory board to finalize the content of the interventions. Five theoretical models form the theoretical framework of the study - the health belief model, social networking, minority health and communications model, Pen III, and the Transtheoretical model. The intervention program will be directed at the clinic and patient levels, and will be tested in a group randomized design. Six clinics will receive the intervention program consisting of clinic and patient-directed interventions and 6 clinics will be randomized to usual care. The clinic intervention component consists of provider, system, and waiting room activities. The individual-directed intervention component begins 12 months after the clinic-directed component will include three stepped stages for patients who have not yet been screened: (1) a tailored physician letter, easy-to-read educational materials about CRC and an FOBT information sheet and card; (2) follow-up telephone barriers counseling for patients who do not complete CRC screening within 3 months after receiving the letter; and(3) in-person home visits by Lay Health Advisors (LH/l) for those who do not complete CRC screening within 3 months after receiving the first two interventions. We will conduct a process evaluation of the interventions to identify problems in implementing them and determine the extent to which each component is successfully carried out. The overall evaluation of the program will determine the effectiveness of the program in increasing CRC screening of men and women over the age of 50 through analyses of two independent cross sectional analyses of medical records in our 12 clinics, and pre and post test interviews among a randomly- selected cohort of 1128 patients. We will also examine how components of the intervention relate to the theoretical frameworks used to motivate CRC screening completion. If successful, this program can easily be adapted for use by primary care practices and clinics to improve CRC screening.