The feasibility of self or partner-assisted digital anal exam screening

描述(由申请人提供)：即使发病率和死亡率增加，也没有肛门癌的标准筛查方案；然而，指端肛门直肠检查(也称为指端直肠检查)将在任何推荐的方案中发挥作用。关键的是，更少 数字肛门直肠检查正在由医生进行，尽管这是一个简单而快速的过程。如果男男性行为者(MSM)能够学会检查肛管，那么这一人群中早期癌症的发现和治疗可能会增加。这项第二阶段的可行性研究将调查增加数字肛门检查(DAE)的使用，以加强27-80岁MSM中肛门癌的筛查。我们假设男男性接触者的DAE结果将与护士从业人员DAE在检测肛门异常(定义为尖锐湿疣、痔疮、裂隙和恶性肿瘤)方面具有中等或基本的一致性。作为第二个假设，我们认为在夫妻内部进行的伴侣辅助DAE将比由单个人进行的自我DAE更符合护士从业人员DAE的要求。它并不建议业外人士承认特定的情况，而是建议任何异常情况都应引发医生就诊。具体目标是：1.评估200名男男性接触者的数字肛门检查与一名经验丰富的执业护士的黄金标准之间的一致性。这一目标将回答这样一个问题：在最佳情况下，男男性接触者在进行他们自己的DAE后是否会报告准确的结果？2.确定与MSM和护士从业者DAE的一致性独立相关的因素，包括年龄、单身男性与夫妇中的男性、种族、民族和腰围。这一目标将有助于深入了解哪些MSM更有可能执行准确的DAE。3.评估DAE的可接受性、自我效能、安全性和寻求后续护理的意向。这一目标将回答这样一个问题：性交进行的DAE是否具有足够的可接受性和安全性，并引发适当的后续护理？其目标是促进关于如何增加数字肛门检查的使用以降低肛门癌发病率和死亡率的知识。这项研究将澄清单身人士是否可以进行自我数码 肛门检查，或者可能检查需要一个伙伴，或者如果检查实际上出于安全性、准确性或可接受性的原因需要临床医生。

DESCRIPTION (provided by applicant): There is no standard screening protocol for anal cancer even as disease incidence and mortality increases; however, a digital anorectal exam (also called a digital rectal exam) will play a role in any recommended protocol. Critically, fewer digital anorectal exams are being performed by physicians even though it is a simple and quick procedure. If men who have sex with men (MSM) can learn to examine the anal canal, then detection and treatment of early cancers among this population may increase. This Phase II feasibility study will investigate increasing digital anal exam (DAE) use to enhance screening for anal cancer among MSM aged 27-80 years. We hypothesize that MSM's DAE findings will have moderate or substantial agreement with a nurse practitioner DAE for detecting an anal abnormality (defined as condylomas, hemorrhoids, fissures, and malignant tumors). As a secondary hypothesis we believe a partner-assisted DAE conducted within a couple will have better agreement with the nurse practitioner DAE than will a self-DAE conducted by a single person. It is not proposed that lay persons recognize specific conditions but, rather, that any abnormality should trigger a doctor visit. The specific aims are: 1. Estimate the agreement between the digital anal exams of 200 MSM and the gold standard of a highly experienced nurse practitioner. This aim will answer the question: under optimal circumstances, will MSM report accurate findings after performing their own DAE? 2. Determine factors independently associated with concordance of MSM and nurse practitioner DAEs including age, single men vs. men in couples, race, ethnicity and waist circumference. This aim will provide insight into which MSM are more likely to perform accurate DAEs. 3. Assess DAE acceptability, self-efficacy, safety, and intentions-to-seek subsequent care. This aim will answer the question: will lay-performed DAEs have sufficient acceptability and safety and trigger appropriate follow-up care? The goal is to advance knowledge of how to increase use of digital anal exams to reduce anal cancer morbidity and mortality. The study will clarify if single persons can do a self-digital anal exam, or perhaps the exam requires a partner, or if, in fact, the exam requires a clinician for reasons of safety, accuracy, or acceptability.