Increasing Colorectal Cancer Screening in Alaska Native Men

增加阿拉斯加原住民男性结直肠癌筛查

基本信息

批准号：
10218913
负责人：
Clemma Jacobsen Muller
金额：
$ 16.93万
依托单位：
WASHINGTON STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-06-18 至 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10218913
关键词：
Address Adult Age Alaska Alaska Native American Cancer Society American Indians Blood Cancer Survivor Cessation of life Clinic Clinical Clinical Practice Guideline Colonoscopy Colorectal Cancer Computerized Medical Record Consent DNA Data Diagnosis Diagnostic Disease Economics Enrollment Ensure Ethnic Origin Ethnic group Evidence based intervention Exploratory/Developmental Grant Feces Feedback Focus Groups Foundations Frequencies Future Guidelines Health Health Care Visit Health Personnel Healthcare Systems Home Incidence Individual Intervention Intervention Trial Interview Lesion Life Malignant Neoplasms Methods Minority Groups Morbidity - disease rate Native-Born Not Hispanic or Latino Patient Recruitments Patients Population Preparation Procedures Race Randomized Randomized Controlled Trials Reaction Reporting Research Risk Schedule Screening Result Structure Surveys Survival Rate Survivors Testing Text Messaging TimeLine Treatment outcome Underserved Population Woman Workload aged base cancer diagnosis cancer health disparity clinical practice colorectal cancer prevention colorectal cancer risk colorectal cancer screening colorectal cancer treatment comparison intervention cost design economic evaluation effective intervention effectiveness testing electronic data ethnic minority population experience follow-up health economics high risk high risk population home test implementation study improved informant male man men mortality patient response post intervention preference premalignant prevent primary outcome racial minority screening screening disparities screening guidelines secondary outcome text messaging intervention theories therapy design treatment arm treatment as usual uptake waiver

项目摘要

ABSTRACT Alaska Native men have higher colorectal cancer (CRC) incidence and mortality than any other US racial or ethnic group. Screening can prevent CRC and improve treatment outcomes by detecting disease in early stages, but Alaska Native men also have low CRC screening uptake. Colonoscopy is the most accurate CRC screening method and results in the most years of life saved. It only requires rescreening every 10 years, but it is a clinic- based procedure and needs extensive preparation. Other screening options include home-based tests that detect blood in the stool and require rescreening every year. More recently, a home-based method has been developed that tests stool for DNA indicative of CRC and requires rescreening every 3 years. Current guidelines recommend CRC screening for average risk adults starting between ages 45-50, but people at higher risk should start at younger ages. Many interventions have been developed to promote CRC screening. Among these, interventions that use text messaging or other electronic health messages to reach people outside of the clinical setting have shown promise for improving CRC screening. In a previous study, our research team developed an intervention that sends up to 3 text messages to Alaska Native people patients of the Southcentral Foundation (SCF) healthcare system in Anchorage, Alaska. We tested the intervention in a randomized controlled trial with 2,386 Alaska Native SCF patients ages 40-75. The intervention increased CRC screening by 50% in women, but it had no effect in men. In the current implementation study, we propose a theory-based approach to culturally tailor the existing text message intervention for Alaska Native men. We will use surveys and focus groups with SCF patients, and key informant interviews with SCF healthcare providers, to assess barriers and facilitators to optimize colorectal cancer screening in Alaska Native men. We anticipate that revisions will include changing the content and frequency of the text messages, and promoting home-based stool DNA screening in addition to colonoscopy. We will then test the effectiveness of the tailored intervention with 600 Alaska Native men ages 40-75 who are active patients at SCF. Eligible men will be identified from the electronic medical record and randomized in equal proportions to the intervention or usual care control conditions. The primary outcome is CRC screening completed within 6 months of sending the first text message. Secondary outcomes include clinical findings and follow-up procedures associated with screening. All data will be collected from the electronic medical record, and we will obtain a waiver of consent for direct patient recruitment. Follow-up interviews will assess patient response to the intervention. If effective, this study has implications for increasing CRC screening in men from other racial and ethnic minority groups who experience CRC disparities.

抽象的阿拉斯加原住民男性的结直肠癌 (CRC) 发病率和死亡率高于任何其他美国种族或人群民族。筛查可以通过早期发现疾病来预防结直肠癌并改善治疗结果，但阿拉斯加原住民男性的 CRC 筛查率也较低。结肠镜检查是最准确的结直肠癌筛查挽救生命最长年数的方法和结果。只需要每10年重新筛查一次，但它是一个诊所—— 基础程序，需要大量准备。其他筛查选项包括家庭测试检测粪便中的血液，需要每年重新筛查。最近，一种基于家庭的方法已经开发出测试粪便中是否存在 CRC 的 DNA 的方法，并且需要每 3 年重新筛查一次。当前指南建议从 45-50 岁开始对平均风险成年人进行 CRC 筛查，但风险较高的人应该从年轻时开始。已经制定了许多干预措施来促进结直肠癌筛查。其中，使用短信或其他电子健康信息接触临床以外人员的干预措施环境已显示出改善结直肠癌筛查的希望。在之前的研究中，我们的研究团队开发了一种向 Southcentral 基金会的阿拉斯加原住民患者发送最多 3 条短信的干预措施 (SCF) 阿拉斯加州安克雷奇的医疗保健系统。我们在一项随机对照试验中测试了干预措施 2,386 名年龄 40-75 岁的阿拉斯加原住民 SCF 患者。该干预措施将女性 CRC 筛查率提高了 50%，但它对男性没有影响。在当前的实施研究中，我们提出了一种基于理论的文化方法为阿拉斯加原住民量身定制现有的短信干预措施。我们将利用调查和焦点小组 SCF 患者以及与 SCF 医疗保健提供者的关键信息访谈，以评估 SCF 患者的障碍和促进因素优化阿拉斯加原住民男性的结直肠癌筛查。我们预计修订将包括更改短信的内容和频率，并推广家庭粪便 DNA 筛查结肠镜检查。然后，我们将测试 600 名阿拉斯加原住民男性的定制干预措施的有效性 40-75 名 SCF 活跃患者。符合资格的男性将从电子病历中识别出来，以相同比例随机分配到干预或常规护理控制条件。主要结果是 CRC 筛查在发送第一条短信后 6 个月内完成。次要结果包括与筛查相关的临床结果和后续程序。所有数据都将从电子数据收集医疗记录，我们将获得直接招募患者的同意豁免。后续采访将评估患者对干预的反应。如果有效，这项研究对增加结直肠癌筛查具有重要意义来自其他种族和少数族裔群体且经历 CRC 差异的男性。