Rural Community Support for Colonoscopy

农村社区对结肠镜检查的支持

• 批准号: 10368045
• 负责人: Allison Cole
• 金额: $ 60.03万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-08 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10368045
• 关键词: Address; Adult; Advisory Committees; Cancer Burden; Cancer Etiology; Caring; Cessation of life; Clinic; Clinical; Colonoscopy; Colorectal Cancer; Communities; Community Health; County; Data; Data Collection; Detection; Diagnosis; Early Diagnosis; Early Intervention; Education; Effectiveness; Enrollment; Evaluation; Excision; Face; Failure; Federally Qualified Health Center; Fright; Geography; Health system; Hybrids; Integrated Health Care Systems; Intervention; Interview; Knowledge; Low Income Population; Low income; Needs Assessment; Observational Study; Pamphlets; Participant; Pathway interactions; Patients; Population; Precancerous Polyp; Preventive service; Primary Health Care; Procedures; Process; Program Sustainability; Provider; Qualitative Methods; Randomized; Randomized Controlled Trials; Recommendation; Resources; Risk; Role; Rural; Rural Community; Rural Health; Rural Population; Schedule; Test Result; Testing; Time; Transportation; Travel; United States; Washington; Work; acceptability and feasibility; aged; base; cancer diagnosis; cancer therapy; cancer type; care coordination; colorectal cancer prevention; colorectal cancer screening; compare effectiveness; early onset colorectal cancer; effective intervention; effectiveness implementation design; effectiveness implementation study; effectiveness study; effectiveness testing; evidence base; follow-up; future implementation; high risk; implementation evaluation; implementation outcomes; improved; insight; mortality; motivational enhancement therapy; patient population; pilot test; procedure cost; program dissemination; programs; rural area; rural counties; rural disparities; rural patients; screening; socioeconomics

PROJECT SUMMARY/ABSTRACT Colorectal cancer (CRC) is the third leading cause of cancer death in the United States. Appropriate screening can reduce CRC mortality. Colonoscopy, a procedure to detect CRC early, is recommended for patients with a positive fecal immunochemical test (FIT) result to detect CRC and can even prevent CRC through the removal of pre-cancerous polyps. Rural and low-income populations face significant barriers to colonoscopy completion after positive FIT, including difficult access to the procedure (lack of local providers/long travel times), socioeconomic barriers to completing the procedure (difficulty getting time off work, arranging childcare and transportation, high out of pocket procedure costs), lack of knowledge about the procedure and its role in CRC screening and early detection, and fear of the procedure and of CRC. Patient navigation is an evidence-based approach to increasing colonoscopy completion. Patient navigation provides one-on-one support to patients preparing for and completing colonoscopy and addresses barriers through education, motivational interviewing, care coordination and connection to community resources. The effectiveness of patient navigation for increasing colonoscopy completion among low-income rural populations with positive FIT has not been demonstrated. The overall objective of this study is to test the effectiveness of a patient navigation program for increasing colonoscopy completion among rural, low-income populations who have had a positive FIT result. The project will be implemented in partnership with the Rural Health Council and the Washington Association for Community Health, and will engage four rural Federally Qualified Health Centers (FQHCs). The intervention will be evaluated in a type 1 hybrid implementation-effectiveness study that includes a 600-patient randomized controlled trial and comprehensive quantitative and qualitative data collection to better understand implementation and sustainability of the program. This project is critical in advancing our knowledge of the effectiveness of patient navigation for increasing colonoscopy in this patient population as well as for understanding factors that can support long term implementation and sustainability of effective interventions.

项目概要/摘要 结直肠癌（CRC）是美国癌症死亡的第三大原因。 适当的筛查可以降低结直肠癌死亡率。结肠镜检查，一种检测 CRC 的程序 建议粪便免疫化学测试 (FIT) 结果呈阳性的患者尽早 检测结直肠癌，甚至可以通过切除癌前息肉来预防结直肠癌。乡村的 和低收入人群在结肠镜检查呈阳性后完成结肠镜检查面临重大障碍 散客，包括难以办理手续（缺乏当地服务提供商/旅行时间长）， 完成该程序的社会经济障碍（难以下班、安排时间 儿童保育和交通、高昂的自付费用）、缺乏相关知识 程序及其在结直肠癌筛查和早期发现中的作用，以及对该程序的恐惧 CRC。患者导航是一种提高结肠镜检查完成率的循证方法。 患者导航为患者准备和完成治疗提供一对一的支持 结肠镜检查并通过教育、动机访谈、护理解决障碍 协调和连接社区资源。患者导航的有效性 提高 FIT 阳性的低收入农村人口的结肠镜检查完成率 尚未得到证明。本研究的总体目标是测试方法的有效性 患者导航计划，以提高农村低收入人群结肠镜检查的完成率 具有阳性 FIT 结果的人群。该项目将合作实施 与农村卫生委员会和华盛顿社区卫生协会合作，并将 与四个农村联邦合格健康中心 (FQHC) 合作。干预措施将是 在一项包含 600 名患者的 1 类混合实施有效性研究中进行了评估 随机对照试验和全面的定量和定性数据收集 更好地了解该计划的实施和可持续性。该项目至关重要 提高我们对患者导航对于增加结肠镜检查的有效性的了解 在这个患者群体中以及了解可以支持长期的因素 有效干预措施的实施和可持续性。