Optimal early colorectal cancer screening initiation

最佳的早期结直肠癌筛查启动

基本信息

批准号：
10526181
负责人：
Joshua Brian Demb
金额：
$ 11.69万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10526181
关键词：
Address Adult Advisory Committees Affect Age Age of Onset Alaska Native American American Indians Asian Americans Award Biometry Black Populations Black race California Cancer Burden Cancer Etiology Caring Cessation of life Colorectal Cancer Communities Complement County Data Decision Making Diagnosis Education Effectiveness Electronic Health Record Ensure Epidemiology Ethnic group Excision Future Gastroenterology Goals Health Disparities Research Health Services Research Health behavior Health system Hispanic Incidence Influentials Insurance Interview Knowledge Latino Population Malignant Neoplasms Medicaid Medical Mentorship Methodology Not Hispanic or Latino Outcome Participant Pathway interactions Patient risk Patients Phase Polyps Population Preventive service Provider Qualitative Research Quality of Care Randomized Randomized Controlled Trials Recommendation Research Research Methodology Research Personnel Research Support Research Training Risk Running Sample Size Screening for cancer Signal Transduction Surveys Testing Training Uninsured United States Universities Update age group cancer epidemiology cancer health disparity cancer type career career development colorectal cancer risk colorectal cancer screening comparative effectiveness trial early onset colorectal cancer early screening experience health disparity health equity low socioeconomic status mortality outreach pilot trial prevent racial and ethnic randomized trial recruit risk perception screening screening disparities screening policy screening program skills sociodemographic disparity sociodemographics treatment as usual trial comparing uptake

项目摘要

PROJECT SUMMARY Colorectal cancer (CRC) accounts for 8% of cancer incidence and 9% of cancer-related mortality in the United States (US). About 11% of CRC cases are diagnosed before age 50—known as early age onset CRC (EOCRC)—with incidence and mortality rates increasing 1.6% and 1% per year between 2005-2014, and an unequal burden among Asian, American Indian/Alaska Native, Black and Hispanic racial/ethnic groups and those with Medicaid or uninsured. The increasing EOCRC burden informed a US Preventive Services Task Force (USPSTF) recommendation to initiate CRC screening among average risk adults starting at age 45, rather than 50. This recommendation would expand CRC screening to 21 million Americans, with 4 million more turning 45 each year. There is a lack of evidence to inform how to optimize impact of CRC screening among adults ages 45-49. Specifically, there are three critical knowledge gaps: 1) we lack information regarding acceptability of CRC screening among those ages 45-49 and have not investigated factors that might influence CRC screening uptake among this newly eligible population, 2) there are concerns that CRC screening disparities that exist among adults ages ≥50 are likely to emerge in this younger age group without a targeted screening strategy and 3) it is unclear whether this age group will respond to current CRC screening practice or more active outreach. The central objective of this proposal is to develop a targeted CRC screening strategy among adults ages 45-49 to maximize screening uptake and prevent cancer disparities. Our study will recruit adults ages 45-49 receiving care within a large health system to answer these questions. First, we will characterize the acceptability of CRC screening by running a pilot trial to establish feasibility of a larger trial (Aim 1a) and conduct surveys and interviews regarding factors influencing CRC screening uptake (Aim 1b) to highlight effective strategies for implementing screening among adults ages 45-49. Next, we will use these pilot data to inform a randomized controlled trial of the comparative effectiveness of an active outreach strategy including mailed fecal immunochemical test versus usual care for optimizing uptake and preventing emergence of CRC screening disparities (Aim 2). This research plan is complemented by a training plan to enhance the applicant’s background in epidemiology and biostatistics, with new training in 1) randomized controlled trials methodology, 2) health behavior and medical decision making research, 3) health equity and disparities research and 4) survey and qualitative research methods. Our study will be the most comprehensive examination of early CRC screening initiation in the US to date and will provide context to the updated CRC screening policy and a potential framework for wider implementation of earlier CRC screening in adults ages 45-49. It also offers a high-quality career development opportunity to develop key skills to become a qualified independent investigator.

项目摘要结直肠癌（CRC）占癌症发病率的8％，在癌症相关的死亡率中占9％美国（美国）。大约11％的CRC病例在50岁之前被诊断出来，称为年龄发作CRC （EOCRC） - 在2005 - 2014年间，事件和死亡率每年增加1.6％和1％，而亚洲人，美洲印第安/阿拉斯加本地人，黑人和西班牙裔种族/族裔中的不平等燃烧以及那些有医疗补助或没有保险的人。越来越多的EOCRC烧毁了美国的预防服务任务武力（USPSTF）建议在45岁开始开始平均风险成年人的CRC筛查，而不是50。该建议将CRC筛查扩大到2100万美国人，有400万每年更多45岁。缺乏证据来告知如何优化CRC筛查的影响在45-49岁的成年人中。特别是有三个关键知识差距：1）我们缺乏信息关于45-49岁的CRC筛查的可接受性，并且没有调查可能会影响CRC筛查在这个新符合条件的人群中的吸收，2）有人担心CRC 在没有A 有针对性的筛选策略和3）尚不清楚该年龄段是否会对当前的CRC筛查做出反应练习或更积极的宣传。该提案的核心目的是开发有针对性的CRC筛查 45-49岁的成年人的策略，以最大程度地提高筛查吸收并预防癌症差异。我们的研究愿意招募45-49岁的成年人在大型卫生系统中接受护理以回答这些问题。首先，我们会的通过进行试验试验来确定较大试验的可行性来表征CRC筛选的可接受性（AIM 1A）并进行有关因素的调查和访谈影响CRC筛查的吸收（AIM 1B）强调了45-49岁成人实施筛查的有效策略。接下来，我们将使用这些飞行员数据以告知一项随机对照试验，以了解主动外展策略的比较有效性包括邮寄的粪便免疫化学测试与通常的护理，以优化吸收和防止出现 CRC筛选差异（目标2）。该研究计划由培训计划完成，以增强申请人在流行病学和生物统计学方面的背景，并在1）随机对照试验中进行了新的培训方法论，2）健康行为和医疗决策研究，3）健康公平和分配研究和4）调查和定性研究方法。我们的研究将是最全面的迄今为止，美国CRC筛查计划的早期筛查计划的检查将为更新的CRC提供背景筛选政策和在成年人年龄更广泛实施早期CRC筛查的潜在框架 45-49。它还提供了高质量的职业发展机会，以发展关键技能以成为合格的技能独立研究者。