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.