Promoting Colon Cancer Screening in At Risk Families

促进高危家庭的结肠癌筛查

基本信息

批准号：
6321736
负责人：
PAUL C SCHROY
金额：
$ 15.18万
依托单位：
BOSTON MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2001
资助国家：
美国
起止时间：
2001-09-30 至 2004-08-31
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): Colorectal cancer is the second leading cause of cancer-related death in U.S. Screening rates among individuals at increased risk of the disease because of a family history colorectal cancer or adenomas are suboptimal. Preliminary studies highlight the need for novel strategies to increase both provider and patient awareness of familial risk factors, promote compliance with appropriate screening recommendations, and facilitate risk communication between providers, affected patients and at-risk family members. Accordingly, the specific aims described herein address each of these needs by proposing novel interventions targeted at providers, adenoma patients and at-risk relatives. Specific Aim #1 is to design, implement and evaluate an educational program for primary care housestaff and assess its impact on their knowledge, risk assessment and screening behavior. The educational program will incorporate both didactic and interactive teaching sessions as well as distribution of a colorectal cancer risk assessment "tool kit." The actual content of the sessions and "tool kit" will be defined during Year 1 using existing literature, focus groups and an expert panel. A randomized controlled trial will be conducted in Year 2 to evaluate the program's effectiveness. A pretest/post-test format will be used to assess knowledge, patient exit interviews will be used to assess risk assessment skills, and chart audit with feedback will be used to assess documentation and screening behavior. Specific Aim #2 is to evaluate the efficacy of an educational program aimed at promoting increased awareness about familial risk and notification of first-degree relatives among adenoma patients. The program employs a standardized computer-based educational intervention that is conducted at the "bedside" immediately post-polypectomy, followed by a tailored notification of risk and recommendations in the form of a personalized letter. A three-arm randomized trial comparing the dual intervention to the bedside computer-based intervention alone versus standard care will be conducted to assess the program's effectiveness. Telephone surveys will be used to assess patient knowledge and extent of communication to at-risk siblings. Specific Aim #3 is to explore patient preferences and the role of shared decision-making as a strategy for promoting compliance with colorectal cancer screening recommendations among individuals with a family history of colorectal adenomas or cancer. Structured interviews will be conducted to assess patient preferences for the five recommended screening strategies colorectal cancer screening strategies, identify factors influencing their choices, and determine the extent to which such patients wish to participate in tho decision-making process using a validated "decision aid" and "Colorectal Cancer Autonomy Index/Autonomy Preference Index."

描述（由申请人提供）：结直肠癌是第二大癌症美国癌症相关死亡原因个人筛查率由于结直肠癌家族史或腺瘤是次优的。初步研究强调需要新颖的提高提供者和患者对家庭风险认识的策略因素，促进遵守适当的筛查建议，以及促进提供者、受影响患者和高危人群之间的风险沟通家庭成员。因此，本文描述的具体目标涉及每个通过提出针对提供者、腺瘤的新干预措施来满足这些需求患者和高危亲属。具体目标#1是设计、实施和评估教育计划针对初级保健家庭工作人员，评估其对他们的知识、风险的影响评估和筛选行为。教育计划将纳入教学和互动教学课程以及分发结直肠癌风险评估“工具包”。实际内容会议和“工具包”将在第一年使用现有的定义文献、焦点小组和专家小组。随机对照试验将在第二年进行，以评估该计划的有效性。一个预测试/后测试格式将用于评估知识、患者退出面谈将用于评估风险评估技能，并与反馈将用于评估文件记录和筛选行为。具体目标#2 是评估旨在实现以下目标的教育计划的有效性：促进提高对家庭风险和通知的认识腺瘤患者的一级亲属。该计划采用了基于计算机的标准化教育干预息肉切除术后立即“床边”，然后是定制的通知以个性化信件的形式提供风险和建议。一个三臂比较双重干预与基于床边计算机的随机试验将进行单独干预与标准护理的比较，以评估计划的有效性。电话调查将用于评估患者与高危兄弟姐妹的知识和沟通程度。具体目标#3是探索患者的偏好和共享的作用决策作为促进结直肠癌依从性的策略对有家族史的个人进行筛查建议结直肠腺瘤或癌症。将进行结构化面试评估患者对五种推荐筛查策略的偏好结直肠癌筛查策略，确定影响其结果的因素选择，并确定此类患者希望参与的程度在决策过程中使用经过验证的“决策辅助工具”以及 “结直肠癌自主指数/自主偏好指数。”