Enhancing Prevention Pathways Towards Tribal Colorectal Health

加强部落结直肠健康的预防途径

• 批准号: 9066409
• 负责人: Kevin Charles English
• 金额: $ 58.5万
• 依托单位: UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9066409
• 关键词: Address; Age; Alaska Native; American Indians; Area; Cancer Control; Cancer Intervention; Clinic Visits; Collaborations; Colonoscopy; Colorectal; Colorectal Cancer; Communities; Consensus; Cost Analysis; Coupled; Diagnosis; Diagnostic; Early Diagnosis; Educational Materials; Evaluation; Evidence based intervention; Excision; Fecal occult blood; Goals; Guidelines; Health; Health Personnel; Health Priorities; Health care facility; Healthy People 2020; Incidence; Indian reservation; Intervention; Lead; Learning; Methods; Modeling; New Mexico; Not Hispanic or Latino; Outcome; Participant; Pathway interactions; Physician Executives; Polyps; Population; Prevention; Prevention Research; Process; Program Sustainability; Pueblo Race; Qualitative Methods; Randomized Controlled Trials; Recommendation; Recording of previous events; Research; Research Methodology; Reservations; Resources; Risk; Rural; Screening for cancer; Services; Stage at Diagnosis; Staging; Survival Rate; Test Result; Testing; Time; Treatment Efficacy; Tribes; Trust; United States Indian Health Service; Universities; aged; arm; base; behavior change; burden of illness; cancer diagnosis; cancer health disparity; cancer prevention; colorectal cancer screening; cost; cost effective; design; disparities in morbidity; effectiveness trial; efficacy testing; evidence base; experience; follow-up; health equity; improved; meetings; mortality; outreach; promoter; public health relevance; racial and ethnic; response; scale up; screening; theories; therapy design; treatment as usual; trial design; tribal health; uptake

 DESCRIPTION (provided by applicant): American Indians/Alaska Natives (AI/ANs) experience significant health inequities and disparities in colorectal cancer (CRC) related incidence, mortality, stage at diagnosis, and survival. Recent reductions in CRC incidence and mortality rates and improvements in stage at diagnosis and survival rates in the general U.S. population have been attributed to routine screening with prompt removal of polyps, early detection, and timely and appropriate treatment. AI/ANs are significantly less likely than non-Hispanic Whites to receive timely and risk- and age-appropriate cancer screenings, including recommended CRC screening. The short-term goal is to test the efficacy of serially implemented interventions designed to enhance annual CRC screening using the fecal immunochemical test (FIT). Serial implementation refers to offering routine screening, irrespective of response to an earlier invitation, in concordance with national guidelines which recommend annual FIT testing between ages 50-75. The FIT is most appropriate because, based on consensus guidelines, it is an approved, high sensitivity fecal occult blood test that is offered annually and is available in Indian Health Service and tribal health facilities where resources to provide screening colonoscopy are limited. We will follow all positive FIT results with timely and appropriate diagnostic and treatment services. We address screening disparities through the testing of interventions designed to enhance annual CRC screening using the FIT among average- risk, on-reservation AIs aged 50-75 in the rural Southwest. The interventions are theory-informed, evidence- based, and graded in their intensity. The high intensity intervention will include navigated outreach, a mailed FIT kit, educational material, and follow-up reminders (Study Group 1). The medium intensity intervention will include a mailed FIT kit, educational material, and follow-up reminders (Study Group 2). The reference group (Study Group 3) will receive usual care (screening recommendation and a FIT kit at a clinic visit). We will use rigorous research methods to: (a) determine the efficacy of interventions to enhance annual CRC screening through completion of the FIT kit; (b) understand contextually relevant factors important for behavior change; (c) identify the most cost-effective strategies to enhance routine CRC screening; and (d) develop plans to inform sustainability and scalability. This is a collaborative effort between the University of New Mexico, the Albuquerque Area Indian Health Board (100% Indian-owned and operated), and six Pueblo Tribes in the rural Southwest. The research team has an extensive and successful history of conducting community based participatory cancer prevention research in collaboration with AI communities. Moreover, the research team recognizes the value of integrating a co-learning process and engaging in trust-based mutually beneficial research. Findings from this research could lead to an immediate increase in CRC screening and ultimately reduce the CRC disease burden among AIs experiencing cancer disparities and health inequities.

 描述（由申请人提供）：美洲印第安人/阿拉斯加原住民 (AI/AN) 在结直肠癌 (CRC) 相关发病率、死亡率、诊断分期和生存率方面存在显着的健康不平等和差异。美国普通人群的诊断阶段和生存率的改善归因于常规筛查、及时切除息肉、早期发现以及及时和适当的治疗，而 AI/AN 的可能性明显较低。非西班牙裔白人及时接受适合风险和年龄的癌症筛查，包括推荐的 CRC 筛查 短期目标是测试旨在使用粪便免疫化学测试 (FIT) 加强年度 CRC 筛查的系列干预措施的有效性。系列是指根据建议对 50 岁至 75 岁之间进行年度 FIT 测试的国家指南提供常规筛查，无论是否对先前的邀请作出回应。根据指南，这是一种经批准的高灵敏度粪便潜血测试，每年提供一次，可在提供筛查共识结肠镜检查的资源有限的印第安卫生服务和部落卫生机构中使用。我们将跟踪所有阳性 FIT 结果，并及时进行适当的诊断。我们通过测试干预措施来解决筛查差异，这些干预措施旨在利用 FIT 在西南部农村地区 50-75 岁的平均风险、保留的 AI 中加强年度 CRC 筛查。以证据为基础，并按强度分级。高强度干预将包括引导外展、邮寄的 FIT 工具包、教育材料和后续行动。 中等强度干预将包括邮寄的 FIT 套件、教育材料和后续提醒（研究组 2）。参照组（研究组 3）将接受常规护理（筛查建议和 FIT）。我们将使用严格的研究方法来：(a) 通过完成 FIT 套件来确定干预措施的有效性，以加强年度 CRC 筛查；(b) 根据具体情况了解对行为改变重要的相关因素； (c) 确定最具成本效益的策略，以加强常规 CRC 筛查；以及 (d) 制定计划，以提高可持续性和可扩展性 这是新墨西哥大学、阿尔伯克基地区印第安人卫生委员会（100% 印度人）之间的合作成果。 -拥有和经营），以及西南部农村的六个普韦布洛部落，该研究团队在与人工智能社区合作开展基于社区的参与性癌症预防研究方面有着广泛而成功的历史。 -学习这项研究的结果可能会导致结直肠癌筛查的立即增加，并最终减少经历癌症差异和健康不平等的人工智能的结直肠癌疾病负担。