Enhancing Prevention Pathways Towards Tribal Colorectal Health

加强部落结直肠健康的预防途径

• 批准号: 9247763
• 负责人: Kevin Charles English
• 金额: $ 55.83万
• 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 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9247763
• 关键词: Address; Age; Alaska Native; American Indians; Area; Cancer Control; 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; Methodology; Methods; Modeling; Morbidity - disease rate; 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; Recruitment Activity; Research; Research Methodology; Reservations; Resources; Risk; Rural; Screening for cancer; Services; Stage at Diagnosis; 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; effectiveness trial; efficacy testing; evidence base; experience; follow-up; health equity; improved; meetings; mortality; outreach; promoter; public health relevance; racial and ethnic; response; rural Americans; 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（由适用提供）：美洲印第安人/阿拉斯加原住民（AI/ANS）在结直肠癌（CRC）相关事件，死亡率，诊断阶段和生存中的健康不平等和差异很大。 CRC事件和死亡率的最新降低以及美国普通人群的诊断和存活率的改善已归因于常规筛查，并迅速清除息肉，早期检测以及及时且适当的治疗方法。 AI/ANS比非西班牙裔白人接受及时，风险和年龄适合癌症筛查的可能性要小得多，包括建议的CRC筛查。短期目标是测试旨在使用粪便免疫化学测试（FIT）增强年度CRC筛查的连续实施干预措施的效率。连续实施是指提供常规筛查，无论对较早的邀请的反应如何，与国家指南一致，这些准则建议在50-75岁之间进行年度拟合测试。拟合是最合适的，因为根据共识指南，它是经过批准的高灵敏度粪便血液测试，可在印度卫生服务和部落卫生设施中提供，提供筛查结肠镜检查的资源是有限的。我们将遵循及时且适当的诊断和治疗服务的所有积极拟合结果。我们通过测试旨在增强年度CRC筛查的干预措施来解决筛查分布，该干预措施使用平均风险，保留在Rough Southwest的50-75岁的平均风险中的拟合度。这些干预措施是理论上的，基于证据的，并以其强度分级。高强度干预措施将包括导航外展，邮寄贴合套件，教育材料和后续材料 提醒（研究第1组）。中等强度干预将包括邮寄贴合套件，教育材料和后续提醒（研究组2）。参考小组（研究组3）将接受常规护理（筛查建议和诊所访问中的合适套件）。我们将使用严格的研究方法来：（a）确定干预措施的效率，以通过完成拟合套件来增强年度CRC筛查； （b）了解对行为改变重要的上下文相关因素； （c）确定增强常规CRC筛查的最具成本效益的策略； （d）制定计划，以告知可持续性和可扩展性。这是新墨西哥大学，阿尔伯克基地区印度卫生委员会（100％印度拥有和经营）的合作努力，以及在西南部的六个Pueblo部落。研究小组与AI社区合作进行基于社区的参与癌症预防研究的历史广泛而成功。此外，研究团队认识到整合共学习过程并参与基于信任的互惠互利研究的价值。这项研究的结果可能导致CRC筛查立即增加，并最终减少CRC疾病的燃烧，而这种AIS经历了癌症分布和健康不平等的AIS。