Increasing Cervical Cancer Screening Uptake Among Emergency Department Patients

提高急诊科患者的宫颈癌筛查率

基本信息

批准号：
10369027
负责人：
DAVID H ADLER
金额：
$ 34.52万
依托单位：
UNIVERSITY OF ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-01 至 2024-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10369027
关键词：
21 year old Accident and Emergency department Acute Address Adherence Advisory Committees American Behavior Therapy Behavioral Behavioral Mechanisms Behavioral Sciences Cancer Prevention Intervention Car Phone Caring Cells Cellular Phone Cervical Cancer Screening Collaborations Community Clinical Oncology Program Control Groups Development Education Educational Background Emergency Care Emergency Department patient Emergency Medicine Environment Goals Grant Health Health behavior Healthy People 2020 Human immunodeficiency virus test Incidence Injury Intention Intervention Lesion Malignant neoplasm of cervix uteri Mediating Mediator of activation protein Mental Depression Methods Motivation Oncology Participant Patient Noncompliance Patients Persons Population Preventive Preventive service Primary Health Care Questionnaires Randomized Randomized Clinical Trials Randomized Controlled Trials Recommendation Reporting Research Research Personnel Risk Rural Self Administration Series Site Smoking Source Subgroup Tablet Computer Tablets Text Messaging The Sun Theory of Change Treatment Efficacy United States National Institutes of Health Woman Work base cervical cancer prevention cost design effectiveness evaluation effectiveness implementation trial effectiveness trial efficacy testing emergency settings ethnic minority evidence base follow-up group intervention health care availability implementation intervention improved intervention effect malignant breast neoplasm mobile computing novel strategies palliation pilot trial programs racial minority recruit screening screening guidelines service intervention smoking cessation theories uptake

项目摘要

PROJECT SUMMARY/ABSTRACT Cervical cancer (CC) is preventable. Still, only 80% of U.S. women report adherence to CC screening guidelines. Lower levels of screening are particularly pronounced among racial and ethnic minorities and patients with lower education levels. The group most likely to be non-adherent with CC screening guidelines is women who use the emergency department (ED) for their usual source of care. The ED setting, therefore, is optimal for the deployment of an intervention to promote CC screening. Short Message Service (SMS) on mobile phones (a.k.a. text messaging) is a low-cost, scalable, and effective means of delivering health behavior interventions. The vast majority of Americans – 95% – own a cell phone, and an estimated 98% of all cell phones have texting capabilities. The overarching goal of the proposed project is to develop a low-cost, scalable SMS intervention to increase CC screening that can be deployed in heterogenous ED settings. The proposed randomized controlled trial will test the efficacy of an SMS- based intervention to increase CC screening uptake among ED patients. Step 1 of the approach is to identify whether the participant is adherent with screening guidelines. Step 2 is to randomize non-adherent participants to one of the two treatment conditions: (1) referral only (control group) or, (2) referral and an SMS-intervention consisting of a series of text messages, grounded in behavioral change theory, aimed at generating intention and motivation to get screened. The investigators’ pilot work demonstrated the feasibility and preliminary efficacy of the proposed approach. To limit costs and increase the scalability of the intervention, determination of adherence with screening guidelines via a self-administered questionnaire on a tablet computer will be evaluated. A total of 1460 non-adherent women, age 21-65, will be recruited from a high-volume urban ED and a low-volume rural ED, randomized among study conditions, and followed-up at 150 days to assess interval CC screening uptake. The Specific Aims of the proposed project are, (1) Compare CC screening uptake between control and intervention groups at follow-up, (2) Compare the impact of in-person (using research staff) vs. self-administered (using a tablet) determination of CC screening adherence on the efficacy of the intervention, and (3) Identify mediators and explore moderators of intervention effects on CC screening at follow-up. The study team has a successful track record of collaboration and combines expertise in CC prevention, emergency medicine, behavioral science, and oncology. This project leverages the universal access setting of the ED to target women most at risk for non-adherence with CC screening guidelines. A low- cost, scalable intervention that is effective in increasing CC screening uptake among this population would decrease CC incidence and save lives. The next step would be a multi-site effectiveness/implementation trial using the NCI Community Oncology Research Program (NCORP) Network.

项目概要/摘要宫颈癌 (CC) 是可以预防的，但只有 80% 的美国女性表示坚持进行宫颈癌筛查。较低水平的筛查在少数种族和族裔中尤其明显。教育水平较低的患者最有可能不遵守 CC 筛查。指南适用于使用急诊科 (ED) 作为日常护理来源的女性。因此，这种环境最适合部署干预措施以促进 CC 筛查。移动电话上的服务 (SMS)（又称短信）是一种低成本、可扩展且有效的方式绝大多数美国人（95%）拥有手机和电脑。估计 98% 的手机具有短信功能该项目的总体目标是。开发一种低成本、可扩展的 SMS 干预措施，以增加可部署在的 CC 筛查拟议的随机对照试验将测试短信的有效性。提高 ED 患者接受 CC 筛查的干预措施的第一步是确定。是否遵守筛选指南第 2 步是对不遵守的参与者进行随机分组。两种治疗条件之一：(1) 仅转诊（对照组）或，(2) 转诊和 SMS 干预由一系列短信组成，基于行为改变理论，旨在产生意图调查人员的试点工作证明了可行性和初步性。限制成本并提高干预、决策的可扩展性。通过平板电脑上的自填问卷调查遵守筛查指南的情况将将从大量城市急诊室招募总共 1460 名年龄在 21 岁至 65 岁之间的非依从女性。低容量的农村急诊室，在研究条件下进行随机分配，并在 150 天后进行随访以评估间隔拟议项目的具体目标是，(1) 比较 CC 筛选率。在随访时控制组和干预组之间，（2）比较面对面的影响（使用研究工作人员）与自我管理（使用平板电脑）比较 CC 筛查依从性对有效性的影响干预，以及 (3) 确定中介因素并探索 CC 筛查干预效果的调节因素该研究团队拥有成功的合作记录，并结合了 CC 方面的专业知识。该项目利用了普遍的预防、急诊医学、行为科学和肿瘤学。急诊室的准入设置针对最有可能不遵守 CC 筛查指南的女性。成本高、可扩展的干预措施可有效提高该人群的 CC 筛查率减少 CC 发生率并挽救生命。下一步将是多地点有效性/实施试验。使用 NCI 社区肿瘤学研究计划 (NCORP) 网络。