Increasing Cervical Cancer Screening Uptake Among Emergency Department Patients

提高急诊科患者的宫颈癌筛查率

• 批准号: 10621704
• 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
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10621704
• 关键词: 21 year old; Accident and Emergency department; Acute; Address; Adherence; American; Behavior Therapy; Behavioral; Behavioral Mechanisms; Behavioral Sciences; Breast Cancer Detection; Cancer Prevention Intervention; Caring; Cellular Phone; Cervical Cancer Screening; Collaborations; Community Clinical Oncology Program; Control Groups; Depression screen; Development; Educational Status; 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; Methods; Motivation; Oncology; Participant; Patient Noncompliance; Patients; Persons; Population; Preventive; Primary Care; Questionnaires; Randomized; Randomized, Controlled Trials; Recommendation; Reporting; Research; Research Personnel; Risk; Rural; Self Administration; Series; Site; Source; Subgroup; Tablet Computer; Tablets; Text Messaging; Theory of Change; Treatment Efficacy; United States National Institutes of Health; United States Preventative Services Task Force; Woman; Work; cervical cancer prevention; cost; design; effectiveness evaluation; effectiveness trial; effectiveness/implementation trial; efficacy evaluation; efficacy testing; emergency settings; ethnic minority; evidence base; follow-up; group intervention; health care availability; implementation intervention; improved; intervention effect; mobile computing; novel strategies; palliation; pilot trial; programs; racial minority; randomized, clinical trials; recruit; screening; screening guidelines; service intervention; smoking cessation; sun safety; theories; uptake

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.

项目摘要/摘要 宫颈癌（CC）仍然可以预防。 较低的筛查水平在种族和少数民族中特别明显 教育水平较低的患者。 指南是使用急诊室（ED）作为美国急诊室来源的妇女 因此，设置是部署干预措施以促进CC筛查的最佳选择。 手机上的服务（SMS）（又称文本消息传递）是一种低成本，可扩展和优势的手段 熟练的健康行为干预措施。 估计所有手机中有98％具有发短信的功能。 开发低成本，可扩展的SMS干预以增加可以部署的CC筛查 异质ED设置。 基于CC筛查ED患者的干预措施是该方法的第1步。 参与者是否遵守筛查指南。 对两个治疗条件之一：（1）仅转介（对照组）或（2）转介和SMS Intertertiontiontiontiont 由文本消息的导演组成，基于行为变化理论，旨在产生直觉 并进行筛选的动机。 支撑方法的功效。 通过平板电脑上的自我管理调查表遵守筛选指南将是 评估。 一个小批量农村ED，在研究条件之间随机分组，并在150天后进行随后进行随后评估间隔 CC筛选吸收。 在随访中的控制和国际团体之间，（2）比较面对面的影响（使用研究 员工）与自助式（使用平板电脑）确定CC筛选遵守功效的确定 间隔和（3）识别调解人并探索在CC筛查上实习的主持人 后续研究团队拥有协作的成功记录，并结合了CC的专业知识 预防，急诊医学，行为科学和肿瘤学。 通过CC筛查指南，急诊室的访问设置最大的危险。 成本，可扩展的间隔，可有效增加CC筛查该人群中的吸收吸收 Decreese CC的刺激性并挽救生命。 使用NCI社区肿瘤研究计划（NCORP）网络。