Tu Shin-Ping, Taylor Vicky, Yasui Yutaka, Chun Alan, Yip Mei-Po, Acorda Elizabeth, Li Lin, Bastani Roshan
Department of Medicine, University of Washington, Seattle, Washington 98104, USA.
Cancer. 2006 Sep 1;107(5):959-66. doi: 10.1002/cncr.22091.
Colorectal cancer (CRC) is a leading cause of cancer mortality in the US. Surveys reveal low CRC screening levels among Asians in the US, including Chinese Americans.
A randomized controlled trial was conducted with Chinese patients to evaluate a clinic-based, culturally and linguistically appropriate intervention promoting fecal occult blood test (FOBT) screening. The multifaceted intervention included a trilingual and bicultural health educator, bilingual materials (a video, a motivational pamphlet, an informational pamphlet, and FOBT instructions), and three FOBT cards. Patients in the control arm received usual care. Our primary outcome measure was FOBT screening within 6 months after randomization. The proportion of FOBT completion in the intervention and control arms was compared by using a chi-square test, and logistic regression analysis was performed to adjust for the effects of sociodemographic variables and prior screening history. Potential effect modifications were also tested by using logistic regression models.
Our intervention had a strong effect on FOBT completion (intervention group, 69.5%; control group, 27.6%), and the adjusted odds of FOBT slightly increased to over 6-fold greater in the intervention arm compared with the control arm. No effect modification by age, gender, language, insurance, or prior FOBT was found.
The authors' multifaceted, culturally appropriate intervention significantly increased FOBT screening in a group of low-income and less-acculturated minority patients. Given the large effect size, future research should determine the effective core component(s) that can increase CRC screening in both the general and minority populations.
结直肠癌（CRC）是美国癌症死亡的主要原因。调查显示，在美国的亚洲人中，包括华裔美国人，结直肠癌筛查水平较低。
对中国患者进行了一项随机对照试验，以评估一种基于诊所、文化和语言适宜的干预措施，促进粪便潜血试验（FOBT）筛查。多方面的干预措施包括一名三语和双文化健康教育者、双语材料（一段视频、一本激励性小册子、一本信息性小册子和FOBT说明）以及三张FOBT卡片。对照组患者接受常规护理。我们的主要结局指标是随机分组后6个月内的FOBT筛查。通过卡方检验比较干预组和对照组中FOBT完成的比例，并进行逻辑回归分析以调整社会人口统计学变量和既往筛查史的影响。还使用逻辑回归模型测试了潜在的效应修饰因素。
我们的干预措施对FOBT完成率有显著影响（干预组为69.5%；对照组为27.6%），与对照组相比，干预组中FOBT的调整后优势比略有增加，超过6倍。未发现年龄、性别、语言、保险或既往FOBT的效应修饰作用。
作者的多方面、文化适宜的干预措施显著提高了一组低收入和文化适应程度较低的少数族裔患者的FOBT筛查率。鉴于效应量较大，未来的研究应确定能够提高普通人群和少数族裔人群结直肠癌筛查率的有效核心组成部分。
