Myers Ronald E, Sifri Randa, Hyslop Terry, Rosenthal Michael, Vernon Sally W, Cocroft James, Wolf Thomas, Andrel Jocelyn, Wender Richard
Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Cancer. 2007 Nov 1;110(9):2083-91. doi: 10.1002/cncr.23022.
Colorectal cancer screening is underutilized. The objective of the current study was to determine whether targeted and tailored interventions can increase screening use.
A total of 1546 primary care practice patients completed a baseline telephone survey and were randomized to 4 study groups: control (387 patients), Standard Intervention (SI) (387 patients), Tailored Intervention (TI) (386 patients), or Tailored Intervention plus Phone (TIP) (386 patients). The control group received usual care throughout the study. The SI group received a targeted intervention by mail (ie, screening invitation letter, informational booklet, stool blood test, and reminder letter). The TI group received the targeted intervention with tailored "message pages." The TIP group received the targeted intervention, tailored message pages, and a telephone reminder. Intervention group contacts were repeated 1 year later. Screening was assessed 24 months after randomization.
Screening rates in study groups were 33% in the control group, 46% in the SI group, 44% in the TI group, and 48% in the TIP group. Screening was found to be significantly higher in all 3 intervention groups compared with the control group (odds ratio [OR] of 1.7 [95% confidence interval (95% CI), 1.3-2.5], OR of 1.6 [95% CI, 1.2-2.1], and OR of 1.9 [95% CI, 1.4-2.6], respectively), but did not vary significantly across intervention groups. Multivariate analyses demonstrated that older age, education, past cancer screening, screening preference, response efficacy, social support and influence, and exposure to study interventions were positive predictors of screening. Having worries and concerns about screening was found to be a significant negative predictor.
Targeted and tailored interventions were found to increase colorectal cancer screening use. However, additional research is needed to determine how to increase the effect of such interventions in primary care.
结直肠癌筛查的利用率较低。本研究的目的是确定有针对性的定制干预措施是否能提高筛查的使用率。
共有1546名初级保健机构的患者完成了基线电话调查，并被随机分为4个研究组：对照组（387例患者）、标准干预组（SI）（387例患者）、定制干预组（TI）（386例患者）或定制干预加电话组（TIP）（386例患者）。对照组在整个研究过程中接受常规护理。SI组通过邮件接受有针对性的干预（即筛查邀请信、信息手册、粪便潜血试验和提醒信）。TI组接受带有定制“信息页”的有针对性干预。TIP组接受有针对性的干预、定制信息页和电话提醒。1年后重复干预组的接触。在随机分组24个月后评估筛查情况。
研究组的筛查率分别为：对照组33%，SI组46%，TI组44%，TIP组48%。与对照组相比，所有3个干预组的筛查率均显著更高（比值比[OR]分别为1.7[95%置信区间（95%CI），1.3 - 2.5]、1.6[95%CI，1.2 - 2.1]和1.9[95%CI，1.4 - 2.6]），但各干预组之间无显著差异。多因素分析表明，年龄较大、受教育程度、既往癌症筛查、筛查偏好、反应效能、社会支持与影响以及接触研究干预措施是筛查的积极预测因素。发现对筛查有担忧是一个显著的消极预测因素。
有针对性的定制干预措施可提高结直肠癌筛查的使用率。然而，需要进一步研究以确定如何增强此类干预措施在初级保健中的效果。
