Lengerich Eugene J, Kluhsman Brenda C, Bencivenga Marcyann, Allen Regina, Miele Mary Beth, Farace Elana
The Pennsylvania State University - Public Health Sciences, P. O. Box 855, Mail Stop A210, 600 Centerview Drive, Hershey, PA 17033, USA.
J Cancer Surviv. 2007 Sep;1(3):205-11. doi: 10.1007/s11764-007-0025-y.
In 2002, 10.4% of the 10 million persons alive who have ever been diagnosed with cancer had colorectal cancer (CRC). Barriers, such as distance, terrain, access to care and cultural differences, to CRC survivorship may be especially relevant in rural communities. We tested the hypothesis that teams from rural cancer coalitions and hospitals would develop a Community Plan (CP) to enhance CRC survivorship. We used community-based participatory research and the PRECEDE-PROCEED model to train teams from rural cancer coalitions and hospitals in Pennsylvania and New York. We measured knowledge at three points in time and tested the change with McNemar's test, corrected for multiple comparisons (p < 0.0167). We also conducted a qualitative review of the CP contents. Fourteen (93.3%) of the 15 coalitions or hospitals initially recruited to the study completed a CP. Knowledge in public health, sponsorship of A National Action Plan for Cancer Survivorship, and CRC survivorship and treatment increased. Teams identified perceived barriers and community assets. All teams planned to increase awareness of community assets and almost all planned to enhance treatment-related care and psychosocial care for the CRC survivor; 50% planned to enhance primary care and CRC screening. The study demonstrated the interest and ability of rural organizations to plan to enhance CRC survivorship, including linkage of CRC survivorship to primary care. Rural cancer coalitions and hospitals may be a vehicle to develop local action for A National Action Plan. Access to more comprehensive care for CRC cancer survivors in rural communities appears to be facilitated by the community-based initiative described and investigated in this study. Efforts such as these could be replicated in other rural communities and may impact the care and quality of life of survivors with many types of cancers. While access to health services may be increased through community-based initiatives, we still need to measure the impact of such initiatives on the long term health and well being of cancer survivors in rural locations.
2002年，在1000万曾被诊断患有癌症的在世人群中，10.4%患的是结直肠癌（CRC）。诸如距离、地形、就医便利性以及文化差异等结直肠癌生存方面的障碍，在农村社区可能尤为突出。我们检验了这样一个假设：农村癌症联盟和医院的团队会制定一项社区计划（CP）以提高结直肠癌生存率。我们采用基于社区的参与性研究以及“教育-组织-实施-评价”（PRECEDE-PROCEED）模式，对宾夕法尼亚州和纽约州农村癌症联盟和医院的团队进行培训。我们在三个时间点测量知识水平，并使用校正了多重比较的McNemar检验来检验变化情况（p < 0.0167）。我们还对社区计划的内容进行了定性审查。最初招募到该研究中的15个联盟或医院中有14个（93.3%）完成了一项社区计划。关于公共卫生、《癌症生存国家行动计划》的赞助以及结直肠癌生存和治疗方面的知识有所增加。各团队识别出了感知到的障碍和社区资产。所有团队都计划提高对社区资产的认识，几乎所有团队都计划加强对结直肠癌幸存者的治疗相关护理和心理社会护理；50%的团队计划加强初级保健和结直肠癌筛查。该研究表明农村组织有兴趣且有能力制定计划以提高结直肠癌生存率，包括将结直肠癌生存与初级保健联系起来。农村癌症联盟和医院可能是推动《癌症生存国家行动计划》地方行动的一种途径。本研究中所描述和调查的基于社区的倡议似乎有助于农村社区的结直肠癌幸存者获得更全面的护理。此类努力可以在其他农村社区复制，并且可能会影响多种癌症幸存者的护理和生活质量。虽然通过基于社区的倡议可能会增加获得卫生服务的机会，但我们仍需衡量此类倡议对农村地区癌症幸存者长期健康和福祉的影响。
