Meng Wen, Bi Xi-Wen, Bai Xiao-Yin, Pan Hua-Feng, Cai Shan-Rong, Zhao Qi, Zhang Su-Zhan
Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
World J Gastroenterol. 2009 Aug 21;15(31):3920-5. doi: 10.3748/wjg.15.3920.
To increase attendance for colonoscopy among nonadherent high-risk individuals for colorectal cancer (CRC) screening in China.
During the first 12 mo without intervention, only 428 of the 2398 high-risk subjects attended a scheduled colonoscopy examination. The 1970 subjects who did not attend for CRC screening were enrolled in the present study. Prior barrier investigation was performed to ascertain the reasons for nonadherence. A barrier-focused intervention program was then established and implemented among eligible nonadherent subjects by telephone interviews and on-site consultations. The completion rates of colonoscopy during the first 12 mo without intervention and the second 12 mo with intervention were compared. Variations in the effect of the intervention on some high-risk factors and barrier characteristics were analyzed using logistic regression.
540 subjects who were not eligible were excluded from the study. The colonoscopy attendance rate was 23.04% (428/1858) during the first 12 mo without intervention, and 37.69% (539/1430) during the second 12 mo with intervention (P < 0.001). Logistic regression analysis showed that the intervention was more effective among subjects with only objective barriers (OR: 34.590, 95% CI: 23.204-51.563) or subjects with some specific high-risk characteristics: first-degree relatives diagnosed with CRC (OR: 1.778, 95% CI: 1.010-3.131), personal history of intestinal polyps (OR: 3.815, 95% CI: 1.994-7.300) and positive result for immunochemical fecal occult blood testing (OR: 2.718, 95% CI: 1.479-4.996).
The barrier-focused telephone or on-site consultation intervention appears to be a feasible means to improve colonoscopy attendance among nonadherent high-risk subjects for CRC screening in China.
提高中国非依从性结直肠癌（CRC）筛查高危个体的结肠镜检查参与率。
在无干预的前12个月期间，2398名高危受试者中只有428人参加了预定的结肠镜检查。1970名未参加CRC筛查的受试者被纳入本研究。进行了前期障碍调查以确定不依从的原因。然后通过电话访谈和现场咨询，在符合条件的非依从性受试者中建立并实施了以障碍为重点的干预计划。比较了无干预的前12个月和有干预的第二个12个月期间结肠镜检查的完成率。使用逻辑回归分析了干预对一些高危因素和障碍特征的影响差异。
540名不符合条件的受试者被排除在研究之外。无干预的前12个月期间结肠镜检查参与率为23.04%（428/1858），有干预的第二个12个月期间为37.69%（539/1430）（P<0.001）。逻辑回归分析表明，干预在仅存在客观障碍的受试者（OR：34.590，95%CI：23.204 - 51.563）或具有某些特定高危特征的受试者中更有效：一级亲属被诊断为CRC（OR：1.778，95%CI：1.010 - 3.131）、有肠道息肉个人史（OR：3.815，95%CI：1.994 - 7.300）以及免疫化学粪便潜血检测结果为阳性（OR：2.718，95%CI：1.479 - 4.996）。
以障碍为重点的电话或现场咨询干预似乎是提高中国非依从性CRC筛查高危受试者结肠镜检查参与率的可行方法。
