Centro Prevenzione Oncologica Regione Piemonte and Azienda Ospedaliero-Universitaria S. Giovanni Battista di Torino, Turin, Italy.
Am J Gastroenterol. 2010 Jan;105(1):188-98. doi: 10.1038/ajg.2009.583. Epub 2009 Oct 13.
The objective of this study was to study predictors of patients' participation in colorectal cancer (CRC) screening.
Men and women, aged 55-64 years, were randomized to the following: (i) biennial fecal occult blood test (FOBT) delivered by mail (n=2,266); (ii) FOBT delivered by a general practitioner (GP)/screening facility (n=5,893); (iii) "once-only" sigmoidoscopy (FS) (n=3,650); (iv) FS followed by FOBT for screenees with negative FS (n=10,867); and (v) patient's choice between FS and FOBT (n=3,579). A stratified (by screening arm) random sample of attenders and nonattenders was contacted by trained interviewers 4 months after the initial invitation. Subjects giving their consent were administered a questionnaire (available online) investigating perceptions of individual CRC risk, attitudes toward prevention, adoption of health protective behaviors, and reasons for attendance/nonattendance. Adjusted prevalence odds ratios (ORs) were computed by multivariable logistic regression.
The response rate was 71.9% (701 of 975) among nonattenders and 88.9% (773 of 870) among attenders. Adjusting for screening arm, center, gender, age, and education, participation was significantly higher among people who consulted their GP before undergoing screening (OR: 4.24; 95% confidence interval (CI): 3.11-5.78), who mentioned one first-degree relative with CRC (OR: 3.62; 95% CI: 2.02-6.49), who reported regular physical activity (OR: 1.85; 95% CI: 1.33-2.55), and who read the mailed information (letter only: OR: 1.85; 95% CI: 1.23-2.78; letter+leaflet: OR: 3.18; 95% CI: 2.12-4.76). People who considered screening to be ineffective (OR: 0.12; 95% CI: 0.08-0.19), those who considered it to be effective but reported even moderate levels of anxiety (OR: 0.32; 95% CI: 0.23-0.45), and those who mentioned previous knowledge of CRC screening tests were less likely to accept the invitation (OR: 0.49; 95% CI: 0.34-0.70).
Adoption of health protective behaviors is associated with a higher attendance rate, whereas anxiety represents a strong barrier, even among people who deemed screening to be effective. Increasing the proportion of people who consult their GP when making a decision regarding screening might enhance participation.
本研究旨在探讨影响结直肠癌（CRC）筛查患者参与度的预测因素。
将年龄在 55-64 岁的男性和女性随机分为以下五组：（i）通过邮件提供的每两年一次粪便潜血试验（FOBT）（n=2266）；（ii）由全科医生/筛查机构提供的 FOBT（n=5893）；（iii）“一次性”乙状结肠镜检查（FS）（n=3650）；（iv）FS 后对 FS 结果为阴性的筛查对象进行 FOBT（n=10867）；（v）患者在 FS 和 FOBT 之间进行选择（n=3579）。在初次邀请后 4 个月，通过培训过的访谈者联系接受了分层（按筛查组）随机抽样的参与者和非参与者。同意参加的受试者接受了一份在线问卷（可在线获取）调查，该问卷调查了他们对个体 CRC 风险的认知、对预防的态度、采取健康保护行为的情况，以及参加/不参加的原因。通过多变量逻辑回归计算调整后的患病率比值比（OR）。
非参与者的应答率为 71.9%（701/975），参与者的应答率为 88.9%（773/870）。在调整了筛查组、中心、性别、年龄和教育程度后，与未接受筛查的人相比，以下人群的参与度显著更高：在接受筛查前咨询过全科医生的人（OR：4.24；95%置信区间（CI）：3.11-5.78）；提到有一位一级亲属患有 CRC 的人（OR：3.62；95% CI：2.02-6.49）；报告有规律的体育锻炼的人（OR：1.85；95% CI：1.33-2.55）；以及阅读了邮寄信息的人（仅信函：OR：1.85；95% CI：1.23-2.78；信函+传单：OR：3.18；95% CI：2.12-4.76）。认为筛查无效的人（OR：0.12；95% CI：0.08-0.19）；认为筛查有效的人但报告有中度焦虑的人（OR：0.32；95% CI：0.23-0.45）；以及提到以前了解过 CRC 筛查试验的人不太可能接受邀请（OR：0.49；95% CI：0.34-0.70）。
采取健康保护行为与更高的参与率相关，而焦虑则是一个强大的障碍，即使是在那些认为筛查有效的人群中也是如此。在决定接受筛查时增加咨询全科医生的人数，可能会提高参与度。
