Department of Family Medicine and Community & Preventive Medicine, University of Rochester, 1381 South Ave, Rochester, NY 14620, USA.
BMC Health Serv Res. 2010 Sep 23;10:280. doi: 10.1186/1472-6963-10-280.
Most randomized controlled trials of interventions designed to promote cancer screening, particularly those targeting poor and minority patients, enroll selected patients. Relatively little is known about the benefits of these interventions among unselected patients.
METHODS/DESIGN: "Get Screened" is an American Cancer Society-sponsored randomized controlled trial designed to promote mammography and colorectal cancer screening in a primary care practice serving low-income patients. Eligible patients who are past due for mammography or colorectal cancer screening are entered into a tracking registry and randomly assigned to early or delayed intervention. This 6-month intervention is multimodal, involving patient prompts, clinician prompts, and outreach. At the time of the patient visit, eligible patients receive a low-literacy patient education tool. At the same time, clinicians receive a prompt to remind them to order the test and, when appropriate, a tool designed to simplify colorectal cancer screening decision-making. Patient outreach consists of personalized letters, automated telephone reminders, assistance with scheduling, and linkage of uninsured patients to the local National Breast and Cervical Cancer Early Detection program. Interventions are repeated for patients who fail to respond to early interventions. We will compare rates of screening between randomized groups, as well as planned secondary analyses of minority patients and uninsured patients. Data from the pilot phase show that this multimodal intervention triples rates of cancer screening (adjusted odds ratio 3.63; 95% CI 2.35 - 5.61).
This study protocol is designed to assess a multimodal approach to promotion of breast and colorectal cancer screening among underserved patients. We hypothesize that a multimodal approach will significantly improve cancer screening rates.The trial was registered at Clinical Trials.gov NCT00818857.
大多数旨在促进癌症筛查的干预措施的随机对照试验，特别是针对贫困和少数族裔患者的试验，都是招募了经过选择的患者。相对而言，我们对于这些干预措施在未经选择的患者中的获益知之甚少。
方法/设计：“接受筛查”（Get Screened）是美国癌症协会（American Cancer Society）资助的一项随机对照试验，旨在促进一家为低收入患者服务的初级保健诊所中的乳房 X 光检查和结直肠癌筛查。符合条件的、已过了乳房 X 光检查或结直肠癌筛查时间的患者被纳入一个跟踪登记处，并随机分配到早期或延迟干预组。这项为期 6 个月的干预措施是多模式的，包括患者提示、临床医生提示和外展服务。在患者就诊时，符合条件的患者会收到一份低识字率的患者教育工具。同时，临床医生会收到一个提示，提醒他们开检查单，并且在适当的时候，还会收到一个简化结直肠癌筛查决策的工具。患者外展服务包括个性化信件、自动电话提醒、协助预约以及为未参保患者与当地的国家乳腺癌和宫颈癌早期检测计划建立联系。对于未能对早期干预做出回应的患者，会重复这些干预措施。我们将比较随机组之间的筛查率，以及对少数族裔患者和未参保患者的计划二次分析。试点阶段的数据显示，这种多模式干预措施使癌症筛查率增加了两倍（调整后的优势比 3.63；95%置信区间 2.35 - 5.61）。
本研究方案旨在评估一种针对服务不足患者的促进乳房和结直肠癌筛查的多模式方法。我们假设，多模式方法将显著提高癌症筛查率。该试验已在 ClinicalTrials.gov 注册，编号为 NCT00818857。
