College of Public Health, The Ohio State University, Suite 525, 1590 North High Street, Columbus, Ohio 43201, USA.
Cancer Epidemiol Biomarkers Prev. 2012 Jan;21(1):45-52. doi: 10.1158/1055-9965.EPI-11-0815. Epub 2011 Nov 8.
Colorectal cancer (CRC) screening rates remain low among low-income and minority populations. The purpose of this study was to determine whether providing patients with screening information, activating them to ask for a screening test, and telephone barriers counseling improves CRC screening rates compared with providing screening information only.
Patients were randomized to CRC screening information plus patient activation and barriers counseling (n = 138) or CRC screening information (n = 132). Barriers counseling was attempted among activated patients if screening was not completed after one month. CRC screening test completion was determined by medical record review at two months after the medical visit. Logistic regression was used to determine whether activated patients were more likely to complete CRC screening, after adjustment for confounding factors (e.g., demographic characteristics and CRC knowledge).
Patients were African American (72.2%), female (63.7%), had annual household incomes less than $20,000 (60.7%), no health insurance (57.0%), and limited health literacy skills (53.7%). In adjusted analyses, more patients randomized to the activation group completed a screening test (19.6% vs. 9.9%; OR = 2.35, 95% CI: 1.14-5.56; P = 0.020). In addition, more activated patients reported discussing screening with their provider (54.4% vs. 27.5%, OR = 3.29, 95% CI: 1.95-5.56; P < 0.001) and had more screening tests ordered (39.1% vs. 17.6%; OR = 3.40, 95% CI: 1.88-6.15; P < 0.001) compared with those in the control group.
Patient activation increased CRC screening rates among low-income minority patients.
Innovative strategies are still needed to increase CRC screening discussions, motivate providers to recommend screening to patients, as well as assist patients to complete ordered screening tests.
在低收入和少数族裔人群中，结直肠癌（CRC）筛查率仍然较低。本研究的目的是确定提供筛查信息、促使患者主动要求进行筛查检测，以及进行电话障碍咨询是否比仅提供筛查信息更能提高 CRC 筛查率。
将患者随机分为 CRC 筛查信息加患者激活和障碍咨询组（n = 138）或 CRC 筛查信息组（n = 132）。如果一个月后未完成筛查，则对激活患者进行障碍咨询。在就诊后两个月通过病历回顾确定 CRC 筛查检测完成情况。采用逻辑回归，在校正混杂因素（如人口统计学特征和 CRC 知识）后，确定激活患者是否更有可能完成 CRC 筛查。
患者为非裔美国人（72.2%）、女性（63.7%）、年收入低于 20,000 美元（60.7%）、没有医疗保险（57.0%）和有限的健康素养技能（53.7%）。在调整后的分析中，更多随机分配到激活组的患者完成了筛查检测（19.6%比 9.9%；OR = 2.35，95%CI：1.14-5.56；P = 0.020）。此外，更多的激活患者报告与他们的提供者讨论了筛查（54.4%比 27.5%，OR = 3.29，95%CI：1.95-5.56；P < 0.001），并要求进行更多的筛查检测（39.1%比 17.6%；OR = 3.40，95%CI：1.88-6.15；P < 0.001）与对照组相比。
患者激活增加了低收入少数族裔患者的 CRC 筛查率。
仍然需要创新策略来增加 CRC 筛查讨论，促使提供者向患者推荐筛查，并帮助患者完成已开的筛查检测。
