Lukin Dana J, Jandorf Lina H, Dhulkifl Rayhana J, Thélémaque Linda D, Christie Jennifer A, Itzkowitz Steven H, Duhamel Katherine N
Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
J Cancer Educ. 2012 Jun;27(2):269-76. doi: 10.1007/s13187-011-0303-2.
Potential barriers to colorectal cancer (CRC) screening include preexisting medical conditions (comorbidities), physician recommendation, psychosocial factors, and screening preparedness. This study's purpose was to investigate the impact of comorbid conditions on CRC screening among African Americans. A stage-matched randomized clinical trial was performed. Asymptomatic African Americans over age 50, with a primary care physician, and eligible for CRC screening were recruited at The Mount Sinai Hospital from 2005 to 2008. One hundred sixty-one patients were assessed for referral for, and completion of, CRC screening, comorbid conditions, "readiness to change," and number of physician visits within the observation period. Data was compared to a pretrial index to predict the likely effect of comorbid conditions on CRC screening. One hundred fifty-nine patients completed the study; 108 (68.9%) were referred for and 34 (21.2%) completed CRC screening. No demographic characteristics were associated with CRC screening completion. CRC screening referrals were similar for all patients, regardless of comorbidities or clinical visits. Comorbidities rated as having extreme influence on CRC screening showed a trend toward lower screening rates. There was a significant increase in screening rates among participants in advanced stages of readiness at enrollment. These data suggest that while comorbidities did not predict colonoscopy completion, they may play a role in concert with other factors. This is the only study to assess the effect of screening colonoscopy in an African American primary care setting. We must continue to explore interventions to narrow the disparate gap in screening and mortality rates.
结直肠癌（CRC）筛查的潜在障碍包括既存疾病（共病）、医生建议、心理社会因素和筛查准备情况。本研究的目的是调查共病情况对非裔美国人CRC筛查的影响。进行了一项阶段匹配的随机临床试验。2005年至2008年期间，在西奈山医院招募了年龄超过50岁、有初级保健医生且符合CRC筛查条件的无症状非裔美国人。对161名患者进行了评估，以确定其是否被转诊进行CRC筛查、是否完成筛查、共病情况、“改变意愿”以及观察期内的医生就诊次数。将数据与预试验指标进行比较，以预测共病情况对CRC筛查可能产生的影响。159名患者完成了研究；108名（68.9%）被转诊进行CRC筛查，34名（21.2%）完成了CRC筛查。没有人口统计学特征与CRC筛查完成情况相关。无论共病情况或临床就诊次数如何，所有患者的CRC筛查转诊情况相似。被评为对CRC筛查有极大影响的共病情况显示出筛查率较低的趋势。在入组时处于准备就绪高级阶段的参与者中，筛查率有显著提高。这些数据表明，虽然共病情况不能预测结肠镜检查的完成情况，但它们可能与其他因素共同发挥作用。这是唯一一项评估非裔美国人初级保健环境中筛查结肠镜检查效果的研究。我们必须继续探索干预措施，以缩小筛查率和死亡率方面的差距。
