Department of Public Health Sciences, Pennsylvania State University College of Medicine, 600 Centerview Dr, Room 2200, Mailstop A210, Hershey, PA 17033, USA.
Prev Chronic Dis. 2012;9:E77.
The Appalachian region of the United States has disproportionately high colorectal cancer (CRC) death rates and low screening rates. The purpose of this pilot study was to assess acceptability of a take-home fecal immunochemical test (FIT) and the effect of follow-up telephone counseling for increasing CRC screening in rural Appalachia.
We used a prospective, single-group, multiple-site design, with centralized laboratory reports of screening adherence and baseline and 3-month questionnaires. Successive patients, aged 50 or older, at average CRC risk and due for screening were enrolled during a routine visit to 3 primary care practices in rural Appalachian Pennsylvania and received a free take-home FIT and educational brochure. Those who had not returned the test 2 weeks later were referred for telephone counseling.
Of 232 patients approached, 200 (86.2%) agreed to participate. Of these, 145 (72.5%) completed the FIT as recommended (adherent) and 55 (27.5%) were referred for telephone counseling (nonadherent), of whom 23 (41.8%) became adherent after 1 to 2 counseling sessions, an 11.5 percentage-point increase in screening after telephone counseling and 84% FIT adherence overall. Lack of CRC-related knowledge and perceived CRC risk were the screening barriers most highly associated with nonadherence. Although not statistically significant, the rate of conversion to screening adherence was higher among participants who received telephone counseling compared to an answering machine reminder.
If confirmed in future randomized trials, provider-recommended take-home FIT and follow-up telephone counseling may be methods to increase CRC screening in Appalachia.
美国阿巴拉契亚地区的结直肠癌（CRC）死亡率过高，筛查率过低。本研究旨在评估居家粪便免疫化学检测（FIT）的可接受性，以及后续电话咨询对增加农村阿巴拉契亚地区 CRC 筛查的影响。
我们采用前瞻性、单组、多站点设计，集中报告筛查依从性和基线及 3 个月的问卷。在宾夕法尼亚州农村阿巴拉契亚地区的 3 家初级保健机构，对处于平均 CRC 风险且需要进行筛查的连续患者，在常规就诊时进行了前瞻性、单组、多站点设计，为每位患者免费提供居家 FIT 和教育手册。如果在 2 周后没有返回检测结果，患者将被转诊接受电话咨询。
在 232 名被接触的患者中，有 200 名（86.2%）同意参与。其中，145 名（72.5%）按照建议完成了 FIT（依从性），55 名（27.5%）被转诊接受电话咨询（非依从性），其中 23 名（41.8%）在 1 至 2 次咨询后变得依从，电话咨询后筛查率提高了 11.5 个百分点，整体 FIT 依从率为 84%。缺乏 CRC 相关知识和感知的 CRC 风险是与不依从性最相关的筛查障碍。尽管没有统计学意义，但与接受电话咨询的参与者相比，收到电话咨询和答录机提醒的参与者转为筛查依从性的比例更高。
如果在未来的随机试验中得到证实，提供者推荐的居家 FIT 和后续电话咨询可能是增加阿巴拉契亚地区 CRC 筛查的方法。
