Section of Gastroenterology, Department of Medicine, University of Chicago, Chicago, IL, USA.
J Gen Intern Med. 2012 Aug;27(8):1033-46. doi: 10.1007/s11606-012-2044-2.
To systematically review the literature to identify interventions that improve minority health related to colorectal cancer care.
MEDLINE, PsycINFO, CINAHL, and Cochrane databases, from 1950 to 2010.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: Interventions in US populations eligible for colorectal cancer screening, and composed of ≥50 % racial/ethnic minorities (or that included a specific sub-analysis by race/ethnicity). All included studies were linked to an identifiable healthcare source. The three authors independently reviewed the abstracts of all the articles and a final list was determined by consensus. All papers were independently reviewed and quality scores were calculated and assigned using the Downs and Black checklist.
Thirty-three studies were included in our final analysis. Patient education involving phone or in-person contact combined with navigation can lead to modest improvements, on the order of 15 percentage points, in colorectal cancer screening rates in minority populations. Provider-directed multi-modal interventions composed of education sessions and reminders, as well as pure educational interventions were found to be effective in raising colorectal cancer screening rates, also on the order of 10 to 15 percentage points. No relevant interventions focusing on post-screening follow up, treatment adherence and survivorship were identified.
This review excluded any intervention studies that were not tied to an identifiable healthcare source. The minority populations in most studies reviewed were predominantly Hispanic and African American, limiting generalizability to other ethnic and minority populations.
Tailored patient education combined with patient navigation services, and physician training in communicating with patients of low health literacy, can modestly improve adherence to CRC screening. The onus is now on researchers to continue to evaluate and refine these interventions and begin to expand them to the entire colon cancer care continuum.
系统地回顾文献，以确定改善与结直肠癌护理相关的少数民族健康的干预措施。
MEDLINE、PsycINFO、CINAHL 和 Cochrane 数据库，时间范围为 1950 年至 2010 年。
研究入选标准、参与者和干预措施：在美国有资格接受结直肠癌筛查的人群中进行的干预措施，且至少有 50%的参与者为少数民族（或包括按种族/民族进行的特定亚组分析）。所有纳入的研究都与可识别的医疗保健来源相关联。三位作者独立审查了所有文章的摘要，并通过共识确定了最终清单。所有论文均由独立审查，并使用 Downs 和 Black 清单计算和分配质量评分。
我们的最终分析纳入了 33 项研究。涉及电话或面对面接触的患者教育与导航相结合，可以使少数民族人群的结直肠癌筛查率适度提高，约为 15 个百分点。发现针对提供者的多模式干预措施（包括教育课程和提醒）以及单纯的教育干预措施在提高结直肠癌筛查率方面也很有效，也约为 10 至 15 个百分点。没有发现任何针对筛查后随访、治疗依从性和生存质量的相关干预措施。
本综述排除了任何未与可识别医疗保健来源相关联的干预研究。大多数研究中所审查的少数民族群体主要是西班牙裔和非裔美国人，这限制了它们在其他族裔和少数民族群体中的推广。
针对患者的教育与患者导航服务相结合，以及医生在与低健康素养患者沟通方面的培训，可以适度提高 CRC 筛查的依从性。现在，研究人员的任务是继续评估和完善这些干预措施，并开始将其扩展到整个结肠癌护理连续体。
