Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
JAMA Intern Med. 2013 Jan 28;173(2):122-9. doi: 10.1001/2013.jamainternmed.1017.
New methods to enhance colorectal cancer (CRC) screening rates are needed. The web offers novel possibilities to educate patients and to improve health behaviors, such as cancer screening. Evidence supports the efficacy of health communications that are targeted and tailored to improve the uptake of recommendations.
We identified unscreened women at average risk for CRC from the scheduling databases of obstetrics and gynecology practices in 2 large health care systems. Participants consented to a randomized controlled trial that compared CRC screening uptake after receipt of CRC screening information delivered via the web or in print form. Participants could also be assigned to a control (usual care) group. Women in the interventional arms received tailored information in a high- or low-monitoring Cognitive Social Information Processing model-defined attentional style. The primary outcome was CRC screening participation at 4 months.
A total of 904 women were randomized to the interventional or control group. At 4 months, CRC screening uptake was not significantly different in the web (12.2%), print (12.0%), or control (12.9%) group. Attentional style had no effect on screening uptake for any group. Some baseline participant factors were associated with greater screening, including higher income (P = .03), stage of change (P < .001), and physician recommendation to screen (P < .001).
A web-based educational intervention was no more effective than a print-based one or control (no educational intervention) in increasing CRC screening rates in women at average risk of CRC. Risk messages tailored to attentional style had no effect on screening uptake. In average-risk populations, use of the Internet for health communication without additional enhancement is unlikely to improve screening participation.
clinicaltrials.gov Identifier: NCT00459030.
需要新的方法来提高结直肠癌（CRC）的筛查率。网络为教育患者和改善健康行为（如癌症筛查）提供了新的可能性。有证据表明，针对特定人群并量身定制的健康传播可以提高建议的采纳率。
我们从两个大型医疗保健系统的妇产科预约数据库中确定了患有 CRC 的平均风险但未接受筛查的女性。参与者同意参加一项随机对照试验，该试验比较了通过网络或印刷形式提供 CRC 筛查信息后 CRC 筛查的接受情况。参与者还可以被分配到对照组（常规护理）。干预组的女性会收到根据认知社会信息处理模型（定义为注意力风格）中的高或低监测来定制的信息。主要结果是在 4 个月时进行 CRC 筛查。
共有 904 名女性被随机分配到干预组或对照组。在 4 个月时，网络组（12.2%）、印刷组（12.0%）和对照组（12.9%）的 CRC 筛查率没有显著差异。注意力风格对任何组的筛查率都没有影响。一些基线参与者因素与更高的筛查率相关，包括更高的收入（P=0.03）、改变阶段（P<0.001）和医生建议筛查（P<0.001）。
与基于印刷的干预或对照组（无教育干预）相比，基于网络的教育干预并没有更有效地提高 CRC 平均风险女性的 CRC 筛查率。针对注意力风格定制的风险信息对筛查率没有影响。在平均风险人群中，不增加额外增强措施而使用互联网进行健康传播不太可能提高筛查参与率。
clinicaltrials.gov 标识符：NCT00459030。
