Charlton Mary E, Mengeling Michelle A, Halfdanarson Thorvardur R, Makki Nader M, Malhotra Ashish, Klutts J Stacey, Levy Barcey T, Kaboli Peter J
VA Office of Rural Health, Rural Health Resource Center-Central Region, and the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System, Iowa City, Iowa; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa.
J Rural Health. 2014 Summer;30(3):322-32. doi: 10.1111/jrh.12052. Epub 2013 Oct 25.
Distance from health care facilities can be a barrier to colorectal cancer (CRC) screening, especially for colonoscopy. Alternatively, an improved at-home stool-based screening tool, the fecal immunochemical test (FIT), requires only a single sample and has a better sensitivity-specificity balance compared to traditional guaiac fecal occult blood tests. Our objective was to determine if FITs mailed to asymptomatic, average-risk patients overdue for screening resulted in higher screening rates versus mailing educational materials alone or no intervention (ie, usual care).
Veterans ages 51-64, asymptomatic, at average risk for CRC, overdue for screening and in a veterans administration (VA) catchment area covering a large rural population were randomly assigned to 3 groups: (1) education only (Ed) group: mailed CRC educational materials and a survey of screening history and preferences (N = 499); (2) FIT group: mailed the FIT, plus educational materials and survey (N = 500); and (3) usual care (UC) group: received no mailings (N = 500).
At 6 months postintervention, 21% of the FIT group had received CRC screening by any method compared to 6% of the Ed group (and 6% of the UC group) (P < .0001). Of the 105 respondents from the FIT group, 71 (68%) were eligible to take the FIT. Of those, 64 (90%) completed the FIT and 8 (12%) tested positive.
This low-intensity intervention of mailing FITs to average risk patients overdue for screening resulted in a significantly higher screening rate than educational materials alone or usual care, and may be of particular interest in rural areas.
与医疗机构的距离可能成为结直肠癌（CRC）筛查的障碍，尤其是结肠镜检查。另外，一种改良的居家粪便筛查工具——粪便免疫化学检测（FIT），只需要一份样本，与传统的愈创木脂粪便潜血试验相比，具有更好的灵敏度 - 特异性平衡。我们的目标是确定，将FIT邮寄给未进行筛查且处于无症状、平均风险的患者，与仅邮寄教育材料或不进行干预（即常规护理）相比，是否能提高筛查率。
年龄在51 - 64岁、无症状、处于CRC平均风险、未进行筛查且在覆盖大量农村人口的退伍军人管理局（VA）集水区的退伍军人被随机分为3组：（1）仅教育（Ed）组：邮寄CRC教育材料以及一份筛查历史和偏好调查问卷（N = 499）；（2）FIT组：邮寄FIT，外加教育材料和调查问卷（N = 500）；（3）常规护理（UC）组：未收到任何邮件（N = 500）。
干预后6个月，FIT组中有21%的患者通过任何方法进行了CRC筛查，而Ed组为6%（UC组也为6%）（P < .0001）。FIT组的105名受访者中，71人（68%）有资格进行FIT检测。其中，64人（90%）完成了FIT检测，8人（12%）检测呈阳性。
这种向未进行筛查的平均风险患者邮寄FIT的低强度干预，导致筛查率显著高于仅使用教育材料或常规护理，在农村地区可能特别有意义。
