1] Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China [2] School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong, China.
Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China.
Am J Gastroenterol. 2014 Jul;109(7):1072-9. doi: 10.1038/ajg.2014.136. Epub 2014 Jun 17.
The objective of this study was to compare the level of adherence to colorectal cancer (CRC) screening programs among screening participants offered vs. not offered informed choices on screening modality.
We recruited 10,606 screening participants aged 50-70 years, including 6,397 subjects who were offered a choice of yearly fecal immunochemical test (FIT) for up to 3 years vs. one colonoscopy, and 4,209 subjects who were offered either FIT or colonoscopy without choice. They were prospectively followed up for 3 years. The proportion of screening participants who returned their specimens in all subsequent years (FIT group) and the attendance rate of scheduled endoscopy appointment (colonoscopy group) were compared between those with vs. without choice.
The adherence rate with FIT was 97.6%, 84.1%, and 72.6% in the first 3 years of follow-up, respectively, among those who were offered a choice. The adherence rate with FIT was 97.5%, 78.4%, and 62.8%, respectively, among those without choices. The proportion of subjects attending colonoscopy was 95.7% (choice offered) and 90.6% (no choice). From binary logistic regression analysis, participants who were offered informed choice were significantly more likely to adhere to the program when compared with those without test choices (odds ratio (OR)=2.54, 95% confidence interval (CI): 2.30-2.82, P<0.001). The respective adjusted OR for the FIT and colonoscopy groups was 1.60 (95% CI: 1.42-1.80, P<0.001) and 2.53 (95% CI: 1.94-3.31, P<0.001).
This study found that patients who were offered an informed choice for screening had higher adherence rates than patients who were not offered a choice in real-life practices, suggesting that providing screening test options for CRC screening is preferred.
本研究旨在比较提供和不提供筛查方式选择的情况下，参加结直肠癌（CRC）筛查计划的患者对筛查的依从程度。
我们招募了 10606 名 50-70 岁的筛查参与者，其中 6397 名参与者可选择每年进行粪便免疫化学检测（FIT），最多 3 年，而另外 4209 名参与者则可选择 FIT 或结肠镜检查。他们前瞻性随访 3 年。在随后的所有年份中，返回标本的筛查参与者比例（FIT 组）和计划内镜预约的就诊率（结肠镜组）在有选择和无选择的患者之间进行了比较。
在有选择的患者中，第 1 年至第 3 年的 FIT 依从率分别为 97.6%、84.1%和 72.6%。无选择的患者中，FIT 的依从率分别为 97.5%、78.4%和 62.8%。接受结肠镜检查的患者比例分别为 95.7%（提供选择）和 90.6%（无选择）。从二项逻辑回归分析中，与无检测选择的患者相比，提供知情选择的患者更有可能坚持该计划（比值比（OR）=2.54，95%置信区间（CI）：2.30-2.82，P<0.001）。FIT 和结肠镜组的相应调整后 OR 分别为 1.60（95%CI：1.42-1.80，P<0.001）和 2.53（95%CI：1.94-3.31，P<0.001）。
本研究发现，在实际实践中，与未提供选择的患者相比，提供筛查检测选择的患者对筛查的依从率更高，这表明提供 CRC 筛查的筛查检测选项是优选的。
