Feng Rui, Shen Xingrong, Chai Jing, Chen Penglai, Cheng Jing, Liang Han, Zhao Ting, Sha Rui, Li Kaichun, Wang Debin
Department of Literature Review and Analysis, Library of Anhui Medical University, Hefei, Anhui, China.
School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
BMC Cancer. 2015 Oct 12;15:674. doi: 10.1186/s12885-015-1688-9.
Proven cost-effectiveness contrasted by low uptake of cancer screening (CS) calls for new methodologies promoting the service. Contemporary interventions in this regard relies primarily on strategies targeting general or specific groups with limited attention being paid to individualized approaches. This trial tests a novel package promoting CS utilization via continuous and tailored counseling delivered by primary caregivers. It aims at demonstrating that high risk individuals in the intervention arm will, compared to those in the delayed intervention condition, show increased use of CS service.
METHODS/DESIGN: The trial adopts a quasi-randomized controlled trial design and involves 2160 high risk individuals selected, via rapid and detailed risk assessments, from about 72,000 farmers aged 35+ in 36 administrative villages randomized into equal intervention and delayed intervention arms. The CS intervention package uses: a) village doctors and village clinics to deliver personalized and thus relatively sophisticated CS counseling; b) two-stage risk assessment models in identifying high risk individuals to focus the intervention on the most needed; c) standardized operation procedures to guide conduct of counseling; d) real-time effectiveness and quality monitoring to leverage continuous improvement; e) web-based electronic system to enable prioritizing complex determinants of CS uptake and tailoring counseling sessions to the changing needs of individual farmers. The intervention arm receives baseline and semiannual follow up evaluations plus CS counseling for 5 years; while the delayed intervention arm, only the same baseline and follow-up evaluations for the first 5 years and CS counseling starting from the 6th year if the intervention proved effective. Evaluation measures include: CS uptake by high risk farmers and changes in their knowledge, perceptions and self-efficacy about CS.
Given the complexity and heterogeneity in the determinant system of individual CS service seeking behavior, personalized interventions may prove to be an effective strategy. The current trial distinguishes itself from previous ones in that it not only adopts a personalized strategy but also introduces a package of pragmatic solutions based on proven theories for tackling potential barriers and incorporating key success factors in a synergetic way toward low cost, effective and sustainable CS promotion.
ISRCTN33269053.
尽管癌症筛查（CS）已被证明具有成本效益，但较低的接受率表明需要新的方法来推广这项服务。目前这方面的干预措施主要依赖于针对普通人群或特定群体的策略，而对个性化方法的关注有限。本试验测试一种新的方案，通过初级护理人员提供持续且量身定制的咨询服务来促进癌症筛查的利用。其目的是证明与延迟干预组相比，干预组中的高危个体将增加对癌症筛查服务的使用。
方法/设计：该试验采用半随机对照试验设计，通过快速且详细的风险评估，从36个行政村中约72000名35岁及以上的农民中选取2160名高危个体，这些行政村被随机分为相等的干预组和延迟干预组。癌症筛查干预方案包括：a）乡村医生和乡村诊所提供个性化且相对复杂的癌症筛查咨询；b）两阶段风险评估模型识别高危个体，以便将干预重点放在最需要的人群上；c）标准化操作程序指导咨询的开展；d）实时有效性和质量监测以促进持续改进；e）基于网络的电子系统，用于确定癌症筛查接受率的复杂决定因素的优先级，并根据个体农民不断变化的需求定制咨询服务。干预组接受基线和半年一次的随访评估，并接受为期5年的癌症筛查咨询；而延迟干预组在前5年只接受相同的基线和随访评估，如果干预被证明有效，则从第6年开始接受癌症筛查咨询。评估指标包括：高危农民对癌症筛查的接受情况以及他们对癌症筛查的知识、认知和自我效能的变化。
鉴于个体癌症筛查服务寻求行为决定因素系统的复杂性和异质性，个性化干预可能是一种有效的策略。当前试验与以往试验的不同之处在于，它不仅采用了个性化策略，还引入了一套基于已证实理论的务实解决方案，以应对潜在障碍，并以协同方式纳入关键成功因素，以实现低成本、有效且可持续的癌症筛查推广。
ISRCTN33269053
