Green Beverly B, Anderson Melissa L, Chubak Jessica, Fuller Sharon, Meenan Richard T, Vernon Sally W
Group Health Permanente, Seattle, Washington.
Group Health Research Institute, Seattle, Washington.
Cancer. 2016 Jan 15;122(2):312-21. doi: 10.1002/cncr.29734. Epub 2015 Oct 21.
The current study was conducted to determine the effect of continuing a centralized fecal occult blood test (FOBT) mailed program on screening adherence.
A patient-level randomized controlled trial was conducted in 21 patient-centered medical home primary care clinics between January 2010 and November 2012. A total of 2208 patients ranging in age from 52 to 75 years in a substudy of the Systems of Support to Increase Colon Cancer Screening and Follow-Up (SOS) trial were randomized at year 3 to continued automated interventions (Continued group), which included mailed information regarding colorectal cancer (CRC) screening choices, and were mailed stool kit tests or to a group in which interventions were stopped (Stopped group). The main outcomes and measures were the completion of CRC screening in year 3 and by subgroup characteristics, respectively.
Adherence to CRC screening in year 3 was found to be significantly higher in patients in the Continued group compared with those in the Stopped group (53.3% vs 37.3%; adjusted net difference, 15.6% [P<.001]). This difference was entirely due to greater completion of FOBT (adjusted net difference, 18.0% [P<.001]). Year 3 CRC screening rates were highest in patients in the Continued group completing FOBT in both years 1 and 2 (77.2%), followed by patients completing only 1 FOBT in 1 of the 2 years (44.6%), with low rates of CRC testing reported among patients not completing any FOBT within the first 2 years (18.1%).
A centralized mailed FOBT CRC screening program continued to be more effective than patient-centered medical home usual-care interventions, but only for those patients who had previously completed FOBT testing. Research is needed regarding how to engage patients not completing CRC testing after being mailed at least 2 rounds of FOBT tests. Cancer 2016;122:312-321. © 2015 American Cancer Society.
本研究旨在确定持续开展集中式粪便潜血试验（FOBT）邮寄项目对筛查依从性的影响。
2010年1月至2012年11月期间，在21家以患者为中心的家庭医疗初级保健诊所进行了一项患者层面的随机对照试验。在“增加结肠癌筛查及随访支持系统”（SOS）试验的一项子研究中，共有2208名年龄在52至75岁之间的患者在第3年被随机分为继续接受自动化干预组（继续组），该组包括邮寄有关结直肠癌（CRC）筛查选择的信息，并邮寄粪便检测试剂盒，以及干预停止组。主要结局指标分别为第3年CRC筛查的完成情况以及按亚组特征分析的情况。
发现继续组患者在第3年对CRC筛查的依从性显著高于停止组（53.3%对37.3%；调整后的净差异为15.6%[P<0.001]）。这种差异完全归因于FOBT完成率更高（调整后的净差异为18.0%[P<0.001]）。第3年CRC筛查率在第1年和第2年都完成FOBT的继续组患者中最高（77.2%），其次是在两年中的1年仅完成1次FOBT的患者（44.6%），在前两年未完成任何FOBT的患者中CRC检测率较低（18.1%）。
集中式邮寄FOBT CRC筛查项目继续比以患者为中心的家庭医疗常规护理干预更有效，但仅适用于那些之前已完成FOBT检测的患者。需要开展研究，以了解如何促使在至少收到两轮FOBT检测邮寄后仍未完成CRC检测的患者参与进来。《癌症》2016年；122:312 - 321。©2015美国癌症协会。
