Arnold Connie L, Rademaker Alfred, Wolf Michael S, Liu Dachao, Lucas Geoffrey, Hancock Jill, Davis Terry C
Department of Medicine, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA.
Department of Preventive Medicine, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
J Community Health. 2016 Aug;41(4):724-31. doi: 10.1007/s10900-015-0146-6.
This three arm study was designed to make CRC screening with FOBTs more accessible, understandable and actionable for patients cared for in predominantly rural Federally Qualified Health Centers. Patients in an enhanced version of usual care received an annual CRC recommendation and FOBT kit; those in the education arm additionally received brief literacy and culturally appropriate education and those in the nurse arm received the education by a nurse manager who followed up by telephone. Baseline FOBT rates in this population were 3 %. We evaluated if FOBT rates could be sustained over 3 years. A three-arm, quasi-experimental evaluation was conducted among eight clinics in Louisiana. Screening efforts included: (1) enhanced usual care, (2) literacy-informed education of patients, and (3) education plus nurse support. Overall, 961 average-risk patients, ages 50-85, eligible for routine CRC screenings were recruited. The primary outcome was completing three annual FOBT tests. Of 961 patients enrolled, 381 (39.6 %) participants did not complete a single FOBT, 60.4 % completed at least one FOBT of which 318 (33.1 %) completed only one, 162 (16.9 %) completed two and 100 (10.4 %) completed three FOBTs over the 3-year period (the primary study outcome). The primary outcome, return of three FOBT kits over the 3-year period, was achieved by 4.7 % in enhanced care, 11.4 % in education and 13.6 % in the nurse arm (p = 0.005). Overall 3-year FOBT screening rates were not sustained with any of the three interventions, despite reports of promising interim results at years 1 and 2. New strategies for sustaining FOBT screening over several years must be developed.
这项三臂研究旨在使在主要为农村地区的联邦合格健康中心接受治疗的患者更易于接受、理解并实施粪便潜血试验（FOBT）进行结直肠癌（CRC）筛查。接受强化常规护理的患者每年收到CRC筛查建议和FOBT检测试剂盒；接受教育干预的患者还额外接受了简短的读写能力培训和符合文化背景的教育；接受护士干预的患者则由护士经理进行教育，并通过电话进行随访。该人群的基线FOBT检测率为3%。我们评估了FOBT检测率能否在3年内保持稳定。在路易斯安那州的8家诊所进行了一项三臂准实验评估。筛查措施包括：（1）强化常规护理，（2）对患者进行基于读写能力的教育，（3）教育加护士支持。总体而言，招募了961名年龄在50 - 85岁、符合常规CRC筛查条件的平均风险患者。主要结局是完成三次年度FOBT检测。在961名登记患者中，381名（39.6%）参与者未完成一次FOBT检测，60.4%的患者完成了至少一次FOBT检测，其中318名（33.1%）仅完成了一次，162名（16.9%）完成了两次，100名（10.4%）在3年期间完成了三次FOBT检测（主要研究结局）。主要结局，即3年期间归还三个FOBT试剂盒的比例，在强化护理组为4.7%，教育组为11.4%，护士干预组为13.6%（p = 0.005）。尽管在第1年和第2年有令人鼓舞的中期结果报告，但这三种干预措施均未使3年总体FOBT筛查率保持稳定。必须制定新的策略以维持数年的FOBT筛查。
