提高结直肠癌监测指南的依从性：一项随机对照试验的结果。

Improving adherence to colorectal cancer surveillance guidelines: results of a randomised controlled trial.

机构信息

Priority Research Centre for Health Behaviour (PRCHB), School of Medicine & Public Health, University of Newcastle, W4, HMRI Building, Callaghan, NSW, Australia.

Hunter Medical Research Institute (HMRI), New Lambton, NSW, Australia.

出版信息

BMC Cancer. 2017 Feb 6;17(1):106. doi: 10.1186/s12885-017-3095-x.

DOI:10.1186/s12885-017-3095-x

PMID:28166751

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5294678/

Abstract

BACKGROUND

Colorectal cancer (CRC) survivors are at increased risk of developing the disease again. Surveillance guidelines are aimed at maximising the early detection of recurring or new cancers and pre-cancerous polyps. The frequency and type of surveillance recommended depends on the type of treatment for the initial CRC, the extent of colonoscopic investigation prior to treatment and the results of previous surveillance tests. This paper aimed to test the effect of a paper-based educational intervention to improve adherence to colonoscopy following treatment for colorectal cancer.

METHODS

People with a diagnosis of colorectal cancer within the last 10 months, aged ≥18 and English speaking were recruited through a population-based cancer registry in Australia. Participants were randomly allocated to either the intervention or control. Participants completed an interview at baseline. Self-reported participation in colonoscopy was obtained at 12 month followup by survey. Those allocated to the control received a generic pamphlet on colorectal cancer treatment; while intervention participants received a letter which provided specific information about guideline recommendations for surveillance colonoscopy. Rates of guideline adherence were compared between groups. The guideline recommendations for the timing of surveillance colonoscopy changed part way through the study. This change occurred after all intervention materials had been sent, but prior to all participants completing the 12 month follow up. Post hoc analyses were conducted to assess adherence to the new guidelines.

RESULTS

Of the 767 participants, 604 (79%) had had surgery, had stage I - III disease and completed the baseline interview within 12 months of diagnosis (intervention = 305; control = 299). There was no significant difference between those adherent to surveillance colonoscopy guidelines, in the control (67, 27%) and intervention groups (80, 31%) at followup (difference = 4.3% (95%CI:-3.7%, 12%), χ (1df) = 1.09, P = 0.296). Overall, 246 (49%) participants were adherent to the new guidelines, compared to 147 (29%) adherent to the old guidelines.

CONCLUSIONS

Results indicate the paper-based educational intervention is not effective in improving adherence to colorectal cancer surveillance guidelines for colonoscopy.

TRIAL REGISTRATION NUMBER

ACTRN12609000628246 Registration date: 28/07/2009.

摘要

背景

结直肠癌（CRC）幸存者再次患病的风险增加。监测指南旨在最大限度地提高对复发或新发癌症和癌前息肉的早期检测。推荐的监测频率和类型取决于初始 CRC 的治疗类型、治疗前结肠镜检查的范围以及之前监测测试的结果。本文旨在检验纸质教育干预对改善结直肠癌治疗后结肠镜检查依从性的效果。

方法

通过澳大利亚的一个人群癌症登记处招募了过去 10 个月内诊断为结直肠癌、年龄≥18 岁且会讲英语的患者。参与者被随机分配到干预组或对照组。参与者在基线时完成了一次访谈。在 12 个月的随访中，通过调查获得自我报告的结肠镜检查参与情况。对照组接受了一份关于结直肠癌治疗的通用小册子；而干预组则收到了一封提供关于监测结肠镜检查指南建议的具体信息的信件。比较了两组之间的指南遵守率。研究进行过程中，监测结肠镜检查的指南建议发生了变化。这一变化发生在所有干预材料寄出之后，但在所有参与者完成 12 个月的随访之前。事后分析用于评估对新指南的遵守情况。

结果

在 767 名参与者中，有 604 名（79%）接受了手术，患有 I-III 期疾病，并在诊断后 12 个月内完成了基线访谈（干预组 305 名；对照组 299 名）。在随访时，对照组（67 例，27%）和干预组（80 例，31%）中遵守监测结肠镜检查指南的患者之间没有显著差异（差异为 4.3%（95%CI：-3.7%，12%）， χ (1df) = 1.09，P = 0.296）。总体而言，246 名（49%）参与者符合新指南，而 147 名（29%）参与者符合旧指南。