影响年度粪便免疫化学试验用于结直肠癌的实用临床试验依从性的因素。
Factors Affecting Adherence in a Pragmatic Trial of Annual Fecal Immunochemical Testing for Colorectal Cancer.
机构信息
Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
出版信息
J Gen Intern Med. 2019 Jun;34(6):978-985. doi: 10.1007/s11606-018-4820-0. Epub 2019 Jan 25.
BACKGROUND
Colorectal cancer screening by fecal immunochemical test (FIT) reduces the burden of colorectal cancer. However, effectiveness relies on annual adherence, which presents challenges for clinic staff and patients.
OBJECTIVE
Describe FIT return rates and identify factors associated with FIT adherence over 2 years in a mailed FIT outreach program in federally qualified health centers.
DESIGN
Observational study nested in the Strategies and Opportunities to Stop Colon Cancer in Priority Populations (STOP CRC) trial. Five thousand one hundred ninety-five patients had an initial FIT order and were followed for ≥ 2 years (3574 also had a FIT order in the second year).
MAIN MEASURES
FIT return percent in each year and patient- and neighborhood-level characteristics associated with FIT adherence.
KEY RESULTS
Overall, the proportion of FIT orders that were completed was 46% in the patients' first year and 41% in the patients' second year. Of the 5195 patients with a FIT order in year 1, 3574 (69%) also had a FIT order in year 2 (71% of year 1 adherers and 67% of year 1 non-adherers, p = 0.009). Among those with a FIT order in the second year, the FIT return rate was about twice as high among those who were adherent in the first year (952/1674, or 57%) as among those who were not (531/1900, or 28%, p < 0.0001). Patient-level characteristics associated with higher odds of FIT return were a history of FIT screening at baseline, age over 65 (vs 50-65), no current tobacco use, recent receipt of a mammogram or flu vaccine, Asian ancestry (compared to non-Hispanic white), and non-English preference. The only neighborhood factor associated with lower FIT return rate was patient's larger residential city size.
CONCLUSION
Our findings can inform the customization of programs to promote FIT return among patients who receive care at federally qualified health centers.
TRIAL REGISTRATION
背景
粪便免疫化学检测（FIT）筛查可降低结直肠癌的负担。然而，其有效性依赖于每年的参与度，这给临床工作人员和患者带来了挑战。
目的
描述在联邦合格健康中心的邮寄 FIT 外展计划中，经过 2 年的时间，FIT 回检率以及与 FIT 依从性相关的因素。
设计
嵌套在优先人群中停止结直肠癌策略和机会（STOP CRC）试验中的观察性研究。5195 名患者接受了初始 FIT 检测，随访时间≥2 年（其中 3574 名患者第二年也接受了 FIT 检测）。
主要测量指标
每年 FIT 回检的比例以及与 FIT 依从性相关的患者和社区特征。
主要结果
总体而言，患者第一年完成 FIT 检测的比例为 46%，第二年为 41%。在第一年接受 FIT 检测的 5195 名患者中，有 3574 名（69%）第二年也接受了 FIT 检测（第一年依从者中 71%，第一年不依从者中 67%，p=0.009）。在第二年接受 FIT 检测的患者中，第一年依从者的 FIT 回检率约为不依从者的两倍（1674 例中有 952 例，57%，1900 例中有 531 例，28%，p<0.0001）。与更高的 FIT 回检率相关的患者特征包括基线时 FIT 筛查史、年龄>65 岁（50-65 岁）、当前无吸烟史、最近接受过乳房 X 光检查或流感疫苗接种、亚裔血统（与非西班牙裔白人相比）以及非英语偏好。唯一与较低 FIT 回检率相关的社区因素是患者居住的城市规模较大。
结论
我们的研究结果可以为在联邦合格健康中心接受治疗的患者提供个性化的 FIT 回检方案。
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