Department of Family and Community Medicine, Pennsylvania State University Health Milton S. Hershey Medical Center, Hershey, PA, USA.
Department of Cancer Control, Penn State Cancer Institute, Hershey, PA, USA.
J Community Health. 2021 Feb;46(1):232-244. doi: 10.1007/s10900-020-00867-z.
African Americans experience colorectal cancer (CRC) related disparities compared to other racial groups in the United States. African Americans are frequently diagnosed with CRC at a later stage, screening is underutilized, and mortality rates are highest in this group. This systematic review focused on intervention studies using stool blood CRC screening among African Americans in primary care and community settings. Given wide accessibility, low cost, and ease of dissemination of stool-based CRC screening tests, this review aims to determine effective interventions to improve participation rates. This systematic review included intervention studies published between January 1, 2000 and March 16, 2019. After reviewing an initial search of 650 studies, 11 studies were eventually included in this review. The included studies were studies conducted in community and clinical settings, using both inreach and outreach strategies to increase CRC screening. For each study, an unadjusted odds ratio (OR) for the CRC screening intervention compared to the control arm was calculated based on the data in each study to report effectiveness. The eleven studies together recruited a total of 3334 participants. The five studies using two-arm experimental designs ranged in effectiveness with ORs ranging from 1.1 to 13.0 using interventions such as mailed reminders, patient navigation, and tailored educational materials. Effective strategies to increase stool blood testing included mailed stool blood tests augmented by patient navigation, tailored educational materials, and follow-up calls or mailings to increase trust in the patient-provider relationship. More studies are needed on stool blood testing interventions to determine effectiveness in this population.
非裔美国人在美国经历着与其他种族群体相比的结直肠癌（CRC）相关差异。非裔美国人通常在较晚阶段被诊断出患有 CRC，筛查利用率低，而且死亡率在这个群体中最高。本系统综述重点关注在初级保健和社区环境中使用粪便潜血 CRC 筛查的干预性研究。鉴于粪便 CRC 筛查测试具有广泛的可及性、低成本和易于传播的特点，本综述旨在确定有效的干预措施以提高参与率。本系统综述纳入了 2000 年 1 月 1 日至 2019 年 3 月 16 日期间发表的干预性研究。在对最初搜索的 650 项研究进行审查后，最终有 11 项研究纳入本综述。纳入的研究在社区和临床环境中进行，采用内部和外部扩展策略来增加 CRC 筛查。对于每项研究，根据每项研究中的数据计算 CRC 筛查干预与对照组相比的未调整比值比（OR），以报告有效性。这 11 项研究共招募了 3334 名参与者。五项采用两臂实验设计的研究有效性不同，OR 范围从 1.1 到 13.0，干预措施包括邮寄提醒、患者导航和定制教育材料。增加粪便潜血检测的有效策略包括通过患者导航、定制教育材料以及后续电话或邮件来增加患者与提供者关系的信任，从而增强邮寄的粪便检测。需要更多关于粪便潜血检测干预的研究来确定该人群的有效性。
