H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America.
H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America.
Prev Med. 2022 May;158:107021. doi: 10.1016/j.ypmed.2022.107021. Epub 2022 Mar 17.
One of the largest disparities in cancer mortality in the United States occurs with colorectal cancer (CRC). The objectives of this multilevel two-arm intervention trial were to compare the efficacy of two interventions to promote CRC screening (CRCS) with fecal immunochemical test (FIT) and examine sociodemographic and psychosocial predictors of FIT screening. Individuals ages 50-75 (n = 326) who were not up-to-date with CRCS, could understand English or Spanish, and were at average CRC risk were recruited from two federally qualified health centers (FQHCs) in Florida. Prior to intervention, CRCS rates in the FQHCs were 27.1% and 32.9%, respectively. Study enrollment occurred April 2018-November 2019. System-level intervention components included leveraging electronic medical record (EMR) systems and delivering patient reminders. Participants were randomized to C-CARES (education+FIT) or C-CARES Plus (C-CARES+personalized coaching [for those not completing FIT within 90 days]). Primary outcome was completed FIT returned <1 year. Primary outcome analyses were performed using logistic regression. 225 participants completed FIT (69.0% [95% CI: 64.0-74.0%]), with no significant difference in FIT uptake by intervention arm (67.3% C-CARES Plus vs. 70.8% C-CARES; p = .49). FIT uptake was significantly higher among patients who received intervention materials in Spanish (77.2%) compared to those who received materials in English (63.2%, p < .01). The personalized coaching in the C-CARES Plus arm did not appear to provide added benefit beyond the C-CARES intervention. Multilevel approaches that include EMR prompts, reminders, FIT access, and provision of low-literacy, language-concordant education can support efforts to improved community clinics' CRCS rates. Future efforts should focus on repeat FIT screening. Trial registration: The trial was registered at ClinicalTrials.gov (NCT03906110).
在美国，癌症死亡率存在最大差异之一的癌症是结直肠癌（CRC）。本多层次、双臂干预试验的目的是比较两种促进粪便免疫化学测试（FIT）结直肠癌筛查（CRCS）的干预措施的疗效，并研究 FIT 筛查的社会人口学和心理社会预测因素。该研究从佛罗里达州的两个联邦合格的健康中心（FQHC）招募了 326 名年龄在 50-75 岁之间、不能及时接受 CRCS 检查、能理解英语或西班牙语、且平均结直肠癌风险的个体。干预前，这两个 FQHC 的 CRCS 率分别为 27.1%和 32.9%。研究招募于 2018 年 4 月至 2019 年 11 月进行。系统级干预措施包括利用电子病历（EMR）系统和提供患者提醒。参与者被随机分配到 C-CARES（教育+FIT）或 C-CARES Plus（C-CARES+个性化辅导[对于在 90 天内未完成 FIT 的患者]）。主要结局是在 1 年内完成 FIT 检测。主要结局分析采用逻辑回归。225 名参与者完成了 FIT（69.0%[95%CI:64.0-74.0%]），干预组之间 FIT 吸收率没有显著差异（C-CARES Plus 组 67.3% vs. C-CARES 组 70.8%；p=.49）。与接受英语材料的患者相比，接受西班牙语干预材料的患者的 FIT 吸收率明显更高（77.2%比 63.2%，p<.01）。C-CARES Plus 组中的个性化辅导似乎并没有在 C-CARES 干预之外提供额外的益处。包括 EMR 提示、提醒、FIT 访问以及提供低识字率、语言一致的教育在内的多层次方法可以支持提高社区诊所的 CRCS 率的努力。未来的努力应集中在重复 FIT 筛查上。试验注册：该试验在 ClinicalTrials.gov（NCT03906110）注册。
