Vachon Eric, Robb Bruce W, Haggstrom David A
School of Nursing, Indiana University, Indianapolis, IN, United States.
Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States.
JMIR Cancer. 2022 Aug 11;8(3):e34851. doi: 10.2196/34851.
There are currently an estimated 1.5 million individuals living in the United States with colorectal cancer (CRC), and although the 5-year survival rate has increased, survivors are at risk for recurrence, particularly within the first 2-3 years after treatment. National guidelines recommend continued surveillance after resection to identify recurrence early on. Adherence among survivors ranges from 23% to 94%. Novel interventions are needed to increase CRC survivors' knowledge and confidence in managing their cancer and thus to increase adherence to follow-up surveillance.
The objective of this study is to develop and test the feasibility and efficacy of a stand-alone, web-based personal health record (PHR) to increase surveillance adherence among CRC survivors, with patient beliefs about surveillance as secondary outcomes.
A pre- and postintervention feasibility trial was conducted testing the efficacy of the colorectal cancer survivor (CRCS)-PHR, which had been previously developed using an iterative, user-centered design approach.
The average age of the sample was 58 (SD 9.9) years, with 57% (16/28) male and the majority married (20/28, 71%) and employed full-time (15/28, 54%). We observed a significant increase in adherence to colonoscopy (before: 11/21, 52% vs after: 18/21, 86%; P=.005) and CEA (14/21, 67% vs 20/21, 95%; P=.01), as well as a slight increase in CT scans (14/21, 67% vs 18/21, 86%; P=.10). The only significant impact on secondary outcome (patient beliefs) was benefits of CEA test (P=.04), as most of the beliefs were high at baseline.
This feasibility study lays the groundwork for continued development of the CRCS-PHR to increase CRC surveillance. Patient-centered technologies, such as the CRCS-PHR, represent an important potential approach to improving the receipt of guideline-concordant care and follow-up surveillance, and not just for CRC survivors. Researchers should continue to develop patient-centered health technologies with clinician implementation in mind to increase patient self-efficacy and surveillance adherence.
目前估计有150万美国人患有结直肠癌（CRC），尽管5年生存率有所提高，但幸存者仍有复发风险，尤其是在治疗后的头2至3年内。国家指南建议在切除术后继续进行监测，以便早期发现复发。幸存者的依从率在23%至94%之间。需要新的干预措施来提高CRC幸存者管理癌症的知识和信心，从而提高对后续监测的依从性。
本研究的目的是开发并测试一种独立的、基于网络的个人健康记录（PHR）的可行性和有效性，以提高CRC幸存者对监测的依从性，并将患者对监测的信念作为次要结果。
进行了一项干预前后的可行性试验，以测试先前使用迭代式、以用户为中心的设计方法开发的结直肠癌幸存者（CRCS）-PHR的有效性。
样本的平均年龄为58岁（标准差9.9），57%（16/28）为男性，大多数已婚（20/28，71%）且全职工作（15/28，54%）。我们观察到结肠镜检查的依从性显著提高（之前：11/21，52%；之后：18/21，86%；P = 0.005），癌胚抗原（CEA）检查的依从性也显著提高（14/21，67%；20/21，95%；P = 0.01），CT扫描的依从性略有提高（14/21，67%；18/21，86%；P = 0.10）。对次要结果（患者信念）的唯一显著影响是CEA检测的益处（P = 0.04），因为大多数信念在基线时就很高。
这项可行性研究为继续开发CRCS-PHR以加强CRC监测奠定了基础。以患者为中心的技术，如CRCS-PHR，是改善接受符合指南的护理和后续监测的重要潜在方法，而且不仅适用于CRC幸存者。研究人员应继续开发以患者为中心的健康技术，并考虑临床医生的实施，以提高患者的自我效能和监测依从性。
