PDF(Pubmed)
Abstract：
BACKGROUND: At-home colorectal cancer (CRC) screening is an effective way to reduce CRC mortality, but screening rates in medically underserved groups are low. To plan the implementation of a pragmatic randomized trial comparing two population-based outreach approaches, we conducted qualitative research on current processes and barriers to at-home CRC screening in 10 community health centers (CHCs) that serve medically underserved groups, four each in Massachusetts and California, and two tribal facilities in South Dakota.
METHODS: We conducted 53 semi-structured interviews with clinical and administrative staff at the participating CHCs. Participants were asked about CRC screening processes, categorized into eight domains: patient identification, outreach, risk assessment, fecal immunochemical test (FIT) workflows, FIT-DNA (i.e., Cologuard) workflows, referral for a follow-up colonoscopy, patient navigation, and educational materials. Transcripts were analyzed using a Rapid Qualitative Analysis approach. A matrix was used to organize and summarize the data into four sub-themes: current process, barriers, facilitators, and solutions to adapt materials for the intervention.
RESULTS: Each site\'s process for stool-based CRC screening varied slightly. Interviewees identified the importance of offering educational materials in English and Spanish, using text messages to remind patients to return kits, adapting materials to address health literacy needs so patients can access instructions in writing, pictures, or video, creating mailed workflows integrated with a tracking system, and offering patient navigation to colonoscopy for patients with an abnormal result.
CONCLUSIONS: Proposed solutions across the three regions will inform a multilevel intervention in a pragmatic trial to increase CRC screening uptake in CHCs.
METHODS: We conducted 53 semi-structured interviews with clinical and administrative staff at the participating CHCs. Participants were asked about CRC screening processes, categorized into eight domains: patient identification, outreach, risk assessment, fecal immunochemical test (FIT) workflows, FIT-DNA (i.e., Cologuard) workflows, referral for a follow-up colonoscopy, patient navigation, and educational materials. Transcripts were analyzed using a Rapid Qualitative Analysis approach. A matrix was used to organize and summarize the data into four sub-themes: current process, barriers, facilitators, and solutions to adapt materials for the intervention.
RESULTS: Each site\'s process for stool-based CRC screening varied slightly. Interviewees identified the importance of offering educational materials in English and Spanish, using text messages to remind patients to return kits, adapting materials to address health literacy needs so patients can access instructions in writing, pictures, or video, creating mailed workflows integrated with a tracking system, and offering patient navigation to colonoscopy for patients with an abnormal result.
CONCLUSIONS: Proposed solutions across the three regions will inform a multilevel intervention in a pragmatic trial to increase CRC screening uptake in CHCs.
摘要：
背景：家庭结直肠癌（CRC）筛查是降低CRC死亡率的有效方法，但是医疗服务不足的人群的筛查率很低。计划实施一项务实的随机试验，比较两种基于人群的外展方法，我们在10个为医疗服务不足的群体提供服务的社区卫生中心（CHC）中，对家庭CRC筛查的当前过程和障碍进行了定性研究。马萨诸塞州和加利福尼亚州各有四个，和南达科他州的两个部落设施。
方法：我们对参与CHC的临床和管理人员进行了53次半结构化访谈。参与者被问及CRC筛查过程，分为八个领域：患者识别，外展，风险评估，粪便免疫化学测试（FIT）工作流程，FIT-DNA(即，Cologuard)工作流，转诊进行后续结肠镜检查，病人导航,和教育材料。使用快速定性分析方法分析转录本。使用矩阵将数据组织和汇总为四个子主题：当前过程，障碍,主持人，以及适应干预材料的解决方案。
结果：每个站点的基于粪便的CRC筛查过程略有不同。受访者认为提供英语和西班牙语教材的重要性，用短信提醒病人退包,调整材料以满足健康素养需求，以便患者可以获得书面说明，图片,或视频，创建与跟踪系统集成的邮寄工作流，并为结果异常的患者提供结肠镜检查的患者导航。
结论：在三个地区提出的解决方案将为一项务实试验中的多水平干预提供依据，以增加CHC的CRC筛查。
方法：我们对参与CHC的临床和管理人员进行了53次半结构化访谈。参与者被问及CRC筛查过程，分为八个领域：患者识别，外展，风险评估，粪便免疫化学测试（FIT）工作流程，FIT-DNA(即，Cologuard)工作流，转诊进行后续结肠镜检查，病人导航,和教育材料。使用快速定性分析方法分析转录本。使用矩阵将数据组织和汇总为四个子主题：当前过程，障碍,主持人，以及适应干预材料的解决方案。
结果：每个站点的基于粪便的CRC筛查过程略有不同。受访者认为提供英语和西班牙语教材的重要性，用短信提醒病人退包,调整材料以满足健康素养需求，以便患者可以获得书面说明，图片,或视频，创建与跟踪系统集成的邮寄工作流，并为结果异常的患者提供结肠镜检查的患者导航。
结论：在三个地区提出的解决方案将为一项务实试验中的多水平干预提供依据，以增加CHC的CRC筛查。
