■生活在农村地区的妇女的乳房比率较低,子宫颈,与生活在城市环境中的女性相比,结直肠癌筛查。
■为了评估(1)邮寄的比较有效性,量身定制的数字视频光盘(DVD)干预;(2)DVD干预加电话患者导航(DVD/PN);(3)常规护理,同时增加对任何乳房的依从性,子宫颈,和在基线时不是最新的结直肠癌筛查,并评估成本效益。
这项随机临床试验招募并随访了来自印第安纳州农村和俄亥俄州(基于社区)的女性,她们在任何或所有推荐的癌症筛查中都没有最新的数据。参与者在2016年11月28日至2019年7月1日之间被随机分配到3个研究组中的1个(DVD,DVD/PN,或常规护理)。统计分析在2021年8月至12月以及2022年3月至9月之间完成。
■DVD以交互方式评估并提供健康信念的信息,包括发展目标癌症和障碍的风险,好处,以及获得所需筛查的自我效能感。患者导航员就获得筛查的障碍向妇女提供咨询。干预措施同时支持在基线时对指南之外的所有或任何测试进行筛查。
■从基线到12个月接收任何或所有需要的癌症筛查,包括乳房,子宫颈,和结肠直肠癌,以及干预措施的成本效益。二元逻辑回归用于比较随机分组在12个月时所有和任何筛查的最新情况。
■样本包括963名50至74岁的女性(平均[SD]年龄,58.6[6.3]年)。DVD组获得所有需要的筛查的几率几乎是常规护理组的两倍(优势比[OR],1.84;95%CI,1.02-3.43;P=0.048),DVD/PN的赔率比常规护理高出近6倍(或,5.69;95%CI,3.24-10.5;P<.001)。DVD/PN干预(但不是单独的DVD)比常规护理(OR,4.01;95%CI,2.60-6.28;P<.001)促进至少1(即,任何)12个月时需要的筛查。迄今为止,DVD组中每位女性的成本效益为14462美元,DVD/PN组中为10638美元。
■在这项针对农村妇女的随机临床试验中,这些妇女至少没有进行过一项推荐的癌症筛查(乳腺癌,子宫颈,或结直肠),旨在同时增加对任何或所有3种癌症筛查测试的依从性的干预措施比常规护理更有效,以相对适中的成本提供,并且能够远程交付,展示了在美国中西部偏远地区实施循证干预的巨大潜力。
■ClinicalTrials.gov标识符:NCT02795104。
Women living in rural areas have lower rates of breast, cervical, and colorectal cancer screening compared with women living in urban settings.
To assess the comparative effectiveness of (1) a mailed, tailored digital video disc (DVD) intervention; (2) a DVD intervention plus telephonic patient navigation (DVD/PN); and (3) usual care with simultaneously increased adherence to any breast, cervical, and colorectal cancer screening that was not up to date at baseline and to assess cost-effectiveness.
This randomized clinical
trial recruited and followed up women from rural
Indiana and Ohio (community based) who were not up to date on any or all recommended cancer screenings. Participants were randomly assigned between November 28, 2016, and July 1, 2019, to 1 of 3
study groups (DVD, DVD/PN, or usual care). Statistical analyses were completed between August and December 2021 and between March and September 2022.
The DVD interactively assessed and provided messages for health beliefs, including risk of developing the targeted cancers and barriers, benefits, and self-efficacy for obtaining the needed screenings. Patient navigators counseled women on barriers to obtaining screenings. The intervention simultaneously supported obtaining screening for all or any tests outside of guidelines at baseline.
Receipt of any or all needed cancer screenings from baseline through 12 months, including breast, cervical, and colorectal cancer, and cost-effectiveness of the intervention. Binary logistic regression was used to compare the randomized groups on being up to date for all and any screenings at 12 months.
The sample included 963 women aged 50 to 74 years (mean [SD] age, 58.6 [6.3] years). The DVD group had nearly twice the odds of those in the usual care group of obtaining all needed screenings (odds ratio [OR], 1.84; 95% CI, 1.02-3.43; P = .048), and the odds were nearly 6 times greater for DVD/PN vs usual care (OR, 5.69; 95% CI, 3.24-10.5; P < .001). The DVD/PN intervention (but not DVD alone) was significantly more effective than usual care (OR, 4.01; 95% CI, 2.60-6.28; P < .001) for promoting at least 1 (ie, any) of the needed screenings at 12 months. Cost-effectiveness per woman who was up to date was $14 462 in the DVD group and $10 638 in the DVD/PN group.
In this randomized clinical
trial of rural women who were not up to date with at least 1 of the recommended cancer screenings (breast, cervical, or colorectal), an intervention designed to simultaneously increase adherence to any or all of the 3 cancer screening tests was more effective than usual care, available at relatively modest costs, and able to be remotely delivered, demonstrating great potential for implementing an evidence-based intervention in remote areas of the midwestern US.
ClinicalTrials.gov Identifier: NCT02795104.