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Effect of Physician Notification Regarding Nonadherence to Colorectal Cancer Screening on Patient Participation in Fecal Immunochemical Test Cancer Screening: A Randomized Clinical Trial.
关于不遵守结直肠癌筛查的医生通知对患者参与粪便免疫化学试验癌症筛查的影响: 一项随机临床试验。

摘要

Importance:Increasing participation in fecal screening tests is a major challenge in countries that have implemented colorectal cancer (CRC) screening programs.
Objective:To determine whether providing general practitioners (GPs) a list of patients who are nonadherent to CRC screening enhances patient participation in fecal immunochemical testing (FIT).
Design, Setting, and Participants:A 3-group, cluster-randomized study was conducted from July 14, 2015, to July 14, 2016, on the west coast of France, with GPs in 801 practices participating and involving adult patients (50-74 years) who were at average risk of CRC and not up-to-date with CRC screening. The final follow-up date was July 14, 2016.
Interventions:General practitioners were randomly assigned to 1 of 3 groups: 496 received a list of patients who had not undergone CRC screening (patient-specific reminders group, 10 476 patients), 495 received a letter describing region-specific CRC screening adherence rates (generic reminders group, 10 606 patients), and 455 did not receive any reminders (usual care group, 10 147 patients).
Main Outcomes and Measures:The primary end point was patient participation in CRC screening 1 year after the intervention.
Results:Among 1482 randomized GPs (mean age, 53.4 years; 576 women [38.9%]), 1446 participated; of the 33 044 patients of these GPs (mean age, 59.7 years; 17 949 women [54.3%]), follow-up at 1 year was available for 31 229 (94.5%). At 1 year, 24.8% (95% CI, 23.4%-26.2%) of patients in the specific reminders group, 21.7% (95% CI, 20.5%-22.8%) in the generic reminders group, and 20.6% (95% CI, 19.3%-21.8%) in the usual care group participated in the FIT screening. The between-group differences were 3.1% (95% CI, 1.3%-5.0%) for the patient-specific reminders group vs the generic reminders group, 4.2% (95% CI, 2.3%-6.2%) for the patient-specific reminders group vs the usual care group, and 1.1% (95% CI, -0.6% to 2.8%) for generic reminders group vs the usual care group.
Conclusions and Relevance:Providing French GPs caring for adults at average risk of CRC with a list of their patients who were not up-to-date with their CRC screening resulted in a small but significant increase in patient participation in FIT screening at 1 year compared with patients who received usual care. Providing GPs with generic reminders about regional rates of CRC screening did not increase screening rates compared with usual care.
Trial Registration:clinicaltrials.gov Identifier: NCT02515344.

译文

重要性: 在实施结直肠癌 (CRC) 筛查项目的国家,增加粪便筛查测试的参与是一项重大挑战。
目的: 确定向全科医生 (GPs) 提供一份不符合 CRC 筛查的患者名单是否能提高患者对粪便免疫化学检测 (FIT) 的参与度。
设计、设置和参与者: 从 2015年7月14日到 2016年7月14日,在法国西海岸进行了一项 3 组分组随机研究, 全球定位系统在 801 个实践中参与并涉及成年患者 (50-74 岁),他们平均有患 CRC 的风险,并且没有及时进行 CRC 筛查。最后的后续行动日期是 2016年7月14日。
干预: 全科医生被随机分配到 3 组中的 1 组: 496 的人收到了一份没有接受过 CRC 筛查的患者名单 (患者特定提醒组,10 名患者), 495 收到了一封描述特定区域 CRC 筛查依从性的信 (一般提醒组,10-606 名患者),455 没有收到任何提醒(常规护理组,10 ~ 147 例患者)。
主要结果和措施: 主要终点是患者在干预后 1 年参与 CRC 筛查。
结果: 在 1482 个随机的全科医生中 (平均年龄 53.4 岁; 576 名女性 [38.9%]),1446 人参加了; 在这些全科医生的 33 名患者中 (平均年龄 59.7 岁; 54.3% 94.5% 女性 []),() 提供 1 年的随访。一年后,24.8% (95% CI,23.4%-26.2%) 的患者在特定提醒组,21.7% (95% CI,20.5%-22.8%) 在一般提醒组, 常规护理组中有 20.6% (95% CI,19.3%-21.8%) 参与了 FIT 筛查。患者特异性提醒组与一般提醒组的组间差异为 3.1% (95% CI,1.3%-5.0%),4.2% (95% CI,2.3%-6.2%) 对于患者特定提醒组与常规护理组,以及一般提醒组与常规护理组的 1.1% (95% CI,-0.6% 至 2.8%)。
结论和相关性: 为有 CRC 平均风险的成年人提供法国全科医生护理,并提供一份未及时进行 CRC 筛查的患者名单,结果是在 1 岁时,患者参与 FIT 筛查的人数略有增加,但显著增加与接受常规护理的患者相比。与常规护理相比,向全球定位系统提供关于区域 CRC 筛查率的一般提醒并没有提高筛查率。
试验注册: clinicaltrials.gov 标识符: nct02515344。

Fecal Immunochemical Test

消化 大肠癌程序性筛查 诊断方式
概述  :  

粪便免疫化学检测法FIT(fical immunochemical test,FIT) 是利用单克隆或多克隆抗体直接检测人粪便中的血红蛋白,不受进食食物的影响。定性 FIT 是在粪便中血红蛋白含量超过一定阈值后会产生可视性的颜色变化,定量 FIT 则可测量数值,当超过一定的正常值范围后被定义为阳性。 适应症可用于大肠癌程序性筛查。 临床应用(1)推荐每年1次采样进行FIT检查;(2)推荐选择定量检测方法而非定性检测方法;(3)建议选择较低的阈值(如20μg/g或

fical 英 [ˈfiːkl] 美 [ˈfiːkl]

释义   adj. 排泄物的;残渣的;糟粕的

例句   Fecal matter should move through your colon easily and in a short time. 粪便的问题应该通过您的结肠容易在很短的时间。

 

immunochemical 英 [,ɪmjʊnəʊ'kemɪkəl]

释义   adj. 免疫化学的

例句   Within the last year, have you had a fecal occult blood test (FOBT) or a fecal immunochemical test (FIT)? 过去一年内,是否曾接受过大便隐血测试或大便免疫化学测试?

 

test 英 [test]

释义   n. 测验,考查;测试;检验;化验

v. 测验;化验,检查;试验,测试;考验

例句   You should test for the overload at each point of the cycle. 您应当在周期的每个时刻都测试超负荷。


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