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。