Challenges to Replicating Evidence-Based Research in Real-World Settings: Training African-American peers as Patient Navigators for Colon Cancer Screening

Many cancer-prevention interventions have demonstrated effectiveness in diverse populations, but these evidenced-based findings slowly disseminate into practice. The current study describes the process of disseminating and replicating research (i.e., peer patient navigation for colonoscopy screening) in real-world settings. Two large metropolitan hospitals collaborated to replicate a peer patient navigation model within their existing navigation systems. Six African-American peer volunteers were recruited and trained to navigate patients through colonoscopy scheduling and completion. Major challenges included: (1) operating within multiple institutional settings; (2) operating within nonacademic/research infrastructures; (3) integrating into an established navigation system; (4) obtaining support of hospital staff without overburdening; and (5) competing priorities and time commitments. Bridging the gap between evidence-based research and practice is critical to eliminating many cancer health disparities; therefore, it is crucial that researchers and practitioners continue to work to achieve both diffusion and fusion of evidence-based findings. Recommendations for addressing these challenges are discussed.     

Cancer and Employment Issues: Perspectives from Cancer Patient Navigators

Among individuals diagnosed with cancer, 40 % are working-age adults who will face numerous challenges in returning to work, yet oncology providers report limited guidance and uncoordinated communication processes in addressing patients’ work-related issues. Cancer patient navigators are uniquely positioned to fill this care and communication gap due to their focus on both practical matters and clinical care. This cross-sectional study utilized survey methodology to collect quantitative and qualitative data from 58 cancer patient navigators to (1) identify patients’ cancer and employment issues that commonly challenge navigators and (2) identify the necessary training navigators felt would allow them to more effectively help patients deal with cancer and employment issues. Participants from the southeast USA were invited to complete a paper survey while in attendance at a statewide cancer patient navigator conference or online via the state comprehensive cancer coalition’s cancer patient navigator listserv. Results suggest financial burdens, work and treatment conflicts, taking unpaid leave for cancer care, and working through treatment were common concerns among their patients. Navigators also identified employment, legal, government programs, and financial resources as important training and education topics that would help them address their clients’ employment and cancer conflicts. Given the fact that employment issues remain one of the most common unmet need of survivors and the increasing presence of navigators across the USA, it is important to address the role of navigators in meeting patients’ needs regarding cancer and employment and ensure they are provide with adequate training and resources.     

A Pilot Study of Lay Health Worker Outreach and Colorectal Cancer Screening Among Chinese Americans

The research team recruited eight Chinese American (seven females, one male) lay health workers (LHWs). They received 12 h of training about colorectal cancer (CRC), its screening, and basic health education techniques. Each LHW were asked to recruit ten participants and conduct two educational sessions. Of the 81 participants recruited, 73 had not received colorectal cancer screening. Their mean age was 63.0 years, and 72.6% were women. Knowledge of colorectal cancer, its causes, and its screening increased significantly. Receipt of first colorectal cancer screening test increased from 0.0% at baseline to 55.7% for fecal occult blood tests, 7.1% for sigmoidoscopy, and 7.1% for colonoscopy. LHW outreach is feasible and may be effective in promoting CRC screening among Chinese Americans.     

大肠癌筛查方案及其实践

大肠癌发生发展大部分均有明确的癌前病变,其过程较长,为筛查发现早期病变提供了可能。故筛查是降低大肠癌发病率与死亡率的可行措施。作者对多年来进行的大肠癌筛查方案的研究进行了论述。     

Community-Based Screening Interventions for Colorectal Cancer

Abstract

This review examines issues related to population-based colorectal cancer screening and strategies to increase screening levels for all clients, particularly the elderly. Because cancer survival is inversely related to the stage of cancer at the time of detection and the costs of screening are less than the costs of treatment, screening levels are used increasingly as a measure of high-quality health care. Patients in acute and primary care settings underestimate their risk and overestimate their screening; providers also overestimate the level of screening in their patients. Strategies to increase patients' completion of screening include speaking directly with patients in the office, making follow-up telephone calls, and using behavioral health education strategies. Provider issues that may act as barriers to the completion of screenings also are discussed. Special concerns related to diverse populations (including immigrants) include issues regarding language and dialect, the appropriate use of interpreters, and the reading level of educational materials.     

重复实施结直肠癌筛查服务的效率分析

摘 要：［目的］ 了解重复开展结直肠癌筛查的成效。［方法］ 以2015—2017年上海市松江区参加结直肠癌筛查的居民为研究对象,比较不同筛查服务次数发现癌前病变和结直肠癌的情况。［结果］ 2015—2017年上海市松江区共完成结直肠癌筛查199 456人次,涉及居民137 715人,发现癌前期病变4147人,结直肠癌201人。34.16%的调查对象3年中参与了多次筛查。一次筛查完成初筛137 715人次,实施肠镜检查10 022人次,癌前病变初筛检出率为2070.94/10万,肠镜检出率为28.46%,结直肠癌初筛检出率为94.40/10万,肠镜检出率为1.30%;二次筛查完成初筛47 045人次,实施肠镜检查4142人次,癌前病变初筛检出率为2442.34/10万,肠镜检出率为27.74%,结直肠癌初筛检出率为108.41/10万,肠镜检出率为1.23%;三次筛查完成初筛14 696人次,实施肠镜检查2141人次,癌前病变初筛检出率为4191.62/10万,肠镜检出率为28.77%,结直肠癌初筛检出率为149.70/10万,肠镜检出率为1.03%。二次、三次筛查的癌前病变初筛检出率高于一次筛查,癌前病变及结直肠癌的肠镜检出率差异无统计学意义。 ［结论］ 3年内多次实施结直肠癌筛查的效率与一次筛查相近,应提高居民肠镜检查依从性,可对60岁以上男性居民提供多次筛查服务从而提高筛查效益。     

大肠癌筛查技术研究进展

大肠癌是一种患病率和发病率都很高的恶性肿瘤。对大肠癌进行筛查可进行早期诊断,降低发病率和死亡率,该文就大肠癌的早期筛查技术进行综述。     

结直肠癌筛查方法的研究进展

结直肠癌是一种常见的恶性肿瘤,存无症状人群中开展结直肠癌的筛查能够发现早期结直肠癌和一些癌前病变,积极治疗和干预后能够降低结直肠癌的发病率和死亡率.结直肠癌常用的筛查手段包括大便潜血试验、乙状结肠镜检查、全结肠镜检查和钡灌肠检查等.最近又出现了仿真结肠镜和粪便DNA检测等新的筛查方法,该文对近年来此方面的研究结果作一综述.     

大肠癌筛查研究进展

大肠癌是我国最常见的消化道肿瘤之一,且随着生活水平的提高其发病率日趋增加.大肠癌早期常无症状,一旦确诊多属中晚期.定期大肠癌筛查是有效降低大肠癌发病率和死亡率的重要方法.近年来随着分子生物学、医学影像学等技术的发展,筛查方法不断改进和创新,为大肠癌的防治提供了更多技术选择.各筛查方法因检测原理和目标的不同,效能不尽相同,全文就大肠癌常用筛查方法及研究进展进行综述.     

Colorectal Cancer Screening Among Chinese Americans

Abstract

This study examined knowledge and practices regarding screening for colorectal cancer among 312 male and 332 female Chinese Americans in Chicago's Chinatown. A Chinese translation and cultural adaptation of the Cancer Control Supplement Questionnaire from the National Health Interview Survey was used to interview the respondents, who ranged in age from 40 to 69 years. Approximately 85% of the respondents had never been screened with the fecal occult blood test (FOBT), compared with 70% of the general population-far below the 50% target set by the Healthy People 2000 program. The majority of respondents had never heard of the digital rectal examination (DRE), and approximately 20% of respondents had never had one. Fewer than half the respondents knew about the FOBT and thus had never had one, and only a third were able to identify at least one warning sign of cancer. Multiple logistic regression analyses identified educational level and knowledge of the warning signs as the significant factors influencing knowledge about DRE and FOBT. Education alone was associated with use of DRE, and age alone was associated with use of FOBT. The majority of respondents lacked a regular source of health care; thus, other sources of health information (e.g., newspapers, magazines, television, community centers) need to be supported and strengthened.     

Colorectal Cancer Screening among Asian Americans

Objectives: Colorectal cancer (CRC) is the most commonly diagnosed cancer for all US populations includingAsian Americans. CRC screening has considerable benefits to prevent CRC and reduce mortality. The purposeof this article was to review the published literature on rates of colorectal cancer screening and factors associatedwith colorectal cancer screening practice among Asian Americans. Methods: Through searching electronicreference databases from 2000 to 2013, 30 articles were found on Chinese, Filipino, Japanese, Korean, andVietnamese Americans. Findings: Asian Americans had significantly low ratesfor CRC screening; KoreanAmericans reported the lowest rates, while higher screening rates were found among Japanese Americans.Older age, longer length of stay in the US, and having a physician’s recommendation were the most commonfacilitators to receiving screening. The common inhibiting factors were financial issues, employment status,and worries/fears about the procedure. Conclusions: Despite a number of Asian Americans being vulnerableto CRC, individual Asian subgroups were underserved with CRC screening and intervention. Further studiesshould focus on each individual Asian subgroup and culturally proficient CRC screening intervention programsshould be developed for each.     

欧洲宫颈癌的普查

欧洲在开展宫颈癌普查工作至少已有30至40年。整体上看，宫颈癌死亡率明显下降。值得注意的是，欧洲一些国家年轻妇女宫颈癌发病率有上升趋势。在进一步开展宫颈癌普查工作中，亟需提高普查的效率，改善普查的价效比。     

Strategies for Increasing Colorectal Cancer Screening Among African Americans

Abstract

African Americans bear a disproportionate burden of mortality from colorectal cancer. Because the majority of excess deaths are linked to delayed detection (after the cancer has spread), interventions to promote acceptance of and compliance with screening are urgently needed. Tins article considers strategies to overcome barriers to screening for colorectal cancer among African Americans. The authors draw attention to the barriers that may be more influential among African Americans than in other groups: for example, fear of cancer, fatalism, reliance on self-care, limhed opportunities to creen, and inadequate provider-patient communication. Previous efforts to promote screening for breast cancer and other health behaviors suggest that community-based approaches designed to effect mutually reinforcing changes at the individual, community and health care system levels my be bist suited to raise awareness of colorectal cancer/promote acceptance of screening, and facilitate compliance in African American communities.