4月9日，《内科学文献》（Archives of Internal Medicine）发表的一项研究表明，对于结直肠癌中危患者，如果仅建议其进行结肠镜检查，则患者对筛查的依从性较低，而如果让其自行从结肠镜检查和粪便潜血试验(FOBT)中选择一种，则患者对筛查的依从性较高。
在这项研究中，华盛顿大学胃肠科的John M. Inadomi博士及其同事纳入997例结直肠癌中危受试者。研究者让公共卫生诊所的初级保健医生对例行就诊的这些受试者随机提出3种结直肠癌筛查建议之一：仅进行结肠镜检查，或仅进行粪便潜血试验(FOBT)，或两者选其一。这些患者的平均年龄为58岁(50岁~79岁)，53%为女性，34%为西班牙裔，30%为亚裔(主要为华人)、18%为美国黑人、15%为白人、4%为其他人种/族裔。
在FOBT组中，医生为患者提供试剂盒，并依照患者的习惯用语(英语、西班牙语、粤语或普通话)为其提供使用说明，让其回家自行检查，同时嘱其递交所有3份样本。在结肠镜组中，也是依照患者的习惯用语为其提供有关该检查和肠道准备的标准信息。同意结肠镜检查的患者被立即安排在2周内接受检查，从而避免了通常阻碍筛查的检查前胃肠科就诊。如有必要，诊所还在检查后为患者提供专车护送回家的服务。
总体而言，共有58%的患者完成医生建议或其自行选择的结直肠癌筛查。结肠镜组完成结肠镜检查的患者比例为38.2%，显著低于FOBT组完成FOBT检查的患者比例(67.2%)和“自选”组完成自选筛查的患者比例(68.8%)。
不同人种/族裔背景的受试者的依从率存在显著差异。美国黑人的总体依从率最低(48%)，而西班牙裔(63%)和亚裔受试者(61%)的依从率最高。非白人受试者对FOBT的依从性较高，而白人受试者对结肠镜检查的依从性较高。讲西班牙语、粤语或普通话的西班牙裔和华人受试者对筛查的依从性高于讲英语的同一族裔受试者。
该研究结果表明，与让患者在结肠镜检查和FOBT中选其一的策略相比，建议患者仅进行结肠镜检查的策略实际上降低了筛查完成率。另外，在减少不利于患者获取医疗服务的障碍后，低收入的少数族裔人群对结直肠癌筛查的依从性可达到较高水平。
该研究获美国国立癌症研究所等多家机构支持。研究者声明无相关经济利益冲突。（生物谷Bioon.com）
doi:10.1001/archinternmed.2012.332
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Adherence to Colorectal Cancer Screening:A Randomized Clinical Trial of Competing Strategies
John M. Inadomi, MD, MD; Sandeep Vijan, MD, MS, MD, MS; Nancy K. Janz, PhD, PhD; Angela Fagerlin, PhD, PhD; Jennifer P. Thomas, BS, BS; Yunghui V. Lin, RN, MA, RN, MA; Roxana Muoz; Chim Lau, BA, BA; Ma Somsouk, MD, MAS, MD, MAS; Najwa El-Nachef, MD, MD; Rodney A. Hayward, MD, MD
Background Despite evidence that several colorectal cancer (CRC) screening strategies can reduce CRC mortality, screening rates remain low. This study aimed to determine whether the approach by which screening is recommended influences adherence.
Methods We used a cluster randomization design with clinic time block as the unit of randomization. Persons at average risk for development of CRC in a racially/ethnically diverse urban setting were randomized to receive recommendation for screening by fecal occult blood testing (FOBT), colonoscopy, or their choice of FOBT or colonoscopy. The primary outcome was completion of CRC screening within 12 months after enrollment, defined as performance of colonoscopy, or 3 FOBT cards plus colonoscopy for any positive FOBT result. Secondary analyses evaluated sociodemographic factors associated with completion of screening.
Results A total of 997 participants were enrolled; 58% completed the CRC screening strategy they were assigned or chose. However, participants who were recommended colonoscopy completed screening at a significantly lower rate (38%) than participants who were recommended FOBT (67%) (P < .001) or given a choice between FOBT or colonoscopy (69%) (P < .001). Latinos and Asians (primarily Chinese) completed screening more often than African Americans. Moreover, nonwhite participants adhered more often to FOBT, while white participants adhered more often to colonoscopy.
Conclusions The common practice of universally recommending colonoscopy may reduce adherence to CRC screening, especially among racial/ethnic minorities. Significant variation in overall and strategy-specific adherence exists between racial/ethnic groups; however, this may be a proxy for health beliefs and/or language. These results suggest that patient preferences should be considered when making CRC screening recommendations.
