PO.PR01.02 · 预防研究
推进结直肠癌筛查的可及性与公平性：来自费城影响循环行动计划的关键洞见
Advancing access and equity in colorectal cancer screening: Key insights from Cycles of Impact Philadelphia Initiative
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：结直肠癌（CRC）是美国癌症死亡的第二大原因，由于系统性障碍和医疗不信任而对黑人美国人造成不成比例的影响。影响循环（COI）费城行动计划是结直肠癌联盟、Independence Blue Cross和宾夕法尼亚大学医学院之间的合作项目，旨在通过集中式外展、行为健康参与和社区动员的多层次整合策略来减少差异。
方法：在2022-2025年间，COI分发了2,400多个粪便免疫化学检测（FIT）试剂盒，并实施了三项关键干预措施：（1）通过主动电话、短信和导航支持，对1,888名未筛查的黑人患者进行集中式外展；（2）在一家为期28天的住院式物质使用治疗机构内整合CRC筛查，利用现场教育和激励计划；（3）通过基于信仰的活动、数字媒体宣传和医疗保健合作伙伴关系进行广泛的社区参与。
结果：在通过集中式外展联系到的1,888名患者中，97名完成了FIT（其中7名阳性），82名接受了结肠镜检查，检出腺瘤（35例）占43%，腺癌占1%。在行为健康机构中，155名符合条件的居民中有125名（81%）完成了FIT，阳性结果为13.5%，并成功转诊至结肠镜检查。在所有COI活动中，共有2,736名参与者参与，完成430次筛查，检出126例腺瘤、8例晚期肿瘤和1例IV期癌症。FIT阳性后的随访完成率平均为27.8%。
结论：以公平为导向的多层次干预措施，包括集中式导航、行为健康整合和社区合作伙伴关系，促成了对费城黑人的结直肠癌筛查和检测，这些人群原本可能不会接受筛查。在受信任的社区环境中部署导航员并建立支付方-学术界合作，创建了一种可扩展、可持续的模式，以应对结直肠癌结局中的种族差异。
查看英文原文 English abstract
Background: Colorectal cancer (CRC) is the second leading cause of cancer death in the U.S., disproportionately affecting Black Americans due to systematic barriers and medical mistrust. The Cycles of Impact (COI) Philadelphia Initiative was a collaboration between the Colorectal Cancer Alliance, Independence Blue Cross, and University of Pennsylvania Medicine designed to reduce disparities through an integrated multi-level strategy of centralized outreach, behavioral health engagement, and community activation.
Methods: Between 2022-2025, COI distributed over 2,400 fecal immunochemical test (FIT) kits and executed three key interventions: (1) centralized outreach to 1,888 unscreened Black patients through proactive phone, text messaging, and navigation support; (2) integration of CRC screening within a 28-day residential substance use treatment facility utilizing on-site education and an incentive program; and (3) broad community engagement through faith-based events, digital media campaigns, and healthcare partnerships.
Results: Out of 1,888 patients reached through centralized outreach, 97 completed FIT, with 7 positive), and 82 underwent colonoscopy, detecting adenomas in (35) 43% and adenocarcinoma in 1%. In the behavioral health facility, 125 of 155 eligible residents (81%) completed FITs, with 13.5% positive results and successful linkage to colonoscopy. Across all COI activities, 2,736 participants were engaged, 430 screenings completed, and 126 adenomas, 8 advanced neoplasms, and 1 instance of stage IV cancer detected. Follow-up completion after positive FIT averaged 27.8%.
Conclusion: Equity-driven, multi-level interventions including centralized navigation, behavioral health integration, and community partnerships led to colorectal cancer screening and detection among Black Philadelphians who may otherwise have not been screened. Deploying navigators in trusted community settings and establishing payer-academic collaborations created a scalable, sustainable model to address racial disparities in colorectal cancer outcomes.
利益披露 Disclosure
K. McNeil, None..
D. Barreto, None..
E. Phillips, None..
P. Edmonds, None..
C. Rhodes, None..
K. Williams, None.