PO.PR02.03 · 预防研究
一项旨在提升结直肠癌认知的社区随机对照试验的初步结果：社区遗传导航参与专家（CoGENES）项目
Preliminary results of a community-based randomized controlled trial to raise colorectal cancer awareness: The Community Genetic Navigation Engagement Specialist (CoGENES) Program
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摘要 Abstract
中文摘要
引言：在洛杉矶县（LAC）的许多社区中，对结直肠癌（CRC）预防和基因检测的知识与认知仍然有限。为解决这一问题，我们通过培训师培训项目培训了42名CRC专业社区卫生工作者（CoGENES）。我们在此展示一项社区随机对照试验（RCT）的初步结果，该试验旨在评估CoGENES提供的材料和培训的影响，作为USC由NCI资助的PE-CGS网络项目的一部分。
方法：一项双臂、单盲RCT于2024年8月启动。参与者年龄≥18岁且为洛杉矶县居民。干预包括由CoGENES提供的一次教育课程以及一份预先制定的教育手册。对照组接受标准的CRC和基因检测材料。在基线时通过经验证或团队自行开发的调查收集了人口统计学、文化适应、文化价值观与宿命论、健康素养、计算能力、一般自我效能（GSE）、基因组知识、癌症预防行为和态度等数据。在干预接受后6-12周和6-8个月进行的随访调查评估了GSE、基因组知识和癌症预防行为的变化。配对饮食变化采用McNemar检验进行评估。分别采用配对t检验和独立t检验比较各组内部和组间的基线与随访结果。
结果：共138名参与者（平均年龄=48.8岁，SD=13.6）被随机分配至干预组（n=72）或对照组（n=66），基线无差异。所有参与者均为西班牙裔/拉丁裔，大多数为女性（83%）、墨西哥人（64%）、天主教徒（61%）、已婚（50%）、完成≤11年级教育（51%），并主要说西班牙语（69%）。中期分析显示，至6-8周时，干预组参与者的饮食行为有所改善，限制加工食品摄入的比例更高（很少或从不：基线时48.6% vs 随访时69.8%；p<0.05）。我们观察到干预组在6-12周时癌症遗传知识显著改善，正确答案更多（平均差异=4.32；p<0.01），“不知道”回答更少（平均差异=-5.40；p<0.01）。这些改善大于对照组：正确答案多2.7个（p<0.01），“不知道”回答少3.25个（p<0.01）。遗传素养和理解得分也有所提高（平均差异=11.38；p<0.01），但相较于对照组的提高并不显著（双重差分=2.20；p=0.43）。
结论：我们提供了初步证据，表明在社区环境中部署经过CRC预防培训的教育者可能改善CRC遗传知识，并凸显了改善生活方式和饮食模式以降低CRC发病率的机会和意愿。
查看英文原文 English abstract
Introduction: Knowledge and awareness of colorectal cancer (CRC) prevention and genetic testing remain limited in many Los Angeles County (LAC) communities. To address this, we trained 42 CRC-specialized community health workers (CoGENES) through a train-the-trainer program. We present preliminary results of a community-based randomized controlled trial (RCT) to evaluate the impact of materials and training delivered by CoGENES as part of an NCI funded PE-CGS network program at USC.
Methods: A two-armed, single blinded RCT was launched in August 2024. Participants are ≥ 18 years of age and residents of LAC. The intervention included the delivery of an educational session by CoGENES and an a priori developed educational handbook. The control group received standard CRC and genetic testing materials. Data on demographics, acculturation, cultural values and fatalism, health literacy, numeracy, generalized self-efficacy (GSE), genomic knowledge, cancer prevention behaviors and attitudes, were collected at baseline with validated or team-developed surveys. Follow-up surveys at 6-12 weeks and 6-8 months after intervention receipt evaluate changes in GSE, genomic knowledge, and cancer prevention behaviors. Paired dietary changes were evaluated using McNemar's test. Paired t-tests and independent t-tests were used to compare baseline and follow-up results within and between arms, respectively.
Results: A total of 138 participants (mean age = 48.8 years, SD = 13.6) were randomized to the intervention (n = 72) or control (n = 66) arm, with no baseline differences. All were Hispanic/Latine, most were female (83%), Mexican (64%), Catholic (61%), married (50%), completed ≤11 th grade education (51%), and spoke primarily Spanish (69%). Interim analyses showed that by 6-8 weeks, participants in the intervention arm demonstrated improved dietary behaviors, with a higher proportion limiting processed food intake (rarely or never: 48.6% at baseline vs 69.8% at follow-up; p <0.05). We observed significant improvements in cancer genetic knowledge within the intervention arm at 6-12 weeks, with more correct answers (mean difference = 4.32; p <0.01), and fewer “don't know” responses (mean difference = -5.40; p<0.01). These improvements were greater than in the control arm: 2.7 more correct answers (p<0.01) and 3.25 fewer “don't know” responses (p<0.01). Genetic literacy and comprehension scores also improved (mean difference = 11.38; p < 0.01), though not significantly more than in the control group (difference-in-differences = 2.20; p = 0.43).
Conclusion: We present preliminary evidence that deploying CRC prevention trained educators in a community setting, may improve CRC genetic knowledge, and highlights opportunities and willingness to improve lifestyle and dietary patterns to reduce CRC incidence.
利益披露 Disclosure
D. Alvarez-Lopez, None..
J. Rodriguez, None.