文章：

农村初级保健实践中通过患者导航进行结肠镜检查随访的结直肠癌筛查推广定性结果

Qualitative Outcomes of Colorectal Cancer Screening Outreach Using Patient Navigation to Follow-Up Colonoscopy in Rural Primary Care Practices

原文发布日期：6 November 2025

DOI: 10.3390/cancers17213590

类型: Article

开放获取: 是

英文摘要：

Background/Objectives:Despite its effectiveness, colorectal cancer (CRC) screening rates are suboptimal in the United States. Navigating patients towards complete CRC screening can be effective in addressing barriers. However, to date, much research on patient navigation has occurred in urban settings or large health systems, thereby missing some populations that could benefit the most.Methods:We report on a patient navigation program delivered by clinic staff during a large pragmatic study to improve CRC screening in rural Medicaid populations. We use qualitative and implementation data from interviews, contract logs, and tracking systems to explore the context, barriers, and facilitators of patient navigation, as well as feasibility and acceptability for rural primary care clinic partners.Results:A total of 35 patients were eligible for navigation following an abnormal FIT (n= 26, 74%) or due to higher CRC risk (n= 9, 24%); only 8 of the 14 intervention clinics (57%) had any eligible patients. Of the 26 patients who needed navigation following an abnormal FIT, 13 patients (50%) received navigation, and 3 (23%) completed a colonoscopy; all 9 of the higher-risk patients received navigation, but none completed colonoscopy. Several barriers impacted adherence to the navigation protocol, such as staffing disruptions, limited colonoscopy availability, patient mistrust, and data tracking limitations. Our findings also highlight implementation facilitators, including protocol adaptations and cross-team collaborations for low-volume settings.Conclusions:Future models to increase patient navigation in rural settings could include more centralized system-level interventions that build on relationships between clinics and colonoscopy providers or payers and leverage quality improvement best practices.

摘要翻译： 

背景/目的：尽管结直肠癌筛查效果显著，但其在美国的筛查率仍不理想。通过患者导航引导患者完成结直肠癌筛查可有效应对筛查障碍。然而，目前多数关于患者导航的研究集中于城市环境或大型医疗系统，未能覆盖部分可能获益最大的群体。 方法：本研究报告了一项在大型实效性研究中由诊所工作人员实施的患者导航项目，旨在提升农村医疗补助人群的结直肠癌筛查率。我们通过访谈记录、项目日志及追踪系统的定性数据与实施数据，深入探讨患者导航的实施背景、障碍因素与促进条件，并评估其对农村基层医疗诊所合作方的可行性与可接受度。 结果：共有35名患者符合导航条件，其中26人（74%）因粪便免疫化学检测结果异常，9人（24%）因结直肠癌高风险状态需接受导航；14家参与干预的诊所中仅8家（57%）存在符合条件患者。在26名因检测异常需导航的患者中，13人（50%）接受了导航服务，其中3人（23%）完成了结肠镜检查；所有9名高风险患者均接受导航，但无人完成结肠镜检查。人员配置变动、结肠镜检查资源有限、患者信任缺失及数据追踪不足等多重障碍影响了导航方案的执行依从性。研究同时发现实施促进因素，包括针对低筛查量环境的方案适应性调整及跨团队协作机制。 结论：未来提升农村地区患者导航覆盖的模型可纳入更多系统层面的集中干预措施，这些措施应基于诊所与结肠镜检查服务方或支付方建立的合作关系，并充分利用质量改进的最佳实践。

原文链接：

Qualitative Outcomes of Colorectal Cancer Screening Outreach Using Patient Navigation to Follow-Up Colonoscopy in Rural Primary Care Practices