Identifying optimal approaches to implement colorectal cancer screening through participation in a learning laboratory

Tangka, Florence; Subramanian, Sujha; DeGroff, Amy; Wong, Faye L.; Richardson, Lisa C.

doi:10.1002/cncr.31679

Cited by 4 publications

(4 citation statements)

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“…Creating linkages between healthcare-based intervention and community resources is important for reducing CRC disparities. 102,103 One reason for the difference between persons of high vs low SES could be the paucity of resources in communities that serve people of disadvantaged backgrounds to deliver CRC screening or timely follow up. A facilitation program supported by the Centers for Disease Control and Prevention reported a 5.4% higher CRC screening participation rate 1 year after the intervention, compared with baseline, but increases were smaller in clinics with small numbers of eligible patients or high numbers of uninsured patients.…”

Section: Community Resources and Community-based Interventionsmentioning

confidence: 99%

“…A facilitation program supported by the Centers for Disease Control and Prevention reported a 5.4% higher CRC screening participation rate 1 year after the intervention, compared with baseline, but increases were smaller in clinics with small numbers of eligible patients or high numbers of uninsured patients. 103 This indicates that clinic capacity and patient factors can each influence success, and highlights the need to increase our understanding of resources needs in areas where patients of low SES patients receive care.…”

Section: Community Resources and Community-based Interventionsmentioning

confidence: 99%

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Causes of Socioeconomic Disparities in Colorectal Cancer and Intervention Framework and Strategies

2020

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Colorectal cancer (CRC) disproportionately affects people from low socioeconomic backgrounds and some racial minorities. Disparities in CRC incidence and outcomes might result from differences in exposure to risk factors such as unhealthy diet and sedentary lifestyle; limited access to risk-reducing behaviors such as chemoprevention, screening, and follow up of abnormal test results; or lack of access to high-quality treatment resources. These factors operate at the individual, provider, health system, community, and policy levels to perpetuate CRC disparities. However, CRC disparities can be eliminated. Addressing the complex factors that contribute to development and progression of CRC with multicomponent, adaptive interventions, at multiple levels of the care continuum, can reduce gaps in mortality. These might be addressed with a combination of healthcare and community-based interventions and policy changes that promote healthy behaviors and ensure access to high-quality and effective measures for CRC prevention, diagnosis, and treatment. Improving resources and coordinating efforts in communities where people of low-socioeconomic status live and work would increase access to evidence-based interventions. Research is also needed to understand the role and potential mechanisms by which factors in diet, intestinal microbiome, and/or inflammation contribute to differences in colorectal carcinogenesis. Studies of large cohorts with diverse populations are needed to identify epidemiologic and molecular factors that contribute to CRC development in different populations.

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Section: Community Resources and Community-based Interventionsmentioning

confidence: 99%

Section: Community Resources and Community-based Interventionsmentioning

confidence: 99%

Causes of Socioeconomic Disparities in Colorectal Cancer and Intervention Framework and Strategies

2020

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“…CDC’s Framework for Program Evaluation was applied to design the clinic survey on which this analysis is based ( 21 ). Other components of the CRCCP evaluation include an annual survey of awardees ( 22 ), cost effectiveness studies ( 23 ), case studies, and studies to explore specific components of CRCCP ( 18 , 24 ).…”

Section: Evaluation Methodsmentioning

confidence: 99%

Evaluating Uptake of Evidence-Based Interventions in 355 Clinics Partnering With the Colorectal Cancer Control Program, 2015–2018

et al. 2022

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Purpose and Objectives Colorectal cancer screening rates remain suboptimal in the US. The Colorectal Cancer Control Program (CRCCP) of the Centers for Disease Control and Prevention (CDC) seeks to increase screening in health system clinics through implementation of evidence-based interventions (EBIs) and supporting activities (SAs). This program provided an opportunity to assess the uptake of EBIs and SAs in 355 clinics that participated from 2015 to 2018. Intervention Approach The 30 funded awardees of CRCCP partnered with clinics to implement at least 2 of 4 EBIs that CDC prioritized (patient reminders, provider reminders, reducing structural barriers, provider assessment and feedback) and 4 optional strategies that CDC identified as SAs (small media, professional development and provider education, patient navigation, and community health workers). Evaluation Methods Clinics completed 3 annual surveys to report uptake, implementation, and integration and perceived sustainability of the priority EBIs and SAs. Results In our sample of 355 clinics, uptake of 4 EBIs and 2 SAs significantly increased over time. By year 3, 82% of clinics implemented patient reminder systems, 88% implemented provider reminder systems, 82% implemented provider assessment and feedback, 76% implemented activities to reduce structural barriers, 51% implemented provider education, and 84% used small media. Most clinics that implemented these strategies (>90%) considered them fully integrated into the health system or clinic operations and sustainable by year 3. Fewer clinics used patient navigation (30%) and community health workers (19%), with no increase over the years of the study. Implications for Public Health Clinics participating in the CRCCP reported high uptake and perceived sustainability of EBIs that can be integrated into electronic medical record systems but limited uptake of patient navigation and community health workers, which are uniquely suited to reduce cancer disparities. Future research should determine how to promote uptake and assess cost-effectiveness of CRCCP interventions.

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“…16 The complexities of implementing a centralized screening outreach program and the need for staff support in doing so have been echoed in other studies of CRC screening interventions. 12,13,17 Few studies of mailed FIT program effectiveness [18][19][20][21] have analyzed factors that contributed to program implementation success. Many studies described intervention components, and some studies have outlined barriers to adapting and implementing mailed FIT outreach programs.…”

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confidence: 99%

Factors Influencing Implementation of a Colorectal Cancer Screening Improvement Program in Community Health Centers: an Applied Use of Configurational Comparative Methods

et al. 2020

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BACKGROUND: Evidence-based programs such as mailed fecal immunochemical test (FIT) outreach can only affect health outcomes if they can be successfully implemented. However, attempts to implement programs are often limited by organizational-level factors. OBJECTIVES: As part of the Strategies and Opportunities to Stop Colon Cancer in Priority Populations (STOP CRC) pragmatic trial, we evaluated how organizational factors impacted the extent to which health centers implemented a mailed FIT outreach program. DESIGN: Eight health centers participated in STOP CRC.The intervention consisted of customized electronic health record tools and clinical staff training to facilitate mailing of an introduction letter, FIT kit, and reminder letter. Health centers had flexibility in how they delivered the program. MAIN MEASURES: We categorized the health centers' level of implementation based on the proportion of eligible patients who were mailed a FIT kit, and applied configurational comparative methods to identify combinations of relevant organizational-level and program-level factors that distinguished among high, medium, and low implementing health centers. The factors were categorized according to the Consolidated Framework for Implementation Research model. KEY RESULTS: FIT tests were mailed to 21.0-81.7% of eligible participants at each health center. We identified a two-factor solution that distinguished among levels of implementation with 100% consistency and 100% coverage. The factors were having a centralized implementation team (inner setting) and mailing the introduction letter in advance of the FIT kit (intervention characteristics). Health centers with high levels of implementation had the joint presence of both factors. In health centers with medium levels of implementation, only one factor was present. Health centers with low levels of implementation had neither factor present. CONCLUSIONS: Full implementation of the STOP CRC intervention relied on a centralized implementation team with dedicated staffing time, and the advance mailing of an introduction letter. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01742065 Registered

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Identifying optimal approaches to implement colorectal cancer screening through participation in a learning laboratory

Cited by 4 publications

References 10 publications

Causes of Socioeconomic Disparities in Colorectal Cancer and Intervention Framework and Strategies

Causes of Socioeconomic Disparities in Colorectal Cancer and Intervention Framework and Strategies

Evaluating Uptake of Evidence-Based Interventions in 355 Clinics Partnering With the Colorectal Cancer Control Program, 2015–2018

Factors Influencing Implementation of a Colorectal Cancer Screening Improvement Program in Community Health Centers: an Applied Use of Configurational Comparative Methods

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