Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) in Appalachia: protocol for a group randomized, delayed intervention trial

Electra D Paskett^{1

2}, Aaron J Kruse-Diehr^{3

4}, Jill M Oliveri¹, Robin C Vanderpool⁵, Darrell M Gray^{1

2}, Michael L Pennell⁶, Bin Huang⁷, Gregory S Young⁸, Darla Fickle¹, Mark Cromo⁹, Mira L Katz^{1

10}, Paul L Reiter^{1

10}, Melinda Rogers¹¹, David A Gross¹², Vickie Fairchild¹², Wendy Xu¹³, Angela Carman⁴, Jean M Walunis¹, Ann Scheck McAlearney^{1

13

14}, Timothy R Huerta^{1

13

14}, Saurabh Rahurkar⁸, Erika Biederman¹, Mark Dignan⁹

Affiliations

¹ The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
² The Ohio State University College of Medicine, Department of Internal Medicine, Columbus, OH, USA.
³ University of Kentucky College of Medicine, Department of Family and Community Medicine, Lexington, KY, USA.
⁴ University of Kentucky Markey Cancer Center, Cancer Prevention and Control Research Program, Lexington, KY, USA.
⁵ University of Kentucky College of Public Health, Department of Health, Behavior and Society, Lexington, KY, USA.
⁶ The Ohio State University College of Public Health, Division of Biostatistics, Columbus, OH, USA.
⁷ University of Kentucky Markey Cancer Center, Division of Biostatistics, Biostatistics and Bioinformatics Shared Resource Facility, Lexington, KY, USA.
⁸ College of Medicine, Department of Biomedical Informatics.
⁹ University of Kentucky College of Medicine, Department of Internal Medicine, Lexington, KY, USA.
¹⁰ The Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, Columbus, OH, USA.
¹¹ University of Kentucky Markey Cancer Center, Community Impact Office, Lexington, KY, USA.
¹² Northeast Kentucky Area Health Education Center, Morehead, KY, USA.
¹³ The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA.
¹⁴ The Ohio State University College of Medicine, Department of Family and Community Medicine, Columbus, OH, USA.

PMID: 37202831
PMCID: PMC10538475
DOI: 10.1093/tbm/ibad017

Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) in Appalachia: protocol for a group randomized, delayed intervention trial

Electra D Paskett et al. Transl Behav Med. 2023.

. 2023 Sep 28;13(10):748-756.

doi: 10.1093/tbm/ibad017.

Authors

Affiliations

¹ The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
² The Ohio State University College of Medicine, Department of Internal Medicine, Columbus, OH, USA.
³ University of Kentucky College of Medicine, Department of Family and Community Medicine, Lexington, KY, USA.
⁴ University of Kentucky Markey Cancer Center, Cancer Prevention and Control Research Program, Lexington, KY, USA.
⁵ University of Kentucky College of Public Health, Department of Health, Behavior and Society, Lexington, KY, USA.
⁶ The Ohio State University College of Public Health, Division of Biostatistics, Columbus, OH, USA.
⁷ University of Kentucky Markey Cancer Center, Division of Biostatistics, Biostatistics and Bioinformatics Shared Resource Facility, Lexington, KY, USA.
⁸ College of Medicine, Department of Biomedical Informatics.
⁹ University of Kentucky College of Medicine, Department of Internal Medicine, Lexington, KY, USA.
¹⁰ The Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, Columbus, OH, USA.
¹¹ University of Kentucky Markey Cancer Center, Community Impact Office, Lexington, KY, USA.
¹² Northeast Kentucky Area Health Education Center, Morehead, KY, USA.
¹³ The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA.
¹⁴ The Ohio State University College of Medicine, Department of Family and Community Medicine, Columbus, OH, USA.

PMID: 37202831
PMCID: PMC10538475
DOI: 10.1093/tbm/ibad017

Abstract

Appalachian regions of Kentucky and Ohio are hotspots for colorectal cancer (CRC) mortality in the USA. Screening reduces CRC incidence and mortality; however, screening uptake is needed, especially in these underserved geographic areas. Implementation science offers strategies to address this challenge. The aim of the current study was to conduct multi-site, transdisciplinary research to evaluate and improve CRC screening processes using implementation science strategies. The study consists of two phases (Planning and Implementation). In the Planning Phase, a multilevel assessment of 12 health centers (HC) (one HC from each of the 12 Appalachian counties) was conducted by interviewing key informants, creating community profiles, identifying HC and community champions, and performing HC data inventories. Two designated pilot HCs chose CRC evidence-based interventions to adapt and implement at each level (i.e., patient, provider, HC, and community) with evaluation relative to two matched control HCs. During the Implementation Phase, study staff will repeat the rollout process in HC and community settings in a randomized, staggered fashion in the remaining eight counties/HCs. Evaluation will include analyses of electronic health record data and provider and county surveys. Rural HCs have been reluctant to participate in research because of concerns about capacity; however, this project should demonstrate that research does not need to be burdensome and can adapt to local needs and HC abilities. If effective, this approach could be disseminated to HC and community partners throughout Appalachia to encourage the uptake of effective interventions to reduce the burden of CRC.

Trial registration: ClinicalTrials.gov NCT04427527.

Keywords: Appalachia; Colorectal cancer; Group randomized trial; Implementation strategy; Multilevel interventions.

Plain language summary

We conducted a multi-site study to evaluate and improve CRC screening processes using implementation science strategies at multiple levels including the patient, provider, health center, and community. Our goals were to increase rates of guideline-recommended CRC screening, follow-up, and referral-to-care in an Appalachian, medically underserved population.

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Figures

**Fig 1**
Study design: data collection time points by county pairs and timeline.

See this image and copyright information in PMC

References

1. Appalachian Community Cancer Network. The Cancer Burden in Appalachia. In progress.
1. Pollard K, Jacobsen LA, Bureau PR.. The Appalachian Region: A Data Overview from the 2011–2015 American Community Survey. Washington, DC: Appalachian Regional Commission; 2017.
1. Siegel RL, Liora S, Anthony R, Ahmedin J.. Where can colorectal cancer screening interventions have the most impact? Cancer Epidemiol Biomarkers Prev. 2015;24(8):1151–1156. - PubMed
1. US Cancer Statistics Working Group. United States Cancer Statistics: 1999–2014 incidence and mortality web-based report; 2017. Available from: www.cdc.gov/uscs. Accessibility verified May 1, 2018.
1. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System.2014; Available from: https://www.cdc.gov/brfss/index.html.

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Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) in Appalachia: protocol for a group randomized, delayed intervention trial

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Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) in Appalachia: protocol for a group randomized, delayed intervention trial

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