Community Collaboration to Advance Racial/Ethnic Equity in Colorectal Cancer Screening: Protocol for a Multilevel Intervention to Improve Screening and Follow-up in Community Health Centers

Folasade P May¹, Suzanne Brodney², Jessica J Tuan³, Sapna Syngal⁴, Andrew T Chan⁵, Beth Glenn⁶, Gina Johnson⁷, Yuchiao Chang⁸, David A Drew⁹, Beverly Moy¹⁰, Nicolette J Rodriguez¹¹, Erica T Warner¹², Adjoa Anyane-Yeboa⁹, Chinedu Ukaegbu¹³, Anjelica Q Davis¹⁴, Kimberly Schoolcraft¹⁴, Susan Regan², Nathan Yoguez⁹, Samantha Kuney¹⁵, Kelley Le Beaux⁷, Catherine Jeffries⁷, Ellen T Lee², Roopa Bhat², Jennifer S Haas¹⁶

Affiliations

¹ Department of Medicine, David Geffen School of Medicine, UCLA Ronald Reagan Medical Center, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, USA; Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 S. Charles E Young Drive, Center for Health Sciences, Suite A2-125, Los Angeles, CA 90095-6900, USA; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA; UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, 650 S. Charles E Young Drive, Center for Health Sciences, Suite A2-125, Los Angeles, CA 90095-6900, USA.
² Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
³ UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, 650 S. Charles E Young Drive, Center for Health Sciences, Suite A2-125, Los Angeles, CA 90095-6900, USA.
⁴ Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA, USA; Population Sciences and Cancer Genetics and Prevention Divisions, Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
⁵ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁶ UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, 650 S. Charles E Young Drive, Center for Health Sciences, Suite A2-125, Los Angeles, CA 90095-6900, USA; Department of Health Policy and Management, UCLA Fielding School of Public Health, United States of America; UCLA Center for Cancer Prevention and Control Research, UCLA Jonsson Comprehensive Cancer Center, UCLA School of Public Health, Los Angeles, CA 90095-6900, USA.
⁷ Community Health Prevention Programs, Great Plains Tribal Leaders Health Board, Rapid City, SD, USA.
⁸ Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
⁹ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
¹⁰ Division of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
¹¹ Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
¹² Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
¹³ Population Sciences and Cancer Genetics and Prevention Divisions, Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
¹⁴ Fight Colorectal Cancer, 134 Park Central Sq. Ste 210, Springfield, MO 65806, USA.
¹⁵ Population Sciences and Cancer Genetics and Prevention Divisions, Dana Farber Cancer Institute, Boston, MA, USA.
¹⁶ Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: Jennifer.Haas@mgh.harvard.edu.

PMID: 39068985
DOI: 10.1016/j.cct.2024.107639

Free article

Community Collaboration to Advance Racial/Ethnic Equity in Colorectal Cancer Screening: Protocol for a Multilevel Intervention to Improve Screening and Follow-up in Community Health Centers

Folasade P May et al. Contemp Clin Trials. 2024 Oct.

Free article

. 2024 Oct:145:107639.

doi: 10.1016/j.cct.2024.107639. Epub 2024 Jul 26.

Authors

Affiliations

¹ Department of Medicine, David Geffen School of Medicine, UCLA Ronald Reagan Medical Center, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, USA; Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 S. Charles E Young Drive, Center for Health Sciences, Suite A2-125, Los Angeles, CA 90095-6900, USA; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA; UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, 650 S. Charles E Young Drive, Center for Health Sciences, Suite A2-125, Los Angeles, CA 90095-6900, USA.
² Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
³ UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, 650 S. Charles E Young Drive, Center for Health Sciences, Suite A2-125, Los Angeles, CA 90095-6900, USA.
⁴ Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA, USA; Population Sciences and Cancer Genetics and Prevention Divisions, Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
⁵ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁶ UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, 650 S. Charles E Young Drive, Center for Health Sciences, Suite A2-125, Los Angeles, CA 90095-6900, USA; Department of Health Policy and Management, UCLA Fielding School of Public Health, United States of America; UCLA Center for Cancer Prevention and Control Research, UCLA Jonsson Comprehensive Cancer Center, UCLA School of Public Health, Los Angeles, CA 90095-6900, USA.
⁷ Community Health Prevention Programs, Great Plains Tribal Leaders Health Board, Rapid City, SD, USA.
⁸ Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
⁹ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
¹⁰ Division of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
¹¹ Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
¹² Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
¹³ Population Sciences and Cancer Genetics and Prevention Divisions, Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
¹⁴ Fight Colorectal Cancer, 134 Park Central Sq. Ste 210, Springfield, MO 65806, USA.
¹⁵ Population Sciences and Cancer Genetics and Prevention Divisions, Dana Farber Cancer Institute, Boston, MA, USA.
¹⁶ Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: Jennifer.Haas@mgh.harvard.edu.

PMID: 39068985
DOI: 10.1016/j.cct.2024.107639

Abstract

Introduction: Colorectal cancer (CRC) screening utilization is low among low-income, uninsured, and minority populations that receive care in community health centers (CHCs). There is a need for evidence-based interventions to increase screening and follow-up care in these settings.

Methods: A multilevel, multi-component pragmatic cluster randomized controlled trial is being conducted at 8 CHCs in two metropolitan areas (Boston and Los Angeles), with two arms: (1) Mailed FIT outreach with text reminders, and (2) Mailed FIT-DNA with patient support. We also include an additional CHC in Rapid City (South Dakota) that follows a parallel protocol for FIT-DNA but is not randomized due to lack of a comparison group. Eligible individuals in participating clinics are primary care patients ages 45-75, at average-risk for CRC, and overdue for CRC screening. Participants with abnormal screening results are offered navigation for follow-up colonoscopy and CRC risk assessment.

Results: The primary outcome is the completion rate of CRC screening at 90 days. Secondary outcomes include the screening completion rate at 180 days and the rate of colonoscopy completion within 6 months among participants with an abnormal result. Additional goals are to enhance our understanding of facilitators and barriers to CRC risk assessment in CHC settings.

Conclusions: This study assesses the effectiveness of two multilevel interventions to increase screening participation and follow-up after abnormal screening in under-resourced clinical settings, informing future efforts to address CRC disparities.

Trial registration: NCT05714644.

Keywords: cancer prevention; cancer screening; disparities; equity; multilevel intervention.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Folasade P. May: Exact Sciences: Advisory Board Sapna Syngal: inventor of the PREMM model (the intellectual property of which is owned by Dana-Farber Cancer Institute); research funding by Exact Sciences, Biological Dynamics, Inc.; consultant for Natera, Inc.

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Community Collaboration to Advance Racial/Ethnic Equity in Colorectal Cancer Screening: Protocol for a Multilevel Intervention to Improve Screening and Follow-up in Community Health Centers

Affiliations

Community Collaboration to Advance Racial/Ethnic Equity in Colorectal Cancer Screening: Protocol for a Multilevel Intervention to Improve Screening and Follow-up in Community Health Centers

Authors

Affiliations

Abstract

Conflict of interest statement

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Associated data

LinkOut - more resources

Full Text Sources

Medical