||5R01CA247642-03 Interpret this number
||Alaska Native Tribal Health Consortium
||Randomized Controlled Trial of the Stool DNA Test to Improve Colorectal Cancer Screening Among Alaska Native People
Only 59% (29-73%) of Alaska Native people have been adequately screened for colorectal cancer (CRC),
which could save lives, despite having the highest reported incidence of CRC in the world. A new at-home
multi-target stool DNA screening test (MT-sDNA; Cologuard®) with high sensitivity for pre-cancerous polyps
and CRC is now available. MT-sDNA has not been tested for feasibility or acceptability within the Alaska tribal
health care delivery system, and it is unknown whether use of this new test will increase Alaska Native CRC
screening rates. Our long-term goal is to improve screening and reduce CRC-attributable mortality. The
objective of this application is to test the effectiveness of MT-sDNA for increasing CRC screening in Alaska
Native communities using a mixed methods, community-based participatory research (CBPR) approach. The
study will be conducted in collaboration with regional Tribal health organizations who are responsible for
providing health care to geographically remote Alaska Native communities. This research has been requested
by Tribal organizations. Although the proposed implementation strategy is evidence-informed and promising, it
is novel in that MT-sDNA has not been evaluated in the tribal health setting or among rural/remote populations.
Using the Social Ecological Model, our research will be multi-level, examining influence on patients, providers,
and tribal health organizations (THOs). This research study will pursue two specific aims: (1) Identify patient-,
provider-, and system-level factors associated with CRC screening preferences, uptake, and follow-up; and (2)
test the effectiveness of graded intensity MT-sDNA intervention in the Alaska Native community setting. For
the first aim, focus groups with Alaska Native people who are non- or inadequately adherent to CRC screening
guidelines, and surveys and interviews with healthcare providers will be used to identify individual,
interpersonal (provider), and health system factors for future intervention. For the second aim, a three-arm
cluster randomized controlled trial (high intensity with patient navigation, medium intensity with mailed
reminders, usual care) will provide evidence on the usefulness of MT-sDNA in remote tribal communities as
well as the first data on MT-sDNA diagnostic follow up adherence rates in the Alaska Native population. This
aim will also provide evidence on the usability of MT-sDNA in the Alaska setting by evaluating MT-sDNA
sample quality and neoplastic yield, which will inform plans to scale-up the intervention model. This project is
innovative because an effective strategy for achieving higher screening rates than current practice could lead
to increased prevention or early detection of CRC cases among Alaska Native people. The proposed research
is significant because it will address a health disparity of community concern. This research has the potential to
sustainably improve public health by increasing CRC screening rates among a rural/remote tribal population as
well as provide a model for other integrated health systems that provide care to high-risk or underserved
populations in the U.S. and worldwide.
Provider- and System-Level Barriers and Facilitators to Colonoscopy and Multi-Target Stool DNA for Colorectal Cancer Screening in Rural/Remote Alaska Native Communities.
, Toffolon M.
, Flanagan C.
, Kisiel J.
, Kaur J.S.
, Jeffries L.
, Zenku M.
, Lent J.
, Bachtold J.
International journal of environmental research and public health, 2023-11-07; 20(22), .
Development of a colorectal cancer screening intervention for Alaska Native people during a pandemic year.
, Finney Rutten L.J.
, Kisiel J.B.
, Lent J.K.
, Bachtold J.F.
, Swartz A.W.
, Redwood D.G.
Contemporary clinical trials communications, 2022 Dec; 30, p. 101016.