Skip to main content
An official website of the United States government
Grant Details

Grant Number: 5UH3CA233251-06 Interpret this number
Primary Investigator: Reuland, Daniel
Organization: Univ Of North Carolina Chapel Hill
Project Title: Scaling Colorectal Cancer Screening Through Outreach, Referral, and Engagement (SCORE): a State-Level Program to Reduce Colorectal Cancer Burden in Vulnerable Populations
Fiscal Year: 2023


Modified Project Summary/Abstract Section PROJECT SUMMARY Despite strong evidence that colorectal cancer (CRC) screening reduces mortality, rates of CRC screening, follow-up, and referral-to-care (herein referred to as “CRC screening”) remain suboptimal in the US. In North Carolina (NC), underuse of screening contributes to particularly high CRC burden in certain regions. Community health centers (CHCs) play a critical role in providing CRC screening for these vulnerable populations. Yet, CRC screening rates in NC CHCs are well below the estimated national rate of 62%. Substantial efforts are needed to reach the national target of 80%. Because multiple patient-, provider-, and system-level factors contribute to low screening rates, multilevel interventions are needed to achieve screening targets. Accumulating evidence shows that interventions involving mailed screening outreach, practice-based screening in-reach (using patient navigators), and systematically improving colonoscopy access, all increase screening. However, in practice, CHCs face substantial resource limitations and lack the means to systematically implement a multi-level intervention of outreach, in-reach, and improved colonoscopy access for uninsured patients. Until a multi-level intervention is shown to be both effective and cost-effective from stakeholder perspectives, screening rates will remain low, leaving thousands of vulnerable patients at risk. We hypothesize that standardizing these interventions for CHCs at the state-level will yield cost-effective approaches to increasing screening. Our long-term goal is to reduce CRC burden and disparities through improved screening. Our objective here is to leverage our expertise in CRC screening intervention research, implementation science, stakeholder engagement, and modeling to achieve this goal for our state. Our central hypothesis is that a pragmatic trial assessing impacts and costs for combinations of these evidence-based interventions (EBIs) will yield one or more strategies that stakeholders find to be cost-effective and sustainable. The specific aims for our study are: Aim 1 (Planning and Exploratory Phase): Pilot test a multilevel intervention to increase CRC screening in vulnerable populations in three NC regions. In this phase, we will complete pilot studies needed for our signature trial, plan for implementation evaluation and sustainability, and develop a process for evaluating locally-developed innovative approaches for improving screening. Aim 2 (Implementation Phase): Building on Aim 1 findings, implement and evaluate multilevel CRC screening approaches in vulnerable populations in NC. In this phase, we will conduct our signature trial, assess implementation outcomes, evaluate the use of stakeholder-engaged modeling for sustaining and scaling the multilevel intervention, and select and evaluate locally-developed innovations for improving screening. This project is innovative in combining outreach and in-reach EBIs and in its use of stakeholder-engaged simulation modeling to inform sustainability. The proposed research is significant because it will have a substantial impact on CRC morbidity, mortality, and disparities in vulnerable communities.


Mail-Based Self-Sampling to Complete Colorectal Cancer Screening: Accelerating Colorectal Cancer Screening and Follow-up Through Implementation Science.
Authors: Gupta S. , Barnes A. , Brenner A.T. , Campbell J. , Davis M. , English K. , Hoover S. , Kim K. , Kobrin S. , Lance P. , et al. .
Source: Preventing chronic disease, 2023-12-07; 20, p. E112.
EPub date: 2023-12-07.
PMID: 38060411
Related Citations

Optimizing process flow diagrams to guide implementation of a colorectal cancer screening intervention in new settings.
Authors: O'Leary M.C. , Hassmiller Lich K. , Reuland D.S. , Brenner A.T. , Moore A.A. , Ratner S. , Birken S.A. , Wheeler S.B. .
Source: Cancer causes & control : CCC, 2023 Dec; 34(Suppl 1), p. 89-98.
EPub date: 2023-09-21.
PMID: 37731072
Related Citations

Uptake of colorectal cancer screening after mailed fecal immunochemical test (FIT) outreach in a newly eligible 45-49-year-old community health center population.
Authors: O'Leary M.C. , Reuland D.S. , Correa S.Y. , Moore A.A. , Malo T.L. , Tan X. , Rohweder C.L. , Wheeler S.B. , Brenner A.T. .
Source: Cancer causes & control : CCC, 2023 Dec; 34(Suppl 1), p. 125-133.
EPub date: 2023-06-10.
PMID: 37300632
Related Citations

Implementation strategies in the Exploration and Preparation phases of a colorectal cancer screening intervention in community health centers.
Authors: Ferrari R.M. , Leeman J. , Brenner A.T. , Correa S.Y. , Malo T.L. , Moore A.A. , O'Leary M.C. , Randolph C.M. , Ratner S. , Frerichs L. , et al. .
Source: Implementation science communications, 2023-09-20; 4(1), p. 118.
EPub date: 2023-09-20.
PMID: 37730659
Related Citations

Reach and effectiveness of a centralized navigation program for patients with positive fecal immunochemical tests requiring follow-up colonoscopy.
Authors: O'Leary M.C. , Reuland D.S. , Randolph C. , Ferrari R.M. , Brenner A.T. , Wheeler S.B. , Farr D.E. , Newcomer M.K. , Crockett S.D. .
Source: Preventive medicine reports, 2023 Aug; 34, p. 102211.
EPub date: 2023-04-17.
PMID: 37214164
Related Citations

Characteristics of patient navigation programs in the Cancer Moonshot ACCSIS colorectal cancer screening initiative.
Authors: Coronado G.D. , Ferrari R.M. , Barnes A. , Castañeda S.F. , Cromo M. , Davis M.M. , Doescher M.P. , English K. , Hatcher J. , Kim K.E. , et al. .
Source: Journal of the National Cancer Institute, 2023-06-08; 115(6), p. 680-694.
PMID: 36810931
Related Citations

Sociodemographic correlates of colorectal cancer screening completion among women adherent to mammography screening guidelines by place of birth.
Authors: Farr D.E. , Cofie L.E. , Brenner A.T. , Bell R.A. , Reuland D.S. .
Source: BMC women's health, 2022-04-21; 22(1), p. 125.
EPub date: 2022-04-21.
PMID: 35449050
Related Citations

Extending analytic methods for economic evaluation in implementation science.
Authors: O'Leary M.C. , Hassmiller Lich K. , Frerichs L. , Leeman J. , Reuland D.S. , Wheeler S.B. .
Source: Implementation science : IS, 2022-04-15; 17(1), p. 27.
EPub date: 2022-04-15.
PMID: 35428260
Related Citations

Centralized colorectal cancer screening outreach and patient navigation for vulnerable populations in North Carolina: study protocol for the SCORE randomized controlled trial.
Authors: Malo T.L. , Correa S.Y. , Moore A.A. , Ferrari R.M. , Leeman J. , Brenner A.T. , Wheeler S.B. , Tan X. , Reuland D.S. , Scaling Colorectal Cancer Screening Through Outreach, Referral, and Engagement (SCORE) Study Protocol Consortium .
Source: Implementation science communications, 2021-10-07; 2(1), p. 113.
EPub date: 2021-10-07.
PMID: 34620250
Related Citations

Mailed fecal immunochemical test outreach for colorectal cancer screening: Summary of a Centers for Disease Control and Prevention-sponsored Summit.
Authors: Gupta S. , Coronado G.D. , Argenbright K. , Brenner A.T. , Castañeda S.F. , Dominitz J.A. , Green B. , Issaka R.B. , Levin T.R. , Reuland D.S. , et al. .
Source: CA: a cancer journal for clinicians, 2020 Jul; 70(4), p. 283-298.
EPub date: 2020-06-25.
PMID: 32583884
Related Citations

Back to Top