Grant Number:	1R01CA299475-01 Interpret this number
Primary Investigator:	Lunze, Karsten
Organization:	Boston Medical Center
Project Title:	Development of Systems and Education for Cervical Cancer Prevention (Dose-Cc)
Fiscal Year:	2025

PROJECT SUMMARY / ABSTRACT Cervical cancer disproportionately affects Black, Hispanic, and low-income Americans. Universal screening has the potential to decrease the overall burden of cervical cancer and to reduce racial and ethnic disparities in this disease. However, more than half of the individuals who develop cervical cancer have not been screened in more than 5 years, and 20% did not follow-up after an abnormal result. To address this problem, we aim to adapt and test an intervention to improve cervical screening and follow-up in three diverse, underserved populations: urban inner city Blacks/Haitians (Boston), Hispanic immigrants (Florida), and Hawaiian Natives/Pacific Islanders (Hawaii). Our research group previously developed a successful intervention to improve HPV vaccination rates, which we plan to adapt for cervical cancer screening. The intervention combines education and quality improvement methods using a mechanism called Performance Improvement Continuing Medical Education. This type of intervention is attractive to clinicians because they are able to improve their cancer prevention practices while fulfilling requirements for maintaining board certification. When applied to HPV vaccination, the intervention improved rates by over 10 percentage points, and gains continued for over 4 years after the intervention concluded. The goal of the proposed research is to adapt the intervention to cervical cancer screening, and to evaluate its effectiveness in improving screening and follow-up after abnormal results. First, we will adapt our successful HPV vaccine intervention to address cervical cancer screening (DOSE-CC). We will interview key stakeholders to explore facilitators and barriers to screening and follow-up at the patient, clinician, and healthcare setting levels and use these findings and Advisory Board input to develop the DOSE-CC intervention. Second, we will validate DOSE-CC using a Hybrid Type 1 effectiveness-implementation, stepped-wedge randomized controlled trial design of the 6-month intervention, reaching over 40,000 patients. Third, guided by the RE-AIM QuEST framework, we will conduct semi- structured interviews of key stakeholders to examine intervention reach, adoption, implementation, maintenance and sustainability, and barriers and facilitators of intervention success. The proposed intervention represents an innovative and scalable model for promoting cancer prevention and screening activities by clinicians. Unlike programs that increase administrative burdens on busy clinicians, the proposed intervention allows clinicians to improve cancer prevention practices while simultaneously fulfilling requirements to maintain their board certification and improving the quality of cancer prevention care. It therefore has great potential for widespread dissemination.





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