Grant Number:	2R01CA121125-06 Interpret this number
Primary Investigator:	Green, Beverly
Organization:	Kaiser Foundation Health Plan Of Washington
Project Title:	Systems of Support (SOS) to Increase Colon Cancer Screening and Follow-Up
Fiscal Year:	2013

DESCRIPTION (provided by applicant): The lifetime risk of colorectal cancer is over 5% in the United States where, despite recent declines in incidence and mortality, colorectal cancer remains the second highest cause of cancer death. Better treatments have improved survival rates, but morbidity and mortality could be more rapidly and cost-effectively reduced by achieving higher uptake and long-term adherence to colorectal cancer screening. The Systems of Support to Decrease Colorectal Cancer (SOS) study successfully advanced colorectal screening. SOS was a 4-arm randomized controlled trial that leveraged electronic health record data and automated systems to implement stepwise increases in screening support. Patients due for screening (n=4675) were randomized to (1) Usual Care, (2) Automated care (automated mailings and fecal occult blood tests), (3) automated plus assisted care from medical assistants (phone reminders and sending orders to physicians to sign), or (4) automated + assisted + navigated care from registered nurses (follow-up until test completion). Interventions were repeated in year 2. Compared to usual care, intervention patients were more likely to be current for colorectal cancer screening in both study years, with increases by intervention intensity: Usual Care 26.5%, Automated 50.7%, Assisted 57.7%, and Navigated 64.4% (P<.001). We propose to improve and continue SOS interventions up to 10 years and measure their effects on long-term adherence and outcomes. We will: 1. Identify factors related to low or non-adherence to screening despite receiving continued interventions and apply these findings to a stepped intervention to increase uptake and long-term adherence of screening. 2. Assess the effectiveness of the SOS interventions on long-term screening adherence up to 10 years. 3. Describe the impact of SOS interventions on colorectal cancer-related costs and clinical outcomes.




A Centralized Program with Stepped Support Increases Adherence to Colorectal Cancer Screening Over 9 Years: a Randomized Trial.
Authors: Green B.B. , Anderson M.L. , Cook A.J. , Chubak J. , Fuller S. , Meenan R.T. , Vernon S.W. .
Source: Journal of general internal medicine, 2022 Apr; 37(5), p. 1073-1080.
EPub date: 2021-05-28.
PMID: 34047921
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Patients' Reactions to Being Offered Financial Incentives to Increase Colorectal Screening: A Qualitative Analysis.
Authors: Shay L.A. , Kimbel K.J. , Dorsey C.N. , Jauregui L.C. , Vernon S.W. , Kullgren J.T. , Green B.B. .
Source: American journal of health promotion : AJHP, 2021 Mar; 35(3), p. 421-429.
EPub date: 2021-01-28.
PMID: 33504161
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Methodologic Considerations in Calculating and Analyzing Proportion of Time Covered as a Measure of Longitudinal Cancer Screening Adherence.
Authors: Chubak J. , Anderson M.L. , Cook A.J. , Murphy C.C. , Jackson M.L. , Green B.B. .
Source: Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2020 Aug; 29(8), p. 1549-1556.
EPub date: 2020-05-28.
PMID: 32467346
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Financial Incentives to Increase Colorectal Cancer Screening Uptake and Decrease Disparities: A Randomized Clinical Trial.
Authors: Green B.B. , Anderson M.L. , Cook A.J. , Chubak J. , Fuller S. , Kimbel K.J. , Kullgren J.T. , Meenan R.T. , Vernon S.W. .
Source: JAMA network open, 2019-07-03; 2(7), p. e196570.
EPub date: 2019-07-03.
PMID: 31276178
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Using a continuum of hybrid effectiveness-implementation studies to put research-tested colorectal screening interventions into practice.
Authors: Green B.B. , Coronado G.D. , Schwartz M. , Coury J. , Baldwin L.M. .
Source: Implementation science : IS, 2019-05-29; 14(1), p. 53.
EPub date: 2019-05-29.
PMID: 31142348
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Colorectal Cancer Control: Where Have We Been and Where Should We Go Next?
Authors: Green B.B. .
Source: JAMA internal medicine, 2018-12-01; 178(12), p. 1658-1660.
PMID: 30326022
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A centralized mailed program with stepped increases of support increases time in compliance with colorectal cancer screening guidelines over 5 years: A randomized trial.
Authors: Green B.B. , Anderson M.L. , Cook A.J. , Chubak J. , Fuller S. , Meenan R.T. , Vernon S.W. .
Source: Cancer, 2017-11-15; 123(22), p. 4472-4480.
EPub date: 2017-07-28.
PMID: 28753230
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Taxonomy for colorectal cancer screening promotion: Lessons from recent randomized controlled trials.
Authors: Ritvo P. , Myers R.E. , Serenity M. , Gupta S. , Inadomi J.M. , Green B.B. , Jerant A. , Tinmouth J. , Paszat L. , Pirbaglou M. , et al. .
Source: Preventive medicine, 2017 Aug; 101, p. 229-234.
EPub date: 2016-12-24.
PMID: 28024865
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Reasons for never and intermittent completion of colorectal cancer screening after receiving multiple rounds of mailed fecal tests.
Authors: Green B.B. , BlueSpruce J. , Tuzzio L. , Vernon S.W. , Aubree Shay L. , Catz S.L. .
Source: BMC public health, 2017-05-30; 17(1), p. 531.
EPub date: 2017-05-30.
PMID: 28558663
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A Quality Improvement Initiative to Increase Colorectal Cancer (CRC) Screening: Collaboration between a Primary Care Clinic and Research Team.
Authors: Green B.B. , Fuller S. , Anderson M.L. , Mahoney C. , Mendy P. , Powell S.L. .
Source: Journal of family medicine, 2017; 4(3), .
EPub date: 2017-04-05.
PMID: 29399669
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Colorectal Cancer Screening Rates Increased after Exposure to the Patient-Centered Medical Home (PCMH).
Authors: Green B.B. , Anderson M.L. , Chubak J. , Baldwin L.M. , Tuzzio L. , Catz S. , Cole A. , Vernon S.W. .
Source: Journal of the American Board of Family Medicine : JABFM, 2016 Mar-Apr; 29(2), p. 191-200.
PMID: 26957375
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Impact of continued mailed fecal tests in the patient-centered medical home: Year 3 of the Systems of Support to Increase Colon Cancer Screening and Follow-Up randomized trial.
Authors: Green B.B. , Anderson M.L. , Chubak J. , Fuller S. , Meenan R.T. , Vernon S.W. .
Source: Cancer, 2016-01-15; 122(2), p. 312-21.
EPub date: 2015-10-21.
PMID: 26488332
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An economic evaluation of colorectal cancer screening in primary care practice.
Authors: Meenan R.T. , Anderson M.L. , Chubak J. , Vernon S.W. , Fuller S. , Wang C.Y. , Green B.B. .
Source: American journal of preventive medicine, 2015 Jun; 48(6), p. 714-21.
PMID: 25998922
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Results of nurse navigator follow-up after positive colorectal cancer screening test: a randomized trial.
Authors: Green B.B. , Anderson M.L. , Wang C.Y. , Vernon S.W. , Chubak J. , Meenan R.T. , Fuller S. .
Source: Journal of the American Board of Family Medicine : JABFM, 2014 Nov-Dec; 27(6), p. 789-95.
PMID: 25381076
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Longitudinal predictors of colorectal cancer screening among participants in a randomized controlled trial.
Authors: Murphy C.C. , Vernon S.W. , Haddock N.M. , Anderson M.L. , Chubak J. , Green B.B. .
Source: Preventive medicine, 2014 Sep; 66, p. 123-30.
EPub date: 2014-06-15.
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"BeneFITs" to increase colorectal cancer screening in priority populations.
Authors: Green B.B. , Coronado G.D. .
Source: JAMA internal medicine, 2014 Aug; 174(8), p. 1242-3.
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Time to screening in the systems of support to increase colorectal cancer screening trial.
Authors: Wang C.Y. , de Dieu Tapsoba J. , Anderson M.L. , Vernon S.W. , Chubak J. , Fuller S. , Green B.B. .
Source: Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2014 Aug; 23(8), p. 1683-8.
EPub date: 2014-06-02.
PMID: 24891548
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Challenges and possible solutions to colorectal cancer screening for the underserved.
Authors: Gupta S. , Sussman D.A. , Doubeni C.A. , Anderson D.S. , Day L. , Deshpande A.R. , Elmunzer B.J. , Laiyemo A.O. , Mendez J. , Somsouk M. , et al. .
Source: Journal of the National Cancer Institute, 2014 Apr; 106(4), p. dju032.
EPub date: 2014-03-28.
PMID: 24681602
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Psychological distress after a positive fecal occult blood test result among members of an integrated healthcare delivery system.
Authors: Laing S.S. , Bogart A. , Chubak J. , Fuller S. , Green B.B. .
Source: Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2014 Jan; 23(1), p. 154-9.
EPub date: 2013-11-12.
PMID: 24220914
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Uptake and positive predictive value of fecal occult blood tests: A randomized controlled trial.
Authors: Chubak J. , Bogart A. , Fuller S. , Laing S.S. , Green B.B. .
Source: Preventive medicine, 2013 Nov; 57(5), p. 671-8.
EPub date: 2013-09-09.
PMID: 24029556
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An automated intervention with stepped increases in support to increase uptake of colorectal cancer screening: a randomized trial.
Authors: Green B.B. , Wang C.Y. , Anderson M.L. , Chubak J. , Meenan R.T. , Vernon S.W. , Fuller S. .
Source: Annals of internal medicine, 2013-03-05; 158(5 Pt 1), p. 301-11.
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Nonparticipation in a population-based trial to increase colorectal cancer screening.
Authors: Green B.B. , Bogart A. , Chubak J. , Vernon S.W. , Morales L.S. , Meenan R.T. , Laing S.S. , Fuller S. , Ko C. , Wang C.Y. .
Source: American journal of preventive medicine, 2012 Apr; 42(4), p. 390-7.
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The hypertension team: the role of the pharmacist, nurse, and teamwork in hypertension therapy.
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Source: Journal of clinical hypertension (Greenwich, Conn.), 2012 Jan; 14(1), p. 51-65.
EPub date: 2011-11-28.
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Systems of support to increase colorectal cancer screening and follow-up rates (SOS): design, challenges, and baseline characteristics of trial participants.
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Source: Contemporary clinical trials, 2010 Nov; 31(6), p. 589-603.
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