Grant Details
Grant Number: |
1UG3CA233251-01 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: |
2018 |
Abstract
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.
Publications
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 00:00:00.0; 20, p. E112.
EPub date: 2023-12-07 00:00:00.0.
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, 2023-09-21 00:00:00.0; , .
EPub date: 2023-09-21 00:00:00.0.
PMID: 37731072
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 00:00:00.0; 4(1), p. 118.
EPub date: 2023-09-20 00:00:00.0.
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 00:00:00.0.
PMID: 37214164
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, 2023-06-10 00:00:00.0; , p. 1-9.
EPub date: 2023-06-10 00:00:00.0.
PMID: 37300632
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 00:00:00.0; 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 00:00:00.0; 22(1), p. 125.
EPub date: 2022-04-21 00:00:00.0.
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 00:00:00.0; 17(1), p. 27.
EPub date: 2022-04-15 00:00:00.0.
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 00:00:00.0; 2(1), p. 113.
EPub date: 2021-10-07 00:00:00.0.
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, 2020-06-25 00:00:00.0; , .
EPub date: 2020-06-25 00:00:00.0.
PMID: 32583884
Related Citations