Implementing a Multilevel Intervention to Accelerate Colorectal Cancer Screening and Follow-up

Summary

Screening for colorectal cancer (CRC) not only detects disease early when treatment is more effective but also prevents cancer by finding and removing precancerous polyps. Because many of our nation's most disadvantaged and vulnerable individuals obtain health care at federally qualified health centers, these centers play a significant role in increasing CRC screenings among the most vulnerable populations. Furthermore, the full benefits of cancer screenings must include timely and appropriate follow-up of abnormal results. Thus, the purpose of this study is to implement a multilevel intervention to increase rates of CRC screenings, follow-ups, and referrals-to-care in federally qualified health centers (FQHCs). Also, we will examine the implementation strategies used to support the implementation process and their contribution to the adoption, implementation, and sustainment of the multilevel intervention. The multilevel intervention will target three different levels of influences: organization, provider, and individual. It will have multiple components, including provider and staff education, provider reminder, provider assessment and feedback, patient reminder, and patient navigation.

This study is a multilevel, three-phase, stepped wedge cluster randomized trial with four clusters of clinics from four different FQHCs. Our FQHC partners together have 40 primary care clinics and 130 primary care providers. During Phase 1, there will be a 3-month waiting period during which no intervention components will be implemented. After the 3-month waiting period, we will randomize two clusters of clinics to cross from the control to the intervention and the remaining two clusters to follow three months later. All clusters of clinics will stay at the same phase for nine months, followed by a 3-month transition period, and then cross over to the next phase. In Phase 1, we will implement provider and staff education sessions. In Phase 2, we will add provider reminders, patient reminders, and provider assessment and feedback. We will add patient navigation during the last phase.

Single level interventions are often insufficient at leading to sustainable changes. Multilevel interventions are needed to address multilevel contextual influences simultaneously. How to take advantage of multilevel interventions and how to implement such interventions and evaluate their effectiveness are the ultimate goals of this study.

Conditions

• Colorectal Cancer

Interventions

BEHAVIORAL

Intervention Phase 1: Provider and Staff education

In Phase 1, CRC control experts will identify critical messages on CRC, screening guidelines, and methods, and provide educational training to providers and staff in our partner FQHCs before implementing any intervention components. Additionally, the research team will provide refresher sessions and offer yearly training in CRC-relevant topics, including CRC and genetics.

BEHAVIORAL

Intervention Phase 2: Provider and staff education + Patient reminder

In Phase 2, we will add a patient reminder component using short message services (SMS) to engage and remind patients to complete the screening. For patients who use colonoscopy as a screening method, the SMS will also include instructions on bowel preparation and dietary restrictions for five days prior to the procedure.

BEHAVIORAL

Intervention Phase 3: Provider and Staff education + Patient reminder + Patient navigation

In Phase 3, we will add patient navigation services, which will address both organizational and individual barriers to obtaining screening.

Sponsors & Collaborators

• National Cancer Institute (NCI)

  collaborator NIH

• Milton S. Hershey Medical Center

  lead OTHER

Principal Investigators

• Karen Kim, MD · University of Chicago

Eligibility

Min Age

50 Years

Max Age

75 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2020-09-01

Primary Completion

2023-12-31

Completion

2023-12-31

Countries

• United States

Study Locations