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Recruiting patients into the CDC's Colorectal Cancer Screening Demonstration Program: strategies and challenges
Jennifer E Boehm1, Elizabeth A Rohan, Judith Preissle
1Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. JBoehm@cdc.gov
Background:
In 2005, the Centers for Disease Control and Prevention (CDC) funded 5 sites as part of the Colorectal Cancer Screening Demonstration Program (CRCSDP) to provide colorectal cancer screening to low-income, uninsured, and underinsured individuals. Funded sites experienced unexpected challenges in recruiting patients for services.
Methods:
The authors conducted a longitudinal, qualitative case study of all 5 sites to document program implementation, including recruitment. Data were collected during 3 periods over the 4-year program and included interviews, document review, and observations. After coding and analyzing the data, themes were identified and triangulated across the research team. Patterns were confirmed through member checking, further validating the analytic interpretation.
Results:
During early implementation, patient enrollment was low at 4 of the 5 CRCSDP sites. Evaluators found 3 primary challenges to patient recruitment: overreliance on in-reach to National Breast and Cervical Cancer Early Detection Program patients, difficulty keeping colorectal cancer screening and the program a priority among staff at partnering primary care clinics responsible for patient recruitment, and a lack of public knowledge about the need for colorectal cancer screening among patients. To address these challenges, site staff expanded partnerships with additional primary care networks for greater reach, enhanced technical support to primary care providers to ensure more consistent patient enrollment, and developed tailored outreach and education.
Conclusions:
Removing financial barriers to colorectal cancer screening was necessary but not sufficient to reach the priority population. To optimize colorectal cancer screening, public health practitioners must work closely with the health care sector to implement evidence-based, comprehensive strategies across individual, environmental, and systems levels of society.
Insights
Colorectal cancer screening programs faced patient recruitment challenges. Addressing these required enhanced partnerships, staff support, and public education beyond just removing financial barriers.
Area of Science:
- Public Health
- Health Services Research
- Cancer Prevention
Background:
- Centers for Disease Control and Prevention (CDC) funded colorectal cancer screening demonstration program (CRCSDP) in 2005.
- Program aimed to provide screening to low-income, uninsured, and underinsured individuals.
- Funded sites encountered significant patient recruitment challenges.
Purpose of the Study:
- To document the implementation of the Colorectal Cancer Screening Demonstration Program (CRCSDP).
- To identify and analyze challenges in patient recruitment for colorectal cancer screening.
- To understand factors influencing program success in reaching the target population.
Main Methods:
- Longitudinal, qualitative case study of all 5 funded sites.
- Data collection through interviews, document review, and observations over 4 years.
- Thematic analysis and triangulation of data, confirmed by member checking.
Main Results:
- Low patient enrollment observed at 4 of 5 sites during early implementation.
- Key recruitment challenges included overreliance on existing programs, competing priorities in primary care, and low public awareness.
- Strategies to address challenges involved expanding partnerships, enhancing provider support, and targeted outreach.
Conclusions:
- Financial barriers alone are insufficient for effective colorectal cancer screening in priority populations.
- Optimizing screening requires comprehensive, multi-level strategies involving the healthcare sector.
- Public health practitioners must collaborate with healthcare to implement evidence-based interventions.
