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Published on: August 1, 2019
Community Collaboration to Advance Racial/Ethnic Equity in Colorectal Cancer Screening: Protocol for a Multilevel
Folasade P May1, Suzanne Brodney2, Jessica J Tuan3
1Department of Medicine, David Geffen School of Medicine, UCLA Ronald Reagan Medical Center, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, USA; Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 S. Charles E Young Drive, Center for Health Sciences, Suite A2-125, Los Angeles, CA 90095-6900, USA; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA; UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, 650 S. Charles E Young Drive, Center for Health Sciences, Suite A2-125, Los Angeles, CA 90095-6900, USA.
Introduction:
Colorectal cancer (CRC) screening utilization is low among low-income, uninsured, and minority populations that receive care in community health centers (CHCs). There is a need for evidence-based interventions to increase screening and follow-up care in these settings.
Methods:
A multilevel, multi-component pragmatic cluster randomized controlled trial is being conducted at 8 CHCs in two metropolitan areas (Boston and Los Angeles), with two arms: (1) Mailed FIT outreach with text reminders, and (2) Mailed FIT-DNA with patient support. We also include an additional CHC in Rapid City (South Dakota) that follows a parallel protocol for FIT-DNA but is not randomized due to lack of a comparison group. Eligible individuals in participating clinics are primary care patients ages 45-75, at average-risk for CRC, and overdue for CRC screening. Participants with abnormal screening results are offered navigation for follow-up colonoscopy and CRC risk assessment.
Results:
The primary outcome is the completion rate of CRC screening at 90 days. Secondary outcomes include the screening completion rate at 180 days and the rate of colonoscopy completion within 6 months among participants with an abnormal result. Additional goals are to enhance our understanding of facilitators and barriers to CRC risk assessment in CHC settings.
Conclusions:
This study assesses the effectiveness of two multilevel interventions to increase screening participation and follow-up after abnormal screening in under-resourced clinical settings, informing future efforts to address CRC disparities.
Trial Registration:
NCT05714644.
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