A Framework for Advancing Colorectal Cancer Screening, Follow-Up, and Care Delivery for All

Increasing colorectal cancer (CRC) screening requires delivery and adaptation of evidence-based and theory-guided interventions. The Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) consortium is funded by the National Cancer Institute, with a primary goal of increasing the availability and use of approaches to CRC prevention and control, from screening through follow-up testing, diagnosis, and referral to care. In this article, we present a framework for improving CRC, follow-up, and referral to care among populations that have low CRC screening rates. We used a multistep, consensus- and data-driven approach to develop the ACCSIS framework. Eight collaborating Research Projects of the ACCSIS consortium evaluated the draft; they provided feedback in relation to their study designs, settings, populations, and methods. They also used evaluation results to refine the framework until they reached consensus. The current framework reflects common elements, expected intervention and screening outcomes, and is intended to contribute to future ACCSIS analyses and others' intervention and research plans. The framework recognizes the iterative nature of CRC screening programs and emphasizes multiple levels of influence-from baseline factors affecting selection of intervention components through measurement of process, screening, and implementation outcomes. Future researchers and practitioners can adapt the ACCSIS framework to advance CRC screening and to improve other cancer prevention and control research and practices that have created and perpetuated health disparities.