Strategies and opportunities to STOP colon cancer in priority populations: pragmatic pilot study design and outcomes

Gloria D Coronado, William M Vollmer, Amanda Petrik, Josue Aguirre, Tanya Kapka, Jennifer Devoe, Jon Puro, Tran Miers, Jennifer Lembach, Ann Turner, Jennifer Sanchez, Sally Retecki, Christine Nelson, Beverly Green, Gloria D Coronado, William M Vollmer, Amanda Petrik, Josue Aguirre, Tanya Kapka, Jennifer Devoe, Jon Puro, Tran Miers, Jennifer Lembach, Ann Turner, Jennifer Sanchez, Sally Retecki, Christine Nelson, Beverly Green

Abstract

Background: Colorectal-cancer is a leading cause of cancer death in the United States, and Latinos have particularly low rates of screening. Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) is a partnership among two research institutions and a network of safety net clinics to promote colorectal cancer screening among populations served by these clinics. This paper reports on results of a pilot study conducted in a safety net organization that serves primarily Latinos.

Methods: The study assessed two clinic-based approaches to raise rates of colorectal-cancer screening among selected age-eligible patients not up-to-date with colorectal-cancer screening guidelines. One clinic each was assigned to: (1) an automated data-driven Electronic Health Record (EHR)-embedded program for mailing Fecal Immunochemical Test (FIT) kits (Auto Intervention); or (2) a higher-intensity program consisting of a mailed FIT kit plus linguistically and culturally tailored interventions delivered at the clinic level (Auto Plus Intervention). A third clinic within the safety-net organization was selected to serve as a passive control (Usual Care). Two simple measurements of feasibility were: 1) ability to use real-time EHR data to identify patients eligible for each intervention step, and 2) ability to offer affordable testing and follow-up care for uninsured patients.

Results: The study was successful at both measurements of feasibility. A total of 112 patients in the Auto clinic and 101 in the Auto Plus clinic met study inclusion criteria and were mailed an introductory letter. Reach was high for the mailed component (92.5% of kits were successfully mailed), and moderate for the telephone component (53% of calls were successful completed). After exclusions for invalid address and other factors, 206 (109 in the Auto clinic and 97 in the Auto Plus clinic) were mailed a FIT kit. At 6 months, fecal test completion rates were higher in the Auto (39.3%) and Auto Plus (36.6%) clinics compared to the usual-care clinic (1.1%).

Conclusions: Findings showed that the trial interventions delivered in a safety-net setting were both feasible and raised rates of colorectal-cancer screening, compared to usual care. Findings from this pilot will inform a larger pragmatic study involving multiple clinics.

Trial registration: ClinicalTrial.gov: NCT01742065.

Figures

Figure 1
Figure 1
CONSORT diagram of STOP CRC pilot.

References

    1. Howlader N, Noone AM, Krapcho M, Garshell J, Neyman N, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA, editor. SEER Cancer Statistics Review, 1975–2010, National Cancer Institute. Bethesda, MD: Bethesda, MD, National Cancer Institute; 2013.
    1. Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, Wilschut J, Van BM, Kuntz KM. Evaluating test strategies for colorectal-cancer screening: a decision analysis for the U.S. Preventive services task force. Ann Intern Med. 2008;149:659–669. doi: 10.7326/0003-4819-149-9-200811040-00244.
    1. Centers for Disease Control. Vital Signs. Colorectal-cancer screening test use - United States report. Morbid Mortal Wkly. 2012;62(44):881–888. 11–8–0013.
    1. Coronado GD, Golovaty I, Longton G, Levy L, Jimenez R. Effectiveness of a clinic-based colorectal-cancer screening promotion program for underserved Hispanics. Cancer. 2011;117:1745–1754. doi: 10.1002/cncr.25730.
    1. Green BB, Wang CY, Anderson ML, Chubak J, Meenan RT, Vernon SW, Green BB, Wang CY, Anderson ML, Chubak J, Meenan RT, Vernon SW, Fuller S. An automated intervention with stepped increases in support to increase uptake of colorectal-cancer screening: a randomized trial. Ann Intern Med. 2013;158:301–311. doi: 10.7326/0003-4819-158-5-201303050-00002.
    1. Walsh JM, Salazar R, Kaplan C, Nguyen L, Hwang J, Pasick RJ. Healthy colon, healthy life (colon sano, vida sana): colorectal-cancer screening among Latinos in Santa Clara, California. J Cancer Educ. 2010;25:36–42. doi: 10.1007/s13187-009-0007-z.
    1. Sequist TD, Zaslavsky AM, Marshall R, Fletcher RH, Ayanian JZ. Patient and physician reminders to promote colorectal-cancer screening: a randomized controlled trial. Arch Intern Med. 2009;169(4):364–371. doi: 10.1001/archinternmed.2008.564.
    1. Fiscella K, Humiston S, Hendren S, Winters P, Idris A, Li SX, Fiscella K, Humiston S, Hendren S, Winters P, Idris A, Li SX, Ford P, Specht R, Marcus S. A multimodal intervention to promote mammography and colorectal-cancer screening in a safety-net practice. J Natl Med Assoc. 2011;103:762–768.
    1. Percac-Lima S, Grant RW, Green AR, Ashburner JM, Gamba G, Oo S, Percac-Lima S, Grant RW, Green AR, Ashburner JM, Gamba G, Oo S, Richter JM, Atlas SJ. A culturally tailored navigator program for colorectal-cancer screening in a community health center: a randomized, controlled trial. J Gen Intern Med. 2009;24:211–217. doi: 10.1007/s11606-008-0864-x.
    1. Lasser KE, Murillo J, Lisboa S, Casimir AN, Valley-Shah L, Emmons KM, Fletcher RH, Ayanian JZ. Colorectal-cancer screening among ethnically diverse, low-income patients: a randomized controlled trial. Arch Intern Med. 2011;171:906–912.
    1. Dietrich AJ, Tobin JN, Cassells A, Robinson CM, Greene MA, Sox CH, Beach ML, DuHamel KN, Younge RG. Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial. Ann Intern Med. 2006;144:563–571. doi: 10.7326/0003-4819-144-8-200604180-00006.
    1. Glasgow RE, Klesges LM, Dzewaltowski DA, Estabrooks PA, Vogt TM. Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues. Health Educ Res. 2006;21(5):688–694. doi: 10.1093/her/cyl081.
    1. Riley WT, Glasgow RE, Etheredge L, Abernethy AP. Rapid, responsive, relevant (R3) research: a call for a rapid learning health research enterprise. Clin Transl Med. 2013;2:10. doi: 10.1186/2001-1326-2-10.
    1. US Department of Commerce. US Census Bureau: State & County QuickFacts. 6–6–0013. ; Accessed 1/14/2014.
    1. Myers RE, Sifri R, Hyslop T, Rosenthal M, Vernon SW, Cocroft J, Wolf T, Andrel J, Wender R. A randomized controlled trial of the impact of targeted and tailored interventions on colorectal-cancer screening. Cancer. 2007;110:2083–2091. doi: 10.1002/cncr.23022.
    1. Costanza ME, Luckmann R, Stoddard AM, White MJ, Stark JR, Avrunin JS, Rosal MC, Clemow L. Using tailored telephone counseling to accelerate the adoption of colorectal-cancer screening. Cancer Detect Prev. 2007;31:191–198. doi: 10.1016/j.cdp.2007.04.008.
    1. Liles EG, Perrin N, Rosales AG, Feldstein AC, Smith DH, Mosen DM, Schneider JL. Change to FIT increased CRC screening rates: evaluation of a US screening outreach program. Am J Manag Care. 2012;18:588–595.

Source: PubMed

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