Colorectal Cancer Screening Intervention Research Articles

Participatory action research to develop and implement multicomponent, multilevel strategies for implementing colorectal cancer screening interventions in American Indian communities in New Mexico

BackgroundDespite the effectiveness of colorectal cancer (CRC) screening, American Indians (AIs) have low screening rates in the US. Many AIs receive care at Indian Health Services, Tribal, and Urban Indian (I/T/U) healthcare facilities, where published evidence regarding the implementation of CRC screening interventions is lacking. To address this gap, the University of New Mexico Comprehensive Cancer Center and the Albuquerque Area Southwest Tribal Epidemiology Center collaborated with two tribally-operated healthcare facilities in New Mexico with the goal of improving CRC screening rates among New Mexico’s AI communities.MethodsGuided by the principles of Community Based Participatory Research, we engaged providers from the two tribal healthcare facilities and tribal community members through focus group (two focus groups with providers (n = 15) and four focus group and listening sessions with community members (n = 65)), to elicit perspectives on the feasibility and appropriateness of implementing The Guide to Community Preventive Services (The Community Guide) recommended evidence-based interventions (EBIs) and strategies for increasing CRC screening. Within each tribal healthcare facility, we engaged a Multisector Action Team (MAT) that participated in an implementation survey to document the extent to which their healthcare facilities were implementing EBIs and strategies, and an organizational readiness survey that queried whether their healthcare facilities could implement additional strategies to improve uptake of CRC screening.ResultsThe Community Guide recommended EBIs and strategies that received the most support as feasible and appropriate from community members included: one-on-one education from providers, reminders, small media, and interventions that reduced structural barriers. From the providers’ perspective, feasible and acceptable strategies included one-on-one education, patient and provider reminders, and provider assessment and feedback. Universally, providers mentioned the need for patient navigators who could provide culturally appropriate education about CRC and assist with transportation, and improved support for coordinating clinical follow-up after screening. The readiness survey highlighted overall readiness of the tribal facility, while the implementation survey highlighted that few strategies were being implemented.ConclusionsFindings from this study contribute to the limited literature around implementation research at tribal healthcare facilities and informed the selection of specific implementation strategies to promote the uptake of CRC screening in AI communities.

A Qualitative Study Exploring Barriers to Colorectal Cancer Screening among Firefighters.

Firefighters are at increased risk of colorectal cancer (CRC), yet rates of CRC screening are low among this occupational group. This study examines perceived risks, barriers, and facilitators to CRC screening. Three semi-structured focus group discussions were conducted by investigators in Tucson, AZ. Thematic analysis was used to identify patterns and themes in the data. Three groups of firefighters (8 male (57%); 6 female (43%) mean age 50.4 (SD = 12.2) years) voluntarily participated in the CRC discussions. Four major themes were examined: (1) perceptions of risk for CRC, (2) barriers to cancer screening, (3) facilitators to getting cancer screening, and (4) misinformation about CRC and screening. Findings indicate unique perceptions, attitudes, and beliefs among firefighters. Results from this study will inform the adaptation of a tailored CRC screening intervention for firefighters.

Evaluation of the effectiveness of colorectal cancer screening intervention.

The effectiveness of the Colorectal Cancer (CRC) screening program is assessed based on the reduction in CRC mortality and incidence rates over time. To accurately estimate the long-term impact, it is advisable to monitor additional indicators such as age and stage-specific incidence rates. Our objective is to evaluate the effectiveness of the National CRC Screening Program in Turkey and analyze its influence on disease stage at diagnosis and survival rates. The National CRC Screening Program was considered an intervention and the distribution of local, regional, and distant diseases, and survival estimates were assessed before and after the intervention to evaluate the effectiveness of the intervention. 518 patients were included in the study. At the time of diagnosis, localized, regional, and distant disease in pre-intervention were 31.3%, 42.9%, 25.8%, while post-intervention were 42.8%, 33.3%, 23.9%, respectively (p = 0.020). The relative effectiveness of the intervention in males, females, and 50-70 ages were calculated as 1.2[95% CI 0.95-1.73], 1.5[95% CI 1.04-2.18], and 1.6[95% CI 1.21-2.28] in localized disease, 0.8[95% CI 0.67-1.18], 0.6[95% CI 0.43-0.90], and 0.6[95% CI 0.46-0.81] in regional diseases, 0.8[95% CI 0.57-1.20], 1.1[95% CI 0.66-1.84], and 1.0[95% CI 0.70-1.57] in distant disease, respectively. A noticeable shift in the disease stage at the time of diagnosis was observed; however, this shift varied among gender and age groups. To effectively evaluate the impact of a cancer screening program on reducing the incidence and mortality rates of the disease, it is essential to monitor and analyze these indicators alongside 5-10-year survival estimates and stage changes at the time of diagnosis.

Abstract A100: Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia

Abstract Background: Significantly higher colorectal cancer (CRC) mortality exists in the five public health districts of Georgia including the Clayton, West Central, East Central, Southeast, and Northeast Georgia. Particularly, CRC outcomes are poorer among patients living in low socioeconomic (SES) areas with predominantly Black population in Georgia. We sought to examine 5-year CRC survival rates between White and Black/Other patients and determine whether regional SES status associated with 5-year CRC survival within different race groups in these five regions of Georgia. Methods: We performed a retrospective cohort analysis using data from the 1975-2016 Surveillance, Epidemiology, and End Results program. The 2015 United State Department of Agriculture Economic Research Services (USDA ERS) county typology codes were used to identify region-level SES with persistent poverty, low employment, and low education. A county is classified by the USDA ERS as a persistent poverty by using 1980, 1990, 2000 censuses and 2007-11 American Community Survey. Five-year CRC survival rates were compared by using Kaplan-Meier method. Cox proportional hazard regression was used to examine the aforementioned associations in different race groups adjusted for demographics (gender, age at diagnosis, marital status, and five Georgia regions) and tumor features (stage, grade, and primary site). Results: Among 11,023 CRC patients (31.9% Black/Other patients), 5-year CRC survival rates were lower among Black/Other patients compared to White patients (65.9% vs. 69.9%; p-value<0.001). Black/Other patients living in low education, low employment, and persistent poverty regions appeared to have lower 5-year survival rates compared to those not living in those regions (59.6% vs. 67.8%, p-value<0.001; 65.4% vs. 66.2%, p-value=0.385; 64.4% vs. 66.5%, p-value=0.089 respectively). In the adjusted analysis, we found that White patients living in regions with persistent poverty were 1.12-fold of increased risk of CRC death (HR, 1.12; 95% CI, 1.00-1.25; p-value=0.043) compared to those living in non-persistent poverty regions. Among Black/Other patients, those living in regions with low education were 1.19-fold of increased risk of CRC death (HR, 1.19; 95% CI, 1.01-1.40; p-value=0.033) compared to those living in non-low education regions. Other factors, such as older age at diagnosis, distant stage, and high-grade tumors, were positively associated with CRC death among the entire cohort, regardless of racial groups. Conclusion: In Georgia, we found that Black/Other patients demonstrated the lower CRC survival rates. Region-level SES was associated with CRC survival among White and Black/Other patients. White patients living in regions with persistent poverty, and Black/Other patients living in regions with low education had an increased risk of CRC death. Our findings provide important evidence to relevant stakeholders in furthering the development of culturally tailored CRC screening interventions aimed at CRC early detection by considering patient’s regional SES status in Georgia. Citation Format: Meng-Han Tsai, Shaoyong Su, Marlo Vernon, Yanbin Dong. Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A100.

Provider communication contributes to colorectal cancer screening intention through improving screening outcome expectancies and perceived behavioral control

Colorectal cancer (CRC) screening continues to be underutilized in the US despite the availability of multiple effective, guideline-recommended screening options. Provider recommendation has been consistently shown to improve screening completion. Yet, available literature provides little information as to how specific information providers communicate influence patient decision-making about CRC screening. We tested the pathways through which information communicated by providers about the “Why” and “How” of CRC screening using the mt-sDNA test contributes to intention to complete the test. Data came from a behavioral theory-informed survey that we developed to identify psychosocial factors associated with mt-sDNA screening. RTI International administered the survey between 03/2022-06/2022 to a sample of US adults ages 45–75 who received a valid order for mt-sDNA screening with a shipping date between 5/2021-9/2021. Participants completed an electronic or paper survey. We tested the proposed relationships using structural equation modeling and tested indirect effects using Monte Carlo method. A total of 2,973 participants completed the survey (response rate: 21.7%) and 81.6% (n = 2,427) reported have had a conversation with their health care provider about mt-sDNA screening before the test was ordered. We found that “Why” information from providers was positively associated with perceived effectiveness of mt-sDNA screening, while “How” information was positively associated with perceived ease of use. “Why” information contributed to screening intention through perceived effectiveness while “How” information contributed to screening intention through perceived ease of use. These findings emphasize the critical role of provider communication in shaping patient decision-making regarding CRC screening. CRC screening interventions could consider implementing provider-patient communication strategies focusing on improving patient understanding of the rationale for CRC screening and the effectiveness of available screening options as well as addressing barriers and enhancing patients’ self-efficacy in completing their preferred screening option.

Assessing the Feasibility of a Faith-Based Colorectal Cancer Education and Screening Intervention for Latino Men in Pennsylvania

Introduction: Limited health knowledge, literacy, engagement in preventive health services, participation in health promotion behaviors, and cultural factors place Latino men at high risk for colorectal cancer (CRC). This pilot study aimed to determine the feasibility and acceptability of a faith-based cancer education intervention focusing on Latino men between 45 and 74 years old. Methods: This pilot study used a single group pre- and post-intervention research design to compare changes in knowledge, perceived benefit of screening, perceived susceptibility and severity of CRC, and the completion of CRC screening after the intervention. Results: In this study, Latino men were willing to participate in a CRC educational intervention supported by a faith-based institution. The participants had limited knowledge about CRC, yet most recognized that screening is beneficial and that getting CRC is serious. Sixty percent of the participants completed the fecal immunochemical screening test, which showed that the intervention impacted the screening uptake among this group. Conclusion: The findings of this study support the further development of faith-based interventions focusing on Latino men.

Intervention recommendations to improve uptake of breast, cervical, and colorectal cancer screening among individuals living with serious mental illness.

Few efforts have been made to inform intervention design for increasing the uptake of cancer screening in individuals living with serious mental illness (ILSMI), who have lower cancer screening rates than the general population. This qualitative study explored ILSMI's and their care team member's (CTM) recommendations on the design of a breast, colorectal, and cervical cancer screening intervention for ILSMI. Twenty-five ILSMI (mean age: 71.4years; 60% female) and 15 CTM (mean age: 45.3years; 80% female) were recruited through purposive sampling.Semi-structured in-depth interviews were used to collect participants' intervention suggestions. Interviews were recorded, transcribed verbatim, and imported into NVivo. Content analysis and the constant comparison method were used to analyze interview data. ILSMI and CTMs provided several salient recommendations. ILSMI should receive disease-specific, logistical, and screening education, and primary care staff should receive education on psychopathology. Mental health providers and patient navigators should be considered as the primary interventionist. The intervention should be delivered where ILSMI receive medical or mental health services, receive community and government services, and/or via various digital media. The intervention should improve the collaboration, communication, and coordination between primary and mental health care. Findings also pointed to the implementation of trauma-informed cancer care and integrated care models comprising mental health care and primary cancer care. These findings bring the skills, knowledge, and expertise of ILSM and their care team to intervention design for increasing colorectal, breast, and cervical cancer screening in ILSMI attending an intensive outpatient program.

Optimizing process flow diagrams to guide implementation of a colorectal cancer screening intervention in new settings

PurposeThe goal of this study was to assess acceptability of using process flow diagrams (or process maps) depicting a previously implemented evidence-based intervention (EBI) to inform the implementation of similar interventions in new settings.MethodsWe developed three different versions of process maps, each visualizing the implementation of the same multicomponent colorectal cancer (CRC) screening EBI in community health centers but including varying levels of detail about how it was implemented. Interviews with community health professionals and practitioners at other sites not affiliated with this intervention were conducted. We assessed their preferences related to the map designs, their potential utility for guiding EBI implementation, and the feasibility of implementing a similar intervention in their local setting given the information available in the process maps.ResultsEleven community health representatives were interviewed. Participants were able to understand how the intervention was implemented and engage in discussions around the feasibility of implementing this type of complex intervention in their local system. Potential uses of the maps for supporting implementation included staff training, role delineation, monitoring and quality control, and adapting the components and implementation activities of the existing intervention.ConclusionProcess maps can potentially support decision-making about the adoption, implementation, and adaptation of existing EBIs in new contexts. Given the complexities involved in deciding whether and how to implement EBIs, these diagrams serve as visual, easily understood tools to inform potential future adopters of the EBI about the activities, resources, and staffing needed for implementation.

Implementation strategies in the Exploration and Preparation phases of a colorectal cancer screening intervention in community health centers

BackgroundAdoption of colorectal cancer (CRC) screening has lagged in community health center (CHC) populations in the USA. To address this implementation gap, we developed a multilevel intervention to improve screening in CHCs in our region. We used the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to guide this effort. Here, we describe the use of implementation strategies outlined in the Expert Recommendations for Implementing Change (ERIC) compilation in both the Exploration and Preparation phases of this project. During these two EPIS phases, we aimed to answer three primary questions: (1) What factors in the inner and outer contexts may support or hinder colorectal cancer screening in North Carolina CHCs?; (2) What evidence-based practices (EBPs) best fit the needs of North Carolina CHCs?; and (3) How can we best integrate the selected EBPs into North Carolina CHC systems?MethodsDuring the Exploration phase, we conducted local needs assessments, built a coalition, and conducted local consensus discussions. In the Preparation phase, we formed workgroups corresponding to the intervention’s core functional components. Workgroups used cyclical small tests of change and process mapping to identify implementation barriers and facilitators and to adapt intervention components to fit inner and outer contexts.ResultsExploration activities yielded a coalition of stakeholders, including two rural CHCs, who identified barriers and facilitators and reached consensus on two EBPs: mailed FIT and navigation to colonoscopy. Stakeholders further agreed that the delivery of those two EBPs should be centralized to an outreach center. During Preparation, workgroups developed and refined protocols for the following centrally-delivered intervention components: a registry to identify and track eligible patients, a centralized system for mailing at-home stool tests, and a process to navigate patients to colonoscopy after an abnormal stool test.ConclusionsThis description may be useful both to implementation scientists, who can draw lessons from applied implementation studies such as this to refine their implementation strategy typologies and frameworks, as well as to implementation practitioners seeking exemplars for operationalizing strategies in early phases of implementation in healthcare.

Psychosocial Risk Profiles and Colorectal Cancer Screening: a Latent Profile Analysis in a Colorectal Cancer Screening Intervention Setting.

Health behavior theories have identified predictors of colorectal cancer (CRC) screening. This study aimed to determine the psychosocial profiles of a predominantly Hispanic population of primarily Mexican origin receiving a CRC screening intervention and whether a specific combination of psychosocial profiles modified the effect of CRC screening intervention on CRC screening uptake. 467 participants aged 50 -75 years due for CRC screening received an educational intervention. Latent profile analysis was performed on baseline psychosocial constructs to identify the homogenous clustering of individuals with similar psychosocial constructs. In addition, CRC screening rates and changes in psychosocial scores between the latent groups were compared. Three psychosocial profiles, including a low benefit and high susceptibility group (LBHS), a high benefit and low susceptibility group (HBLS), and a high barrier and high susceptibility group (HBHS), were identified in this study. The HBLS group had the lowest susceptibility, with no improvement in benefits and barriers. This group had the lowest screening rate (80.85%) compared to 88.8% in LBHS and 86.3% in HBHS following the intervention. Finally, the intervention effect size on psychosocial score changes was smaller in HBLS than in other groups. This subgroup analysis suggests that CRC educational interventions should be tailored to improve the benefits and barriers among individuals with high susceptibility scores.

Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians (Version 2).

The purpose of this updated guidance statement is to guide clinicians on screening for colorectal cancer (CRC) in asymptomatic average-risk adults. The intended audience is all clinicians. The population is asymptomatic adults at average risk for CRC. This updated guidance statement was developed using recently published and critically appraised clinical guidelines from national guideline developers since the publication of the American College of Physicians' 2019 guidance statement, "Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults." The authors searched for national guidelines from the United States and other countries published in English using PubMed and the Guidelines International Network library from 1 January 2018 to 24 April 2023. The authors also searched for updates of guidelines included in the first version of our guidance statement. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument was used to assess the quality of eligible guidelines. Two guidelines were selected for adoption and adaptation by raters on the basis of the highest average overall AGREE II quality scores. The evidence reviews and modeling studies for these 2 guidelines were also used to synthesize the evidence of diagnostic test accuracy, effectiveness, and harms of CRC screening interventions and to develop our guidance statements. Clinicians should start screening for colorectal cancer in asymptomatic average-risk adults at age 50 years. Clinicians should consider not screening asymptomatic average-risk adults between the ages of 45 to 49 years. Clinicians should discuss the uncertainty around benefits and harms of screening in this population. Clinicians should stop screening for colorectal cancer in asymptomatic average-risk adults older than 75 years or in asymptomatic average-risk adults with a life expectancy of 10 years or less. Clinicians should select a screening test for colorectal cancer in consultation with their patient based on a discussion of benefits, harms, costs, availability, frequency, and patient values and preferences. Clinicians should select among a fecal immunochemical or high-sensitivity guaiac fecal occult blood test every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus a fecal immunochemical test every 2 years as a screening test for colorectal cancer. Clinicians should not use stool DNA, computed tomography colonography, capsule endoscopy, urine, or serum screening tests for colorectal cancer.

The Diagnostic Value of Fecal Fusobacterium nucleatum Combined with FIT and CA199 in the Diagnosis of Colorectal Cancer

Objective: To analyze the diagnostic value of fecal Fusobacterium nucleatum detection, fecal immunochemical test (FIT), and carbohydrate antigen 19-9 (CA19-9) detection for colorectal cancer (CRC). Method: A total of 78 CRC patients and 60 healthy individuals were enrolled in this study. Stool and blood samples were collected for the 3 diagnoses, and ROC curves were analyzed for diagnostic value. Result: The 3 diagnoses’ positive detection rates in CRC samples were significantly higher than those of healthy samples (P < 0.05). The combined CRC diagnoses showed significantly higher sensitivity as compared to individual fecal F. nucleatum detection (χ2 = 6.495, P = 0.011), FIT (χ2 = 4.871, P = 0.027), and serum CA19-9 detection (χ2 = 7.371, P = 0.007). The area under the ROC curve for fecal F. nucleatum detection was 0.63 [95% confidence interval (CI) = 1.124–6.238], with a sensitivity of 73.08% and specificity of 85.00%, whereas FIT was 0.65 (95% CI = 1.365–9.241), with a sensitivity of 51.28% and specificity of 96.67%, meanwhile, serum CA19-9 detection was 0.62 (95% CI = 1.517–12.342), with a sensitivity of 69.23% and specificity of 98.33%. The combined CRC diagnoses showed an area under the ROC curve of 0.76 (95% CI = 1.213–6.254), with a sensitivity of 87.18% and specificity of 70.00%. Conclusion: The combined diagnoses of fecal F. nucleatum detection, FIT, and serum CA19-9 detection can significantly improve the sensitivity and accuracy of CRC diagnosis, which has high clinical application value to provide guidance for clinical CRC screening and early intervention treatment.

Trends and disparities in incidence and mortality of early-onset colorectal cancer (EOCRC) in the United States (1999-2019).

e15551 Background: There has been a startling rise in the reported incidence of colorectal cancer (CRC) among adolescents and young adults (AYA; ages 15-39 years) in the US.These patients are often diagnosed with advanced stage and have a relatively poor prognosis.Population-based data on disparities and trends in incidence and mortality in this understudied population are lacking. Methods: We used the Centers for Disease Control WONDER cancer statistics database to extract data on annual age-adjusted incidence (AAIR) and mortality (AAMR) rates per 100,000 population for “colon and rectal cancer” in AYA. We compared AYA statistics with the overall as well as the non-AYA population (40-85 years). Sex and race comparisons were analyzed. Variations in AAIR and AAMR over time, assessed with Joinpoint regression modelling (Joinpoint regression program 4.9.1.0), were expressed as estimated average annual percentage change (AAPC). Comparisons were reported using average annual percentage change difference (AAPCD). Results: 83,371 cases of EOCRC were reported between 1999-2019. We recorded an increase in AAIR of EOCRC (AAPC 2.9, p < 0.001). We noted a concomitant decline in AAIR of CRC overall (AAPC -2.4, P < 0.001) and among the non-AYA population (AAPC -2.4, p < 0.001). Subgroup comparisons showed statistically significant differences in AAIR of EOCRC for females vs males (AAPCD 0.6, p = 0.04), Whites vs Blacks (AAPCD 1.8, p < 0.001), and White females vs White males (AAPCD 0.6, p = 0.02) [table]. AAMR increased for EOCRC over the study period (AAPC 0.8, p = 0.001), as opposed to a decline in AAMR of CRC overall (AAPC -2.5, p < 0.001) and among the non-AYA population (AAPC -2.5, p < 0.001). The increase in AAMR of EOCRC was similar among males and females (AAPCD 0.3, p = 0.351), but higher among Whites vs Blacks (AAPCD 1.1, p = 0.007). Conclusions: This analysis from a large population-level database shows an increasing trend in incidence and mortality of EOCRC in the US, despite a concomitant decline in the incidence and mortality of CRC overall. The incidence appears to be rising more rapidly among females, particularly White females. Both incidence and mortality of EOCRC appear to be rising more rapidly among Whites compared with Blacks. Our analysis underscores the critical need to develop strategies to identify high-risk AYA populations who may benefit from more aggressive CRC screening and prevention interventions. [Table: see text]

Engaging stakeholders in the use of an interactive simulation tool to support decision-making about the implementation of colorectal cancer screening interventions

PurposeWe aimed to understand how an interactive, web-based simulation tool can be optimized to support decision-making about the implementation of evidence-based interventions (EBIs) for improving colorectal cancer (CRC) screening.MethodsInterviews were conducted with decision-makers, including health administrators, advocates, and researchers, with a strong foundation in CRC prevention. Following a demonstration of the microsimulation modeling tool, participants reflected on the tool’s potential impact for informing the selection and implementation of strategies for improving CRC screening and outcomes. The interviews assessed participants’ preferences regarding the tool’s design and content, comprehension of the model results, and recommendations for improving the tool.ResultsSeventeen decision-makers completed interviews. Themes regarding the tool’s utility included building a case for EBI implementation, selecting EBIs to adopt, setting implementation goals, and understanding the evidence base. Reported barriers to guiding EBI implementation included the tool being too research-focused, contextual differences between the simulated and local contexts, and lack of specificity regarding the design of simulated EBIs. Recommendations to address these challenges included making the data more actionable, allowing users to enter their own model inputs, and providing a how-to guide for implementing the simulated EBIs.ConclusionDiverse decision-makers found the simulation tool to be most useful for supporting early implementation phases, especially deciding which EBI(s) to implement. To increase the tool’s utility, providing detailed guidance on how to implement the selected EBIs, and the extent to which users can expect similar CRC screening gains in their contexts, should be prioritized.

Developing a Social Marketing–Based Colorectal Cancer Screening Campaign Centered on Stool-Based Testing for Patients Utilizing Services at a Federally Qualified Healthcare Center

Background More than 50% of colorectal cancer (CRC)–related deaths could be prevented with early detection and treatment. Federally Qualified Healthcare Centers (FQHCs)—safety-net facilities that provide primary care services to uninsured, underinsured and minority patients—report some of the lowest CRC screening rates. Effective CRC screening interventions within FQHCs may help to promote CRC screening utilization among patients from diverse backgrounds. Focus of Article This study was designed to explore average-risk, patient perceptions of facilitators and impediments of using the Fecal Immunochemical Test (FIT) kit for CRC screening within the social marketing framework of the 4 “P’s”—product, price, place, and promotion. Research Aim To conduct formative research with priority populations (i.e., diverse, FQHC patients), assess acceptability of the FIT kit, and identify ways to better meet preferences and needs. Program Design/Approach Qualitative, Focus Groups. Importance to the Social Marketing Field Findings from this study would aid in the future development of a community-based prevention marketing intervention to promote CRC screening within FQHCs that serve diverse patient populations. Methods Focus groups were conducted in English and Spanish with CRC screening age-eligible patients from a South Florida FQHC System. Interview guides were designed to better understand FQHC patient perceptions of CRC Screening via the FIT kit (product) by up-to-date and not up-to-date participants. Additional topics included likes/dislikes (price), preferred location for completing CRC screening and receiving CRC prevention education (place), and strategies for persuasive communication to increase CRC screening among patients who visit FQHCs (promotion). Data were analyzed to identify FIT screening facilitators and impediments using thematic coding in MaxQDA. Results Five focus groups, involving 36 participants aged 50 and older, were conducted. Over half of participants self-identified as Hispanic (36%) or non-Hispanic Black (28%). Key facilitators were the convenience and simplicity of at-home testing (product), presumed affordability of it compared to colonoscopy (price), and ability to return by mail (place). Participants also shared numerous strategies for promotion, including direct referral from Primary Care Providers, mass media campaigns, mailed or electronic reminders from the clinic, and peer advocacy events in churches. Recommendations for Research or Practice Social marketing provides an adequate approach for developing a patient-centered campaign to promote CRC screening uptake at FQHCs. Future CRC screening promotional campaigns at FQHCs should build on the motivation that patients must prioritize their health by emphasizing the convenience of completing CRC screening at home with the capability of mailing it back. Clinics should also work to reduce patient responsibility by developing automated clinic system reminders to openly communicate with patients about CRC screening.

Budget impact analysis of a home-based colorectal cancer screening programme in Malaysia

ObjectivesThe 2020–2022 research project ‘Colorectal Cancer Screening Intervention for Malaysia’ (CRC-SIM) evaluated the implementation of a home-based CRC screening pilot in Segamat District. This budget impact analysis (BIA) assessed the...

OWL: an optimized and independently validated machine learning prediction model for lung cancer screening based on the UK Biobank, PLCO, and NLST populations.

A reliable risk prediction model is critically important for identifying individuals with high risk of developing lung cancer as candidates for low-dose chest computed tomography (LDCT) screening. Leveraging a cutting-edge machine learning technique that accommodates a wide list of questionnaire-based predictors, we sought to optimize and validate a lung cancer prediction model. We developed an Optimized early Warning model for Lung cancer risk (OWL) using the XGBoost algorithm with 323,344 participants from the England area in UK Biobank (training set), and independently validated it with 93,227 participants from UKB Scotland and Wales area (validation set 1), as well as 70,605 and 66,231 participants in the Prostate, Lung, Colorectal, and Ovarian cancer screening trial (PLCO) control and intervention subpopulations, respectively (validation sets 2 & 3) and 23,138 and 18,669 participants in the United States National Lung Screening Trial (NLST) control and intervention subpopulations, respectively (validation sets 4 & 5). By comparing with three competitive prediction models, i.e., PLCO modified 2012 (PLCOm2012), PLCO modified 2014 (PLCOall2014), and the Liverpool Lung cancer Project risk model version 3 (LLPv3), we assessed the discrimination of OWL by the area under receiver operating characteristic curve (AUC) at the designed time point. We further evaluated the calibration using relative improvement in the ratio of expected to observed lung cancer cases (RIEO), and illustrated the clinical utility by the decision curve analysis. For general population, with validation set 1, OWL (AUC=0.855, 95% CI: 0.829-0.880) presented a better discriminative capability than PLCOall2014 (AUC=0.821, 95% CI: 0.794-0.848) (p<0.001); with validation sets 2 & 3, AUC of OWL was comparable to PLCOall2014 (AUCPLCOall2014-AUCOWL < 1%). For ever-smokers, OWL outperformed PLCOm2012 and PLCOall2014 among ever-smokers in validation set 1 (AUCOWL=0.842, 95% CI: 0.814-0.871; AUCPLCOm2012=0.792, 95% CI: 0.760-0.823; AUCPLCOall2014=0.791, 95% CI: 0.760-0.822, all p<0.001). OWL remained comparable to PLCOm2012 and PLCOall2014 in discrimination (AUC difference from-0.014 to 0.008) among the ever-smokers in validation sets 2 to 5. In all the validation sets, OWL outperformed LLPv3 among the general population and the ever-smokers. Of note, OWL showed significantly better calibration than PLCOm2012, PLCOall2014 (RIEO from 43.1% to 92.3%, all p<0.001), and LLPv3 (RIEO from 41.4% to 98.7%, all p<0.001) in most cases. For clinical utility, OWL exhibited significant improvement in average net benefits (NB) over PLCOall2014 in validation set 1 (NB improvement: 32, p<0.001); among ever smokers of validation set 1, OWL (average NB=289) retained significant improvement over PLCOm2012 (average NB=213) (p<0.001). OWL had equivalent NBs with PLCOm2012 and PLCOall2014 in PLCO and NLST populations, while outperforming LLPv3 in the three populations. OWL, with a high degree of predictive accuracy and robustness, is a general framework with scientific justifications and clinical utility that can aid in screening individuals with high risks of lung cancer. National Natural Science Foundation of China, the US NIH.

Implementation of a home-based colorectal cancer screening intervention in Malaysia (CRC-SIM)

IntroductionThe Colorectal Cancer Screening Intervention for Malaysia (CRC-SIM) was a CRC study of home-based testing designed to improve low screening uptake using the immunochemical fecal occult blood test (iFOBT) in Malaysia.MethodsThis quasi-experimental study was informed by the Implementation Research Logic Model and evaluated with the RE-AIM framework. Trained data collectors recruited by phone, randomly selected, asymptomatic adults aged 50-75 years from Segamat District, who previously completed a health census form for the South East Asia Community Observatory (SEACO). Participants were posted an iFOBT kit and asked to return a photo of the completed test for screening by health care professionals. A regression analysis of evaluation data was conducted to identify which variables were associated with the outcome indicators of ‘study participation’ and ‘iFOBT completion’ and the CRC-SIM was evaluated in terms of its appropriateness, feasibility and acceptability.ResultsSeven hundred forty-seven eligible adults (52%) agreed to participate in this study and received an iFOBT kit. Participation was significantly lower amongst Chinese Malaysians (adjusted OR 0.45, 95% CI 0.35 - 0.59, p<0.001) compared to Malays and amongst participants from the rural sub-district (Gemereh) (adjusted OR 0.71, 95% CI 0.54 - 0.92, p=0.011) compared to the urban sub-district (Sungai Segamat). Less than half of participants (42%, n=311/747) completed the iFOBT. Test-kit completion was significantly higher amongst Chinese Malaysians (adjusted OR 3.15, 95% CI 2.11 - 4.69, p<0.001) and lower amongst participants with a monthly household income ≥RM 4,850 (adjusted OR 0.58, 95% CI 0.39 - 0.87, p=0.009) compared to participants with a lower household income. The main reported reason for non-participation was ‘not interested’ (58.6%) and main implementation challenges related to invalid photographs from participants and engaging iFOBT positive participants in further clinic consultations and procedures.ConclusionHome-testing for CRC (test completion) appeared to be acceptable to only around one-fifth of the target population in Malaysia. However, mindful of the challenging circumstances surrounding the pandemic, the CRC-SIM merits consideration by public health planners as a method of increasing screening in Malaysia, and other low- and middle-income countries.

Implementing a mailed stool sample screening program in clinics providing care for an underserved Hispanic population

Colorectal cancer (CRC) is a leading cause of cancer-related deaths in Hispanics in the US. Despite this, Hispanics are being screened for CRC at a much lower rate than their non-Hispanic white counterparts. Implementing mailed fecal immunochemical tests (FITs) is a cost-effective intervention for increasing CRC screening rates in vulnerable populations, such as Hispanic populations in border metroplexes. We aimed to describe the effect of introductory calls coupled with mailed in-home FIT kits on CRC screening completion in two federally qualified health centers (FQHCs) in a US–Mexico border county. This was a prospective, pragmatic, two-arm intervention study with participants allocated to receive a FIT kit with a reminder call (usual care) or usual care preceded by an introductory call. The primary outcome was the percentage of patients who returned the FIT kits. Participants who returned to the FIT were primarily unemployed (54.4%), had less than a high school education (60.2%), lived in the US for at least 20 years (74.4%), and had poor self-reported health (54.4%). In addition, we observed a statistically significant increase in the absolute rate (4.5%, P = 0.003) of FITs returned when a mailed FIT kit was preceded by an introductory call compared with no initial call. This study demonstrated that adding an introductory phone call significantly improved the screening completion rate in a mailed-out CRC screening intervention in the US–Mexico border population.

Examining colorectal cancer screening uptake and health provider recommendations among underserved middle aged and older African Americans.

Background: The purpose of this study is to determine whether underserved middle-aged and older African Americans are receiving a colorectal cancer (CRC) screening test (sigmoidoscopy or colonoscopy) and if recommended by their provider. Additionally, we examined correlates of both provider recommendation and uptake of CRC screening. Methods: Seven hundred forty African American individuals, aged 55 and older, participated in this local community cross-sectional survey. We used a multivariate technique of logistic regression. Results: One out of three participants reported that they never received a sigmoidoscopy or colonoscopy for CRC screening. More than 31% indicted that their providers never suggested CRC testing. However, participants who indicated that their providers recommended sigmoidoscopy/colonoscopy were almost 49 times (odds ratio [OR]: 48.9, 95% confidence interval [CI]: 29.5-81.2) more likely to obtain it compared to their counterparts who were not advised to have these procedures. Our data suggest that African American men were significantly less likely than women to receive recommendations from their providers (OR: 0.70, 95% CI: 0.50-0.91). Furthermore, controlling for other variables, the following factors: 1) living arrangement (OR: 1.44, 95% CI: 1.02-2.04), 2) health maintenance organization (HMO) membership (OR: 1.84, 95% CI: 1.28-2.67), 3) number of providers (OR: 1.15, 95% CI: 1.01-1.32), 4) satisfaction with access to and quality of care (OR: 1.24, 95% CI: 1.03-1.51), 5) depressive symptoms (OR: 0.92, 95% CI: 0.86-0.98), and 6) gastrointestinal conditions (OR: 1.73, 95% CI: 1.16-2.58) were associated with obtaining a sigmoidoscopy or colonoscopy test. Conclusion: Our findings suggest that the absence of a provider recommendation is the primary barrier preventing underserved older African Americans from obtaining CRC screening. In addition, our data revealed significant association between obtaining CRC screening and some of the predisposing characteristics of participants, satisfaction with access to and quality of care, and physical and mental health. These findings are consistent with this notion that disparities in health care for African Americans can be traced back to four primary factors: patients, healthcare providers, the healthcare system, and society as a whole, and emphasize the need for establishing theory-driven, culturally-sensitive, and cost-effective CRC screening interventions that recognize and address the constraints to cancer screening experienced by this segment of population.