Colorectal Cancer Screening Uptake Research Articles

Distrust in health care and cultural factors are associated with uptake of colorectal cancer screening in Hispanic and Asian Americans.

There are racial/ethnic disparities in colorectal cancer (CRC) screening, including lower uptake rates among Hispanic Americans (HAs) and Asian Americans (AAs) relative to non-Hispanic white Americans. The objective of this study was to explore pathways associated with the use of health services and to characterize multifaceted associations with the uptake of CRC screening among HAs and AAs. Data were obtained from the Medical Expenditure Panel Survey (2012-2013). Participants included HA (n = 3731) and AA (n = 1345) respondents ages 50 to 75 years who met CRC screening recommendations. A modified Andersen behavioral model was used to examine pathways that lead to CRC screening uptake, including predisposing characteristics (education, economic, and cultural factors), health insurance, health needs (perceived health status and several comorbidities), and health provider contextual factors (access to care, perceived quality of health services, and distrust in health care). Structural equation modeling was used to examine the models for HAs and AAs. In the HA model, cultural factors (standardized regression coefficient [β] = -0.04; P = .013) and distrust in health care (β = -0.05; P = .007) directly and negatively affected CRC screening. Similarly, cultural factors (β = -0.11; P = .002) negatively affected CRC screening in the AA model, but distrust in health care was not significant (P = .103). In both models, perceived quality of health services was positively associated with CRC screening uptake and mediated the negative association between cultural factors and CRC screening. Access to care was not associated with CRC screening. Correlations between CRC screening and associated factors differ among HAs and AAs, suggesting a need for multilevel interventions tailored to race/ethnicity. The current findings suggest that facilitating access to care without improving perceived quality of health services may be ineffective for increasing the uptake of CRC screening among HAs and AAs. Cancer 2018;124:335-45. © 2017 American Cancer Society.

Colorectal Cancer Screening Uptake's Association With Psychosocial and Sociodemographic Factors Among Homeless Blacks and Whites.

The homeless represent an extremely disadvantaged population that fare worse than minority groups in access to preventive services and health, and minority groups fare worse than Whites. Early detection screening for colorectal cancer (CRC) saves lives, but empirical data about CRC screening practices among homeless Blacks and Whites are limited. Psychosocial risk factors may serve as a barrier to CRC screening completion among homeless Black individuals. A secondary data analysis of a randomized clinical trial for smoking cessation among homeless smokers was conducted to determine whether psychosocial factors and sociodemographic factors were more highly associated with CRC screening uptake among homeless Blacks than among their White counterparts. Study participants ( N = 124) were surveyed on their CRC screening status, sociodemographic variables, and psychosocial correlate measures including anxiety, depression, hopelessness, depression severity, and perceived stress. Associations between these factors were examined with logistic regression. White participants who were currently disabled/unable to work were 6.2 times more likely to ever receive CRC screening than those who were employed. Black participants with public health insurance coverage were 90% less likely to ever obtain CRC screening than participants without health insurance. Black and White participants had similar levels of anxiety symptoms, depression, and hopelessness, yet depression was the only psychosocial variable negatively associated with CRC screening status. Black and White participants with symptoms of depression were 58% less likely to complete screening than those without depression. Mental health risk and sociodemographic factors may serve as barriers to CRC screening among homeless Blacks and Whites.

Enhancing access to cervical and colorectal cancer screening for women in rural and remote northern Alberta: a pilot study.

Women in rural and remote northern Alberta access breast cancer screening through a mobile mammogram program (Screen Test). The Enhanced Access to Cervical and Colorectal Cancer Screening (EACS) project was a 2-year pilot that aimed to integrate cervical and colorectal cancer screening with the Screen Test program. This study compares cervical and colorectal cancer screening uptake among women screened through the pilot (Screen Test-EACS) versus Screen Test. Screen Test-EACS was offered between 2013 and 2015 in selected rural and remote sites, with a focus on hard-to-reach women living in First Nations, Métis and Hutterite communities. Participation in cervical and colorectal cancer screening was analyzed for Screen Test and Screen Test-EACS participants 6 weeks before clients received their mammogram and then again 3 months after. A total of 8390 and 1312 women participated in Screen Test and Screen Test-EACS, respectively. Screen Test-EACS significantly increased uptake of cervical (10.1% v. 27.5%) and colorectal (10.9% v. 22.5%) cancer screening, increasing the prevalence of women up to date with screening from 52.5% to 62.9% for cervical cancer screening and from 37.3% to 48.7% for colorectal cancer screening. Screen Test-EACS increased participation in and the overall prevalence of cervical and colorectal cancer screening among hard-to-reach clients in northern Alberta, probably through removal of barriers to access and increased awareness. Further research should focus on balancing the benefits of increased participation with the costs and potential risks of over-screening.

Testing the Effectiveness of a Primary Care Intervention to Improve Uptake of Colorectal Cancer Screening: A Randomized Controlled Trial Protocol.

BackgroundScreening for colorectal cancer (CRC) significantly reduces mortality associated with this disease. In Australia, the National Bowel Cancer Screening Program provides regular fecal occult blood tests (FOBT) for those aged 50 to 74 years, however, participation rates in the program have plateaued at 36%. Given low uptake in the National Bowel Cancer Screening Program, it is necessary to explore alternate methods to increase CRC screening rates. Primary care is a promising adjunct setting to test methods to increase CRC screening participation. Primary care guidelines support the recommendation and provision of CRC screening to primary care patients. Those in the National Bowel Cancer Screening Program target age range frequently present to their primary care provider.ObjectiveThis study tests the effect that a multicomponent primary care–based intervention has on CRC screening uptake when compared to usual care.MethodsPrimary care patients presenting for an appointment with their primary care provider complete a touchscreen survey to determine eligibility for the trial. Those aged 50 to 74 years, at average risk of CRC, with no history of CRC or inflammatory bowel disease, who have not had an FOBT in the past 2 years or a colonoscopy in the past 5 years are eligible to participate in the trial. Trial participants are randomized to the intervention or usual care group by day of attendance at the practice. The intervention consists of provision of an FOBT, printed information sheet, and primary care provider endorsement to complete the FOBT. The usual care group receives no additional care.ResultsThe primary outcome is completion of CRC screening 6 weeks after recruitment. The proportion of patients completing CRC screening will be compared between trial groups using a logistic regression model.ConclusionsCRC screening rates in Australia are suboptimal and interventions to increase screening participation are urgently required. This protocol describes the process of implementing a multicomponent intervention designed to increase CRC screening uptake in a primary care setting.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12616001299493; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371136&isReview=true (Archived by WebCite at http://www.webcitation.org/6pL0VYIj6). Universal Trial Number U1111-1185-6120.

Factors influencing the decision to attend screening for cancer in the UK: a meta-ethnography of qualitative research.

This review aimed to better understand experiences of being invited to cancer screening and associated decision-making. Qualitative evidence explaining UK cancer screening attendance decisions was systematically identified. Data were extracted and meta-ethnography used to identify shared themes, synthesize findings and generate higher level interpretations. Thirty-four studies met inclusion criteria. They related to uptake of breast, cervical, colorectal, prostate, ovarian and lung cancer screening. Three primary themes emerged from the synthesis. 'Relationships with the health service' shaped decisions, influenced by trust, compliance with power, resistance to control or surveillance and perceived failures to meet cultural, religious and language needs. 'Fear of cancer screening' was both a motivator and barrier in different ways and to varying degrees. Strategies to negotiate moderate fear levels were evident. 'Experiences of risk' included the creation of alternative personal risk discourses and the use of screening as a coping strategy, influenced by disease beliefs and feelings of health and wellness. The findings highlight the importance of the provider-patient relationship in screening uptake and enrich our understanding of how fear and risk are experienced and negotiated. This knowledge can help promote uptake and improve the effectiveness of cancer screening.

Colorectal Cancer Screening Initiation After Age 50 Years in an Organized Program

Recent studies report racial disparities among individuals in organized colorectal cancer (CRC) programs; however, there is a paucity of information on CRC screening utilization by race/ethnicity among newly age-eligible adults in such programs. This was a retrospective cohort study among Kaiser Permanente Northern California enrollees who turned age 50 years between 2007 and 2012 (N=138,799) and were served by a systemwide outreach and facilitated in-reach screening program based primarily on mailed fecal immunochemical tests to screening-eligible people. Kaplan-Meier and Cox model analyses were used to estimate differences in receipt of CRC screening in 2015-2016. Cumulative probabilities of CRC screening within 1 and 2 years of subjects' 50th birthday were 51% and 73%, respectively. Relative to non-Hispanic whites, the likelihood of completing any CRC screening was similar in blacks (hazard ratio, 0.98; 95% CI=0.96, 1.00); 5% lower in Hispanics (hazard ratio, 0.95; 95% CI=0.93, 0.96); and 13% higher in Asians (hazard ratio, 1.13; 95% CI=1.11, 1.15) in adjusted analyses. Fecal immunochemical testing was the most common screening modality, representing 86% of all screening initiations. Blacks and Hispanics had lower receipt of fecal immunochemical testing in adjusted analyses. CRC screening uptake was high among newly screening-eligible adults in an organized CRC screening program, but Hispanics were less likely to initiate screening near age 50 years than non-Hispanic whites, suggesting that cultural and other individual-level barriers not addressed within the program likely contribute. Future studies examining the influences of culturally appropriate and targeted efforts for screening initiation are needed.

Providing Quantitative Information and a Nudge to Undergo Stool Testing in a Colorectal Cancer Screening Decision Aid: A Randomized Clinical Trial.

Guidelines recommend that patient decision aids should provide quantitative information about probabilities of potential outcomes, but the impact of this information is unknown. Behavioral economics suggests that patients confused by quantitative information could benefit from a "nudge" towards one option. We conducted a pilot randomized trial to estimate the effect sizes of presenting quantitative information and a nudge. Primary care patients (n = 213) eligible for colorectal cancer screening viewed basic screening information and were randomized to view (a) quantitative information (quantitative module), (b) a nudge towards stool testing with the fecal immunochemical test (FIT) (nudge module), (c) neither a nor b, or (d) both a and b. Outcome measures were perceived colorectal cancer risk, screening intent, preferred test, and decision conflict, measured before and after viewing the decision aid, and screening behavior at 6 months. Patients viewing the quantitative module were more likely to be screened than those who did not ( P = 0.012). Patients viewing the nudge module had a greater increase in perceived colorectal cancer risk than those who did not ( P = 0.041). Those viewing the quantitative module had a smaller increase in perceived risk than those who did not ( P = 0.046), and the effect was moderated by numeracy. Among patients with high numeracy who did not view the nudge module, those who viewed the quantitative module had a greater increase in intent to undergo FIT ( P = 0.028) than did those who did not. The limitations of this study were the limited sample size and single healthcare system. Adding quantitative information to a decision aid increased uptake of colorectal cancer screening, while adding a nudge to undergo FIT did not increase uptake. Further research on quantitative information in decision aids is warranted.

Su1578 - A Multilevel Quality Improvement Initiative to Improve Colorectal Cancer Screening in a Managed Care Population

Colorectal cancer (CRC) is a common but largely preventable disease with suboptimal screening rates despite national guidelines to screen individuals age 50–75. Single-component interventions aimed to improve screening uptake only modestly improve rates; data suggest that multi-modal approaches may be more effective. We designed, implemented, and evaluated the impact of a multi-modal intervention on CRC screening uptake among unscreened patients in a large managed care population. Patient-level components included a mailed letter with education about screening options and pre-colonoscopy telephone counseling. For providers, we facilitated communication of screening test results and work-flow for abnormal results. System-level modifications included establishment of a patient navigator, expedited work-up for abnormal results, and stream-lined colonoscopy scheduling. We measured the rate of screening uptake overall, screening uptake by modality, change in the proportion of the population screened, and positive fecal immunochemical test (FIT) follow-up rates in the 1-year study period. There were 5093 patients in the intervention cohort. Of these, 33.2% participated in FIT or colonoscopy screening within 1 year of the mailing. A total of 1078 (21.2%) participants completed a FIT and 611 (12.0%) completed a screening colonoscopy. The screening rate in the managed care population increased from 65.1 to 76.6%. Fifty-nine patients (5.5%) had a positive FIT, of which 30 (50.8%) completed a diagnostic colonoscopy. Multi-modal interventions can result in substantial improvement in CRC screening uptake in large and diverse managed care populations. Health systems should shift their focus from single-level to multi-level interventions when addressing barriers to CRC screening.

Su1746 - An Online Risk Assessment Tool Demonstrates Patient Risk Factors and Behaviors Associated with Uptake of Colorectal Cancer Screening

Su1746 - An Online Risk Assessment Tool Demonstrates Patient Risk Factors and Behaviors Associated with Uptake of Colorectal Cancer Screening

Uptake trends in the Scottish Bowel Screening Programme and the influences of age, sex, and deprivation.

Objective Age, sex, and deprivation are known factors influencing colorectal (bowel) cancer screening uptake. We investigated the influence of these factors on uptake over time. Methods Data from the Scottish Bowel Screening Programme (SBoSP) were collected between 2007 and 2014. End-points for analysis were uptake, faecal occult blood test positivity, and disease detection, adjusted for age, sex, deprivation, and year of screening. Results From 5,308,336 individual screening episodes documented, uptake gradually increased with increasing age up to 65-69 and was lower in men than women (52.4% vs. 58.7%, respectively). Deprivation had a significant effect on uptake by men and women of all age groups, with the most deprived least likely to complete a screening test. Uptake has increased with time in both sexes and across the deprivation gradient. The number needed to screen to detect significant neoplasia was significantly lower in men than women overall (170 vs. 365), and this held over all age and deprivation groups. The number needed to screen was also lower in the more deprived population. Conclusions Although lower age, male sex, and increased deprivation are associated with lower bowel cancer screening uptake in Scotland, uptake has increased since SBoSP introduction in all age groups, both sexes, and across the deprivation gradient. Despite a lower uptake, the number needed to screen to find significant disease was lower in men and in those with higher levels of deprivation.

Do Primary Care Provider Strategies Improve Patient Participation in Colorectal Cancer Screening?

Screening rates for colorectal cancer (CRC) remain suboptimal. The impact of provider strategies to enhance screening participation in the population is uncertain. The objective of this study was to determine the effect of provider strategies to increase screening in a single-payer system. A population-based survey was conducted in primary care providers (PCPs) linked to patients using administrative data in Ontario, Canada. Patients were due for CRC screening from April 2012 to March 2013. Patients were followed up until 31 March 2014. We determined time to become up-to-date with CRC screening. Cox proportional hazards models examined the association between PCP strategies and uptake of screening, adjusted for physician and patient factors. A total of 717 PCPs and their 147,834 rostered patients due for CRC screening were included. Most physicians employed strategies to enhance screening participation, including electronic medical record use, reminders, generation of lists, audit and feedback reports, or designating staff responsible for screening. No single strategy was strongly associated with screening. For those >1 year overdue, a systematic approach to generate lists of patients overdue for screening was weakly associated with screening uptake (hazard ratio (HR)=1.14, 95% CI: 1.03-1.26, P=0.04 >5 years overdue vs. <1 year overdue). The use of multiple PCP strategies was associated with screening participation (HR=1.27, 95% CI: 1.16-1.39, P<0.0001 for PCPs using 4-5 vs. 0-1 strategies). Practice-based strategies were self-reported. In practice, while individual PCP strategies have little effect, the use of multiple strategies to enhance screening appears to improve CRC screening uptake in patients.

The Chinese and Korean American immigrant experience: a mixed-methods examination of facilitators and barriers of colorectal cancer screening

ABSTRACTObjective: Among Asian Americans, colorectal cancer (CRC) is the second leading cause of cancer deaths. Despite strong evidence that screening can reduce CRC-related mortality, fewer Chinese and Koreans receive screening as compared to non-Hispanic whites and blacks. The objective of this study was to examine facilitators and barriers as well as strategies to promote CRC screening in this population.Design: This study employed a mixed-methods design. We conducted 17 key informant interviews and 12 focus groups in the Washington, D.C. metropolitan area. 120 Chinese and Korean focus group participants, aged 50 to 85, also provided quantitative data through self-administered surveys. All participants were asked to discuss facilitators and barriers of CRC screening, including in relation to culture.Results: Participants who had a regular physician and doctor’s recommendation for CRC screening were more likely to ever receive a colonoscopy (adjusted odds ratio (aOR) = 3.51; 95% confidence interval (CI): 1.26, 9.79 and aOR = 6.61; 95% CI: 2.63, 16.65, respectively). A doctor’s recommendation was also significantly associated with receipt of a fecal occult blood test (FOBT) (aOR = 4.00; 95% CI: 1.43, 11.15). In terms of barriers, those who reported having no time and not having symptoms were less likely to have a colonoscopy (aOR = 0.15; 95% CI: 0.03, 0.82 and aOR = 0.02; 95% CI: 0.002, 0.23, respectively) than those who had time and symptoms. Preventive healthcare was often not viewed as a priority, particularly for those living the‘immigrant life,’ who gave precedence to work. Cultural barriers to CRC screening included language (e.g. limited English proficiency and low health literacy); fear of finding CRC and burdening the family especially children; fatalism; and stigma towards cancer.Conclusions: Future interventions and programs aiming to increase CRC screening among Chinese and Korean Americans should address both cultural and non-cultural factors that influence CRC screening uptake.

Abstract B02: Utilizing Cancer Control P.L.A.N.E.T. to develop a colorectal cancer control plan

Abstract Colorectal cancer is the third most common cancer in the US and accounts for the second highest cancer deaths among men and women. Scientific evidence shows colorectal cancer as one of the most preventable cancers, if detected and treated early. National efforts are underway to accelerate the uptake of colorectal cancer screening to 80% of eligible adults being screened by 2018. The Cancer Control P.L.A.N.E.T. (Plan, Link, Act, Network with Evidence-based Tool) is a comprehensive web portal that can be used to inform the development of effective cancer control programs, providing an accurate profile of cancer and evidence-based interventions among the different population subgroups at the state and local levels. The P.L.A.N.E.T. web portal was used to demonstrate how to develop a cancer control plan to improve colorectal cancer screening rates and reduce disparities at the local level. State Cancer Profiles, Research to Reality, Research Synthesis and Research-tested Intervention Programs were four resources utilized from P.L.A.N.E.T. to profile colorectal cancer and develop a cancer control plan for St Landry Parish, Louisiana, a large culturally diverse and historic area. A series of maps and tables were generated to communicate the geographic, SES and racial differences in colorectal cancer at the local and state levels. The State Cancer Profiles resource provided rate/trend comparisons, mortality rates, historical trends as well as screening and risk factors data to profile colorectal cancer. Five Parishes, including St. Landry, showed higher death rates above Louisiana, but stable. High rates of obesity, smoking, poverty and lower education persist in the Parish. St. Landry also showed a colorectal screening rate of 46.7%, which is far below the new 80% goal. The Research to Reality resource provided statistical and anecdotal evidence, opportunities to collaborate and a colorectal learning community to help mobilize community resources and influence implementation of a cancer control program. The Research Synthesis resource provided national scientific recommendations and policy from systematic and evidence reviews on colorectal cancer. Thirteen research-tested colorectal intervention programs were available with 50% focused on the medically underserved that can be adopted for a specific population. The results show the utility of Cancer Control P.L.A.N.E.T. web portal when there is a targeted approach to improving cancer outcomes. A colorectal cancer control plan for St. Landry should include a focus on obesity reduction, smoking cessation and screening. Evidence-based interventions and other resources to reduce the risk factors can be accessed on P.L.A.N.E.T. The demonstration of P.L.A.N.E.T. shows how it can be used to elicit action from cancer control planners to set priorities, allowing for the development and implementation of effective cancer control programs in the areas most impacted in order to reduce cancer burden and disparities. Citation Format: Antoinette Percy-Laurry. Utilizing Cancer Control P.L.A.N.E.T. to develop a colorectal cancer control plan. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B02.

Abstract A63: Changes in health beliefs among medically-underserved patients enrolled in a community-based randomized controlled trial to promote colorectal cancer screening

Abstract Marked health disparities exist in colorectal cancer (CRC) screening, incidence, and mortality among medically-underserved communities. Literature suggests certain health beliefs (e.g., perceived risk) may be related to screening behavior. This study examined changes in CRC health beliefs following receipt of one of two educational interventions aimed at promoting CRC screening uptake among a medically-underserved population. We compared changes in CRC health beliefs at baseline and 12 months later both within and between the two intervention groups. Enrolled participants were aged 50-75, at average CRC risk, not up-to-date with CRC screening guidelines, enrolled in a randomized controlled trial to increase CRC screening that was conducted at community clinics in the Tampa Bay area, and completed both the baseline and 12 month follow-up assessments. Participants were randomized to receive either a culturally-targeted photonovella and DVD plus fecal immunochemical test (FIT) intervention (titled Colorectal Cancer Awareness, Research, Education and Screening, or CARES, intervention group condition) or a Centers for Disease Control and Prevention (CDC) standard educational brochure plus FIT intervention (comparison group condition). At both time points, participants completed a questionnaire that included multiple health-related beliefs including Preventive Health Model (PHM) constructs (i.e., perceived susceptibility, perceived salience, self-efficacy, response efficacy, cancer worry, social influence, and religious beliefs), CRC awareness, decisional conflict regarding CRC screening, cancer fatalism, trust in the healthcare system, and perceived discrimination. Changes in health belief scores and group differences in change were examined using Student's t-tests. The majority of participants (n=270) were: female (58%); white (67%) or black (26%); insured (59%) including county health insurance; had a household income &amp;lt;$10,000 (65%); and had a high school education (35%) or more than high school education (41%). In both intervention conditions, there was an increase in CRC awareness, PHM social influence, and trust in the healthcare system (all p's&amp;lt;.0001). In the CARES intervention group, there also was an increase in PHM salience (p&amp;lt;.05). Among individuals in the comparison group, there was an increase in PHM response efficacy (p&amp;lt;.01) and PHM self-efficacy (p&amp;lt;.0001). There were no significant between-group differences on any of the health belief change scores. Both CRC screening interventions promoted positive changes in multiple health beliefs from baseline to 12 months which suggests clear benefits of educational interventions. The interventions had common positive effects (i.e., CRC awareness, PHM social influence, and trust in the healthcare system), but also unique effects on PHM salience (CARES condition) and PHM self-efficacy and PHM response efficacy (comparison condition). However, between-group intervention comparisons were not significant suggesting that both educational interventions are beneficial. Given that individuals in both intervention groups were provided with access to CRC screening via FIT kit, future analyses will examine whether changes in health beliefs were associated with higher CRC screening uptake. Citation Format: Shannon M. Christy, Steven K. Sutton, Enmanuel Chavarria, Stacy N. Davis, Rania Abdulla, Gwendolyn P. Quinn, Susan T. Vadaparampil, Chitra Ravindra, Ida Schultz, Richard Roetzheim, David Shibata, Cathy D. Meade, Clement K. Gwede. Changes in health beliefs among medically-underserved patients enrolled in a community-based randomized controlled trial to promote colorectal cancer screening. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A63.

Abstract B64: Impact of neighborhood effects on a multi-approach Colorectal Cancer screening navigation program in an urban federally qualified health center

Abstract Purpose. Mortality and morbidity disparities exist in Colorectal Cancer (CRC). CRC screening rates differs among race/ethnicity, which contribute to these existing disparities. In response, multiple interventions have been developed and assed to address these gaps. Little is known about how efficacy varies across patient populations. In response, multiple interventions have been developed and assessed, including patient navigation. Little is known about how efficacy varies across socioenvironmental contexts. Objective. The study sought to examine the interactive effects of patient navigation and provider navigation with contextual factors (facility and residential neighborhood characteristics) on CRC screening uptake among a Chicago-based sample population. Methods. Two evidence-based CRC screening interventions were implemented at University of Illinois Mile Square Health Center (MSHC) clinics. The study eligible population was those: 1) Ages 50-75; 2) Had an appointment in 2014 or 2015; and 3) Not up-to-date on CRC screening. The controls were matched by clinic, race/ethnicity, and sex. An individual-level database for the retrospective evaluation of comparative effectiveness of patient navigation-based versus provider-based navigation was created. This database included all patients ages 50-75 who completed at least one patient visit in MSHC in 2015. The database includes patients navigated by the patient navigator, and patients navigated by the provider. The following information was collected from electronic medical record (EMR) data: 1) age; 2) race/ethnicity; 3) insurance status; 4) date mailed birthday reminder was sent; 5) type of one-on-one navigation (CHW, provider, or both); 6) date navigation was administered; 7) patient full address, including zip code; 8) date FOBt given to patient during 2015; 9) date FOBt returned; 10) date colonoscopy scheduled; 11) date colonoscopy completed;12) FOBt result; 13) Screening colonoscopy result; 14) Diagnostic colonoscopy date; 15) Diagnostic colonoscopy date; 16) Cancer Diagnosis date; 17) provider name; and 18) clinic site. The neighborhood characteristics of interest were median household income, poverty, percent black, percent white, and percent of Latino residents based on American Community Survey 2007-2011 data. Results. A preliminary analysis was conducted on the database, n= 340. There were significant differences in clinic using Chi-Square statistic (X= 10.7, p = .005). When looking at individual clinics, for the Englewood and Main clinic, patients responded better to provider navigation (20% and 21%) compared to patient navigation (8% and 15%), respectively. Whereas, the Back of the Yards clinic had patients respond better to provider navigation versus patient navigation, 56% versus 14%. Adjusted for clinic, gender, and race/ethnicity, patient navigation was most strongly associated with CRC completion (OR = 5.5, 95% CI:3.1-9.8, p = &amp;lt;.0001). Provider navigation was associated with CRC completion (OR = 1.81, p = .04). The next steps in the study analysis will be to complete the data abstraction with matched-controls and conduct multivariable spatial logistic and Cox regression models to compare the different types of navigation on a) date patient received FOBt and b) days to FOBt returned since date of navigation c) days to completed colonoscopy since date of navigation. Second, multiple effect modification analyses will be conducted to examine interactive effects by 1) race/ethnicity; 2) clinic site; and 3) neighborhood factors (concentrated disadvantage and racial/ethnic composition). Conclusions. In this sample, patient navigation as an intervention was most strongly associated with CRC completion, relative to those who received the standard CRC screening recommendations (controls). CRC screening can lead to increases early detection and improved outcomes. Navigation programs that are tailored to address specific populations can increase uptake and compliance and have far reaching implications in FQHC populations who carry some of the largest burden of cancer morbidity and mortality. Citation Format: Yazmin San Miguel, Yamile Molina, L. San Miguel, Scott Grumeretz, K. Matthews, Robert Winn, Karriem Watson. Impact of neighborhood effects on a multi-approach Colorectal Cancer screening navigation program in an urban federally qualified health center. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B64.

Abstract A25: A culturally-linguistically salient intervention to increase fecal immunochemical test uptake among Spanish-preferring Latino adults receiving care in community-based clinics

Abstract Background: Among Latinos in the US, colorectal cancer (CRC) is the third leading cause of cancer-related deaths. Despite the benefits of colorectal cancer screening (CRCS) being well recognized, screening is underutilized among Latino adults, ages 50-75. The availability of language and literacy appropriate educational information paired with an accessible, easy-to-use screening tool, such as fecal immunochemical test (FIT), within community health settings is a promising way to impact cancer-related disparities for Spanish-preferring Latino older adults. Formative qualitative efforts (focus groups, key informant interviews, and learner verification interviews) produced a culturally, and linguistically salient photonovella booklet and DVD titled, Latinos Colorectal Cancer Awareness, Research, Education and Screening (CARES). Purpose: This pilot study compared the efficacy of two intervention conditions on FIT uptake among Spanish-preferring Latino adults receiving care in community clinics. Participants were randomized to receive either the Latinos CARES intervention + FIT or CDC Brochure + FIT. We report preliminary findings at 6 months. Methods: Participants (N=76) were Latinos, accessing care at community-based clinics, prefer to receive their health information in Spanish, aged 50-75, at average CRC risk, and non-adherent to CRCS guidelines. Consented participants were administered a baseline interview assessing awareness of CRCS tests, preventive health model constructs, health literacy (consisting of two validated items), eHealth literacy (eHEALS), and sociodemographic variables. Following the baseline questionnaire, participants were randomized (1:1 allocation) to receive Latinos CARES intervention + FIT or CDC Brochure + FIT. The primary outcome was FIT kit screening uptake at 6 months. Results: Participants were mostly female (67.8%), median age of 55, with less than a High school diploma (61.8%), annual income of less than $10,000 (48.7%), no medical insurance (75.0%), were unemployed or retired (45.3%), self-identified as “other” for race (67.1%), and born in a country other than the US (93.4%). For those born outside the US, the mean number of years spent in the US was 23.4 years. No significant differences on baseline characteristics were found between study conditions. Accrual rate was an average 11 participants per month for 7 months. To date, FIT uptake is 87% (for both groups), a rate that exceeds the Healthy People 2020 goal of 70.5%. One participant with abnormal FIT results was referred for a colonoscopy. Results of participant's colonoscopy indicated cancer was not present. Conclusions: Providing educational materials (print and/or video), coupled with a FIT kit to Spanish-preferring Latinos receiving care in community clinics may be a promising strategy to bolster CRC screening uptake. The successful accrual rate is reflective of a high interest for education on CRCS among Spanish-preferring Latinos. Three-month follow-up for post-intervention assessments on awareness of CRCS tests, preventive health model constructs, and intervention use is currently underway, and assessment of intervention group differences is pending. Although preliminary, the high overall screening uptake among both study conditions far exceeds national targets and provides evidence to move to a larger scale RCT. Citation Format: Enmanuel Antonio Chavarria, Rania Abdulla, Liliana Gutierrez, Lynne Klasko, Dinorah Martinez Tyson, Claudia Aguado Loi, Julian Sanchez, Cathy Meade, Clement Gwede. A culturally-linguistically salient intervention to increase fecal immunochemical test uptake among Spanish-preferring Latino adults receiving care in community-based clinics. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A25.

Colorectal cancer screening.

Colorectal cancer, which is the leading cancer in Singapore, can be prevented by increased use of screening and polypectomy. A range of screening strategies such as stool-based tests, flexible sigmoidoscopy, colonoscopy and computed tomography colonography are available, each with different strengths and limitations. Primary care physicians should discuss appropriate screening modalities with their patients, tailored to their individual needs. Physicians, patients and the government should work in partnership to improve uptake of colorectal cancer screening to reduce the morbidity and mortality from colorectal cancer.

Increasing Colorectal Cancer Screening Uptake in Patients: Provider-Initiated Discussion at Every Primary Care Patient Encounter

Colorectal cancer killed 51,651 people in the United States in 2014, despite this type of cancer being almost completely preventable and, if diagnosed in early stages, highly treatable. Colorectal cancer screening is recommended for all people 50-75 years of age at specified intervals depending on the type of screening used, as well as the screening results. However, only 58.2% of people in the United States had received appropriate screening based on their age, past screening participation, and the results of past screenings in 2013. Although patients have many barriers pertaining to uptake of colorectal cancer screening, most often cited is lack of knowledge and lack of provider recommendation. Population-based interventions are cost-effective ways of increasing the knowledge of the general public. Offering colorectal screening methods other than colonoscopy increases colorectal screening recommendation adherence. Despite these interventions, the importance of the patient-provider discussion is widely cited in the literature as a critical factor in decreasing barriers to screening and providing individualized screening recommendations with a high probability of uptake. Multiple missed opportunities exist every day within established primary care practices, and can be captured with provider-initiated discussion of colorectal cancer screening recommendations at every primary care patient encounter.

Development of a Colorectal Cancer Screening Intervention for Iranian Adults: Appling Intervention Mapping

Background:While the incidence rate of the colorectal cancer (CRC) has been increasing over the last three decades in Iran, very limited interventions to increase CRC screening have been developed for Iranian population. The purpose of this study was to describe the use of Intervention Mapping (IM) for applying theory and evidence and considering local contexts to develop a CRC screening program among adults in Iran.Materials and Methods:From April 2014 to July 2016 following the IM process, six steps were formulated and implemented. First a need assessment was conducted involving relevant stakeholders and using focus groups discussions (n=10), individual interviews (n=20), and a household survey (n= 480). Then a matrix of change objectives was developed for each behavioral outcome and theoretical methods and their practical applications were identified to guide intervention development and implementation. A multi-component intervention was developed and piloted. Decision on suitable parts of intervention was made based on feedback of pilot study. Finally, evaluation plan including process and outcome evaluation was generated and conducted to inform future scale up.Results:The needs assessment highlighted factors affecting CRC screening including knowledge, self efficacy, social support and perceived benefit and barriers (financial problems, fear of detection of cancer and etc). Results of needs assessment were used to develop next steps IM. The program utilized methods like information delivery, modeling, and persuasion. Practical applications included video presentation, group discussion, role playing and postcards. This program was assessed through a cluster-randomized controlled trial. Results showed that there were significant differences in CRC screening uptake between intervention groups and control (P<0.001).Conclusions:IM is a useful process in the design of a theory-based intervention addressing CRC screening among Iranian population.

Approaching the Hard-to-Reach in Organized Colorectal Cancer Screening: an Overview of Individual, Provider and System Level Coping Strategies.

BackgroundDespite the proven effectiveness of colorectal cancer (CRC) screening on reduction of CRC mortality, the uptake of CRC screening remains low. Participation rate is one of determinants for the success of organized population-based screening program. This review aims to identify those who are hard-to-reach, and summarize the strategies to increase their screening rate from individual, provider and system levels.MethodsA systematic search of electronic English databases was conducted on the factors and strategies of uptake in CRC screening for the hard-to-reach population up to May 2017.DiscussionThe coverage rate and participation rate are two indexes to identify the hard-to-reach population in organized CRC screening program. However, the homeless, new immigrants, people with severe mental illness, the jail intimates, and people with characteristics including lower education levels and/or low socioeconomic status, living in rural/remote areas, without insurance, and racial minorities are usually recognized as hard-to-reach populations. For them, organized screening programs offer a better coverage, while novel invitation approaches for eligible individuals and multiple strategies from primary care physicians are still needed to enhance screening rates among subjects who are hard-to-reach. Suggestions implied the effectiveness of interventions at the system level, including linkages to general practice; use of decision making tools; enlisting supports from coalition; and the continuum from screening to diagnosis and treatment.ConclusionOrganized CRC screening offers a system access to approach the hard-to-reach populations. To increase their uptake, multiple and novel strategies from individual, provider and system levels should be applied. For policymakers, public healthcare providers and community stakeholders, it is a test to tailor their potential needs and increase their participation rates through continuous efforts to eliminate disparities and inequity in CRC screening service.