Colorectal Cancer Screening Completion Research Articles

Abstract PO-246: Supporting community health center patients in completing follow-up colonoscopy: A qualitative summary of patient navigation activities

Abstract Background Fecal immunochemical tests (FITs) are an acceptable and cost-effective way to identify patients at risk for colorectal cancer (CRC). However, patients who receive an abnormal FIT result must obtain a follow-up colonoscopy. Rates of follow- up colonoscopy are low in most healthcare settings, particularly in federally qualified health centers (FQHCs). Half of patients with an abnormal FIT result fail to complete this essential colonoscopy screening component. Patient navigation can provide much needed support for patients to complete the follow-up colonoscopy. Methods PRECISE is a patient-randomized trial of patient navigation vs usual care for follow-up colonoscopy that will enroll 1,200 patients across 28 community health center clinics in Washington State (anticipated 37% Latinx). For the study, we trained a bilingual (native Spanish speaker) patient navigator (PN) using an intensive 8-week program, based on the New Hampshire Colorectal Cancer Screening Program. As part of the recruitment and data tracking tool used by the PN, open text fields are available for documenting interactions with navigated patients. We present a qualitative content analysis of the open text fields of navigated patients. These findings identify a broad range of supportive interactions engaged in by the PN to assist patients in overcoming barriers to follow-up colonoscopy completion. Results To-date, 124 patients have been randomized to navigation, and 44 of these had open text field documentation. Our content analysis found slightly more than half (N=23) required more intensive navigation assistance for overcoming a variety of barriers such as fear of or misinformation about the colonoscopy; help with scheduling, transportation, and interpreter services; and assistance with obtaining and completing the bowel preparation. Those that needed less navigation (N=21) mostly required assistance with scheduling the colonoscopy and often had protective factors such as prior colonoscopy experience or support from family/friends for completing the procedure. Overall, the top three areas the PN tended to provide support for overcoming barriers included: contacting the gastroenterologist office to problem- solve issues like lack of referral, scheduling delays, or to obtain appointment information (40 instances); assisting the patient with obtaining, understanding, and completing the bowel preparation including diet restrictions, medication interaction, and preparing/consuming the mixture (25 instances); and verifying, coordinating, and offering transportation/escort support before and after the colonoscopy procedure (22 instances). Conclusion The PRECISE trial highlights the importance of targeted patient navigation to improve CRC screening completion. Our open text field findings demonstrate the necessary role of patient navigation for overcoming the multitude of educational and structural challenges facing FQHC patients when attempting to complete a follow-up colonoscopy. Citation Format: Jennifer L. Schneider, Jennifer S. Rivelli, Jamie Thompson, Amanda Petrik, Neha Yadav, Hanna Dinh, Cindy Pulido, Shirley Mendez, DeeDee Torres, Gloria Coronado. Supporting community health center patients in completing follow-up colonoscopy: A qualitative summary of patient navigation activities [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-246.

Psychosocial determinants of colorectal Cancer screening uptake among African-American men: understanding the role of masculine role norms, medical mistrust, and normative support

ABSTRACT Objectives Despite having the highest colorectal cancer (CRC) incidence and mortality across all major racial/ethnic groups, African-American men consistently have poor CRC screening rates. Gendered and racialized beliefs and norms have been associated with African-American men’s lower medical assistance-seeking rates, but how these notions influence African-American men’s CRC screening practices merits further investigation. The purpose of this study was to examine the influence of psychosocial determinants of men’s health on CRC screening uptake among African-American men in three states. Design Participants were recruited via CuttingCRC.com and through culturally-tailored flyers, newspaper ads, and snowball sampling, among other methods. From April 2019-August 2019, 11 focus groups were conducted with English-speaking Black/African-American men who (a) were between ages 45-75, (b) were born in the United States, (c) had a working telephone, and (d) lived in Minnesota, Ohio, or Utah. Multiple-cycle coding, Hatch’s 9-step approach, and constant comparative data analysis was employed for de-identified transcript data. Results Eighty-four African-American men met inclusion criteria and participated. Their mean age was 59.34 ± 7.43. In regards to CRC screening status, Ohio had the most previously screened participants (85%), followed by Minnesota (84%) and Utah (76%). Two major CRC screening barriers (masculine role norms and medical mistrust) – both encompassed 3–5 subthemes, and one major facilitator (normative support from family members or social networks) emerged. Conclusions Despite CRC screening’s life-saving potential, African-American men have had the lowest 5-year relative survival for more than 40 years. When developing interventions and health promotion programs aiming to eliminate the racial disparity in CRC outcomes, addressing both masculine role norms and medical mistrust barriers to CRC screening completion among African-American men is warranted.

S0285 Improving the Rate of Colorectal Cancer Screening in the Outpatient Clinic

INTRODUCTION: While colonoscopy remains the gold standard for colorectal cancer (CRC) screening, in 2016 in the United States only 67.3% of eligible adults were screened for CRC, despite multiple studies showing a 68%–88% reduction in CRC mortality in patients receiving CRC screening. With roughly 147,950 new cases expected to be diagnosed in 2020 with a subsequent 53,200 deaths, we created a quality improvement initiative to determine if physician education could have a significant impact on increasing CRC screening adherence in the outpatient setting. METHODS: We queried our electronic medical record to harvest the number of patients who qualified for screening colonoscopy, with an average risk for colon cancer (i.e., those without a family history of colorectal neoplasia). From January 2018 through January 2019, a total of 1777 patients over ten residency cohorts at two different locations were found to be eligible CRC screening, we calculated the rate of completed CRC screening amongst these patients. This was calculated as the percentage of patients with either a colonoscopy within the past 10 years, or a flexible sigmoidoscopy over the last 5 years, or a fecal occult blood testing over the last year. Physician education interventions were performed in January 2019. Our educational interventions included an academic day focused on the American College of Gastroenterology (ACG) CRC screening guidelines, the importance of CRC screening, and the percentage of completed CRC screenings per residency cohort over the past year. We then calculated the difference in percentages of completed CRC screenings by each of the ten residency cohorts before and after physician education from January 2019 to June 2019. RESULTS: Our results show that physician education increased the percentage of completed CRC screening in the outpatient resident clinics overall. Individual Cohort data can be seen in Figures 1 and 2. Figures 1 and 2 show the percent change from baseline for each residency outpatient clinic cohort at two resident clinic sites, Clinic #1, and Clinic #2, respectively. CONCLUSION: Our study shows that physician education may have an impact on increasing CRC screening percentages in the outpatient setting, despite patient factors. We recommend physician education on the importance of CRC screening, the ACG guidelines for CRC screening, and the percentages of eligible patients who go unscreened.Figure 1.: Shows the percentage improvement in each of the 5 Clinic #1 cohorts. Cohort E showed the most significant results, improving 13.3%. Cohorts A-D also showed positive results, ranging from 0.4% to 3.9%.Figure 2.: Shows the increase in the percentage of CRC screening for each of the 5 Clinic #2 cohorts. Cohorts B-D all showed positive results ranging from 6.4% to 9.6%, while Cohorts A and E showed negative results at −6.9% and −1.9%, respectively.

Interventions for increasing colorectal cancer screening uptake among African-American men: A systematic review and meta-analysis.

BackgroundAfrican-American men have the lowest 5-year survival rate in the U.S. for colorectal cancer (CRC) of any racial group, which may partly stem from low screening adherence. It is imperative to synthesize the literature evaluating the effectiveness of interventions on CRC screening uptake in this population.Materials and methodsIn this systematic review and meta-analysis, Medline, CINAHL, Embase, and Cochrane CENTRAL were searched for U.S.-based interventions that: were published after 1998–January 2020; included African-American men; and evaluated CRC screening uptake explicitly. Checklist by Cochrane Collaboration and Joanna Brigg were utilized to assess risk of bias, and meta-regression and sensitivity analyses were employed to identify the most effective interventions.ResultsOur final sample comprised 41 studies with 2 focused exclusively on African-American men. The most frequently adopted interventions were educational materials (39%), stool-based screening kits (14%), and patient navigation (11%). Most randomized controlled trials failed to provide details about the blinding of the participant recruitment method, allocation concealment method, and/or the outcome assessment. Due to high heterogeneity, meta-analysis was conducted among 17 eligible studies. Interventions utilizing stool-based kits or patient navigation were most effective at increasing CRC screening completion, with odds ratios of 9.60 (95% CI 2.89–31.82, p = 0.0002) and 2.84 (95% CI 1.23–6.49, p = 0.01). No evidence of publication bias was present for this study registered with the International Prospective Registry of Systematic Reviews (PROSPERO 2019 CRD42019119510).ConclusionsAdditional research is warranted to uncover effective, affordable interventions focused on increasing CRC screening completion among African-American men. When designing and implementing future multicomponent interventions, employing 4 or fewer interventions types may reduce bias risk. Since only 5% of the interventions solely focused on African-American men, future theory-driven interventions should consider recruiting samples comprised solely of this population.

Colorectal cancer screening completion: An examination of differences by screening modality.

Average-risk colorectal cancer (CRC) screening is broadly recommended, using one of several endorsed test options. However, CRC screening participation rates remain below national goals. To gain further insights regarding recent, population-based patterns in overall and test-specific CRC screening participation, we conducted a retrospective study of adults, ages 50–75 years, utilizing comprehensive data resources from the Rochester Epidemiology Project (REP).Among residents of Olmsted County, MN eligible and due for CRC screening, we identified 5818 residents across three annual cohorts who completed screening between 1/1/2016 and 12/31/2018. We summarized CRC screening rates as incidence per 1000 population and used Poisson regression to test for overall and mode-specific CRC trends. We also analyzed rates of follow-up colonoscopy within 6-months after a positive stool-based screening result.While no significant differences over time were observed in overall CRC screening incidence rates among those due for screening, we observed a statistically significant increase in mt-sDNA test and statistically significant decreases in screening colonoscopy and FIT/FOBT test completion rates; differences in screening overall and by modality were observed by age, sex, and race/ethnicity. The diagnostic colonoscopy follow-up rate within six months after a positive stool-based test was significantly higher following mt-sDNA (84.9%) compared to FIT/FOBT (42.6%).In this retrospective, population-based study, overall CRC screening incidence rates remained stable from 2016 to 2018, while test-specific rates for mt-sDNA significantly increased and decreased for colonoscopy and FIT/FOBT. Adherence with follow-up colonoscopy after a positive stool-based test was significantly higher among patients who underwent mt-sDNA screening compared to FIT/FOBT.

Colorectal Cancer Screening Patient Navigation for Patients with Mental Illness and/or Substance Use Disorder: Pilot Randomized Control Trial

Objective Colorectal cancer (CRC) is the second leading cause of cancer death in the US. Screening has decreased CRC mortality. However, disadvantaged patients, particularly those with mental illness or substance use disorder (SUD), are less likely to be screened. The aim of this trial was to evaluate the impact of a patient navigation program on CRC screening in patients with mental illness and/or SUD. Methods A pilot randomized nonblinded controlled trial was conducted from January to June 2017 in an urban community health center serving a low-income population. We randomized 251 patients aged 50–74 years with mental illness and/or SUD diagnosis overdue for CRC screening to intervention (n = 126) or usual care (n = 125) stratified by mental illness, SUD, or dual diagnosis. Intervention group patients received a letter followed by a phone call from patient navigators. Navigators helped patients overcome their individual barriers to CRC screening including: education, scheduling, explanation of bowel preparation, lack of transportation or accompaniment to appointments. If patient refused colonoscopy, navigators offered fecal occult blood testing. The main measure was proportion of patients completing CRC screening in intervention and usual care groups. Results Navigators contacted 85 patients (67%) in the intervention group and 26 declined to participate. In intention-to treat analysis, more patients in the intervention group received CRC screening than in the usual care group, 19% versus 10.4% (p = .04). Among 56 intervention patients who received navigation, 19 completed screening (33.9% versus 10.4% in the control group, p = .001). In the subgroup of patients with SUD, 20% in the intervention group were screened compared to none in the usual care group (p = .05). Conclusions A patient navigation program improved CRC screening rates in patients with mental illness and/or SUD. Larger studies in diverse care settings are needed to demonstrate generalizability and explore which modality of CRC screening is most acceptable and which navigator activities are most effective for this vulnerable population. Trials Registration Number 2016P001322

Effect of a Digital Health Intervention on Decreasing Barriers and Increasing Facilitators for Colorectal Cancer Screening in Vulnerable Patients.

Colorectal cancer is the second leading cause of cancer-related death in the United States, in part, because one third of Americans fail to get screened. In a prior randomized controlled trial, we found that an iPad patient decision aid called Mobile Patient Technology for Health-CRC (mPATH-CRC) doubled the proportion of patients who completed colorectal cancer screening. All data for the current analysis were collected as part of a randomized controlled trial to determine the impact of mPATH-CRC on receipt of colorectal cancer screening within 24 weeks. Participants were enrolled from six community-based primary care practices between June 2014 and May 2016 and randomized to either usual care or mPATH-CRC. Six potential mediators of the intervention effect on screening were considered. The Iacobucci method was used to assess the significance of the mediation. A total of 408 patients had complete data for all potential mediators. Overall, the potential mediators accounted for approximately three fourths (76.3%) of the effect of the program on screening completion. Perceived benefits, self-efficacy, ability to state a screening decision, and patient-provider discussion were statistically significant mediators. Patient-provider discussion accounted for the largest proportion of the effect of mPATH-CRC (70.7%). mPATH-CRC increased completion of colorectal cancer screening by affecting patient-level and system-level mediators. However, the most powerful mediator was the occurrence of a patient-provider discussion about screening. Digital interventions like mPATH-CRC are an important adjunct to the patient-provider encounter. Understanding the factors that mediated mPATH-CRC's success is paramount to developing other effective interventions.

Comparative cost-effectiveness of mailed fecal immunochemical testing (FIT)-based interventions for increasing colorectal cancer screening in the Medicaid population.

Mailed reminders to promote colorectal cancer (CRC) screening by fecal immunochemical testing (FIT) have been shown to be effective in the Medicaid population, in which screening is underused. However, little is known regarding the cost-effectiveness of these interventions, with or without an included FIT kit. The authors conducted a cost-effectiveness analysis of a randomized controlled trial that compared the effectiveness of a reminder + FIT intervention versus a reminder-only intervention in increasing FIT screening. The analysis compared the costs per person screened for CRC screening associated with the reminder + FIT versus the reminder-only alternative using a 1-year time horizon. Input data for a cohort of 35,000 unscreened North Carolina Medicaid enrollees ages 52 to 64 years were derived from the trial and microcosting. Inputs and outputs were estimated from 2 perspectives-the Medicaid/state perspective and the health clinic/facility perspective-using probabilistic sensitivity analysis to evaluate uncertainty. The anticipated number of CRC screenings, including both FIT and screening colonoscopies, was higher for the reminder + FIT alternative (n=8131; 23.2%) than for the reminder-only alternative (n=5533; 15.8%). From the Medicaid/state perspective, the reminder + FIT alternative dominated the reminder-only alternative, with lower costs and higher screening rates. From the health clinic/facility perspective, the reminder + FIT versus the reminder-only alternative resulted in an incremental cost-effectiveness ratio of $116 per person screened. The reminder + FIT alternative was cost saving per additional Medicaid enrollee screened compared with the reminder-only alternative from the Medicaid/state perspective and likely cost-effective from the health clinic/facility perspective. The results also demonstrate that health departments and state Medicaid programs can efficiently mail FIT kits to large numbers of Medicaid enrollees to increase CRC screening completion.

An RCT of Fecal Immunochemical Test Colorectal Cancer Screening in Veterans Without Recent Primary Care

The use of screening can prevent death from colorectal cancer, yet people without regular healthcare visits may not realize the benefits of this preventive intervention. The objective of this study was to determine the effectiveness of a mailed screening invitation or mailed fecal immunochemical test in increasing colorectal cancer screening uptake in veterans without recent primary care encounters. Three-arm pragmatic randomized trial. Participants were screening-eligible veterans aged 50-75 years, without a recent primary care visit who accessed medical services at the Corporal Michael J. Crescenz Veteran Affairs Medical Center between January 1, 2017, and July 31, 2017. All data were analyzed from March 1, 2018, to July 31, 2018. Participants were randomized to (1) usual opportunistic screening during a healthcare visit (n=260), (2) mailed invitation to screen and reminder phone calls (n=261), or (3) mailed fecal immunochemical test outreach plus reminder calls (n=61). The main outcome under investigation was the completion of colorectal cancer screening within 6 months after randomization. Of 782 participants in the trial, 53.9% were aged 60-75 years and 59.7% were African American. The screening rate was higher in the mailed fecal immunochemical test group (26.1%) compared with usual care (5.8%) (rate difference=20.3%, 95% CI=14.3%, 26.3%; RR=4.52, 95% CI=2.7, 7.7) or screening invitation (7.7%) (rate difference=18.4%, 95% CI=12.2%, 24.6%; RR=3.4, 95% CI=2.1, 5.4). Screening completion rates were similar between invitation and usual care (rate difference=1.9%, 95% CI= -2.4%, 6.2%; RR=1.3, 95% CI=0.7, 2.5). Mailed fecal immunochemical test screening promotes colorectal cancer screening participation among veterans without a recent primary care encounter. Despite the addition of reminder calls, an invitation letter was no more effective in screening participation than screening during outpatient appointments. This study is registered at clinicaltrials.gov NCT02584998.

Abstract B113: Colorectal cancer screening completion rates and barriers to colorectal cancer screening 6 months following participation in CRC screening intervention

Abstract Background: Though colorectal cancer (CRC) screening rates have increased significantly over the past two decades, screening disparities persist among Latinos. To increase CRC screening rates among Latinos, a promotor-led intervention was implemented to provide educational workshops and link community members to screenings through a partnered Federally Qualified Health Center (FQHC). Aims: To assess screening completion at 6-months follow-up. To identify barriers influencing adherence to CRC screening among participants who participated in a promotor-led intervention. Methods: The Juntos Contra el Cáncer/Together Against Cancer (JUNTOS) program was a promotor-led cancer prevention study that provided CRC prevention workshops to adults ages 50 to 75 in a primarily Latino community in San Diego, CA. Based on the Social Ecological Framework, the intervention targeted knowledge of CRC, screening attitudes, social support, screening barriers, and linked participants to community resources. Promotors assisted participants in scheduling appointments, which is the first step in CRC screening at the partnering FQHC. From December 2016 to July 2018, a total of 66 participants who were not up to date with CRC screening attended a 2.5-hour workshop, received follow-up calls from promotors, and completed a 6-month assessment. Demographics, health conditions, CRC knowledge, and attitudes changes towards screening were compared between participants who completed a CRC screening (adherent) and those who did not at 6 months (nonadherent). Chi-squared and t-tests were conducted to assess significant differences among adherent and nonadherent participants. For nonadherent participants, barriers to scheduling an appointment were evaluated. Results: The sample included 66 Latinos ages 50 to 75 (women=70%). Results from the 6-month follow-up show that 59% participants reported completing CRC screening. Findings show a statistically significant decrease in negative attitudes towards CRC screening from baseline to follow-up (M1=2.88 [SD=.81], M2=2.53 [SD=.85], p<.001). Differences in demographics, health conditions, attitudes towards screening, CRC knowledge, and health behaviors were not statistically significant at baseline between adherent and nonadherent participants at follow-up. The most frequently reported barriers for nonadherent participants to schedule an appointment with their medical provider were being too busy (48%) and not having health insurance (41%). Conclusions: Preliminary findings suggest that the delivery of the promotor-led intervention improved attitudes of CRC screening and led to increases in self-reported screening rates among nonadherent adults. For uninsured participants, waiving the appointment or providing additional support to navigate the health system may help them complete CRC screening. Overall, these findings build the evidence on the preliminary efficacy of group-based CRC education and linkages to care for nonadherent adults. Citation Format: Carolina López de la Torre, Jill N. JoaDumbauld, Jessica Haughton, Anthony Barrios, Dalia Rojas, Mirna Díaz, José López, Maria Milla, Samir Gupta, Jesse Nodora, Christian Ramers, Felipe Garcia-Bigley, Jessica Marquez, Balambal Baharti, Elva M. Arredondo. Colorectal cancer screening completion rates and barriers to colorectal cancer screening 6 months following participation in CRC screening intervention [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B113.

Abstract C108: Sociodemographic determinants of colorectal cancer screening completion among women adherent to mammography screening guidelines

Abstract Background Several initiatives have focused on increasing colorectal cancer (CRC) screening rates, but national rates still fall below 70% for many groups, particularly those in underserved communities. Examining CRC screening determinants in groups who have completed screening for other cancer sites may provide useful information to support future initiatives. In 2015, 71.6% of women nationally completed mammograms in the past two years, while only 63% completed any CRC screening procedures. Purpose We examined data from the 2015 National Health Interview Survey to identify determinants of CRC screening completion among women adherent to breast cancer (BrCa) screening guidelines. We hypothesized that race, income, and psychosocial factors would explain CRC screening non-adherence. Methods The sample contained women (N=1206), aged 50-74 years, BrCa free, who completed a mammogram in the past two years, and were of average CRC risk (no first degree relative with cancer, history of polyps or inflammatory bowel disease). Bivariate associations between sociodemographic, health access, perceived BrCa risk, perceived CRC risk variables, and CRC screening status were examined using chi-square tests. Multivariate logistic regression analysis was used to examine factors associated with CRC screening completion. Results Prevalence of CRC screening in this sample was 55.52% including: Sigmoidoscopy (1.47%), colonoscopy (50.33%), fecal occult blood test (10.81%). Significant differences in CRC screening (p <.01) by education, income, insurance, foreign birth status, and language regularly spoken were revealed. Having insurance (OR:4.52, CI:2.20-9.31) and being foreign-born (OR: 1.77, CI:1.17-2.66) were independently associated with CRC screening completion after controlling for all other factors. Conclusion CRC screening rates among women completing breast cancer screening were lower than the national average for women. Neither perceived BrCa risk nor perceived CRC risk explained CRC screening behavior. Income and health insurance variables appear to drive sociodemographic differences in screening completion. However, foreign-born status had a direct impact on CRC screening behavior. Differences in the availability of free or low-cost screening programs for BrCa and CRC may explain these findings. More research is needed to understand how sociodemographic factors interact to impact CRC screening rates in this group. Citation Format: Deeonna E Farr, Leslie E Cofie, Alison T Brenner, Ronny A Bell, Daniel S Reuland. Sociodemographic determinants of colorectal cancer screening completion among women adherent to mammography screening guidelines [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C108.

Abstract C109: Colorectal cancer knowledge and screening status among companions of patients undergoing a colonoscopy: An opportunity for a targeted intervention

Abstract PURPOSE: To determine the colorectal cancer (CRC) knowledge, screening compliance, and preference(s) for an intervention to improve screening compliance among companions of patients undergoing colonoscopy. METHODS: Between March and June 2017, we approached individuals who accompanied patients undergoing a colonoscopy (companions) at one of three endoscopy centers to participate in a survey to determine CRC and CRC screening knowledge, attitudes, beliefs, and behaviors. Participants were also asked to provide input about content and format for a future CRC screening intervention. Companions aged 50 to 75 years were eligible to participate. RESULTS: Of the 338 companions approached for participation, 224 (66%) were eligible and completed the survey. Most companions were a spouse or family member (83%), married/living with a partner (78%), female (57%), and had less than a college degree (51%). The sample included companions from a minority race/ethnicity (20%) and those with an annual household income of less than $30,000 (18%). In addition, companions predominantly had health insurance (96%), reported having a personal doctor (88%) and had an evaluation by a healthcare provider within the last year (85%). Among companions at average-risk for CRC (n=166), 38 (23%) were not within screening guidelines and 29 companions reported that they had never completed a screening test. Many companions lacked knowledge about what age to begin CRC screening (85%) and factors associated with increased risk for CRC such as being African American (73%) or male (60%). Among companions not within screening guidelines, the most frequently reported barriers to CRC screening were being asymptomatic (74%) and lack of a provider recommendation (32%). While the majority of companions agreed or strongly agreed that CRC would be serious to their health (99%) and that CRC screening would help protect their health (97%), only 29% of average risk companions not within screening guidelines reported that they intended to undergo CRC screening within the next 6 months. Suggestions for a future CRC screening intervention to be completed by waiting companions included a video shown on a tablet that included men and women from all races/ethnicities, a doctor and nurse, testimonials from individuals who completed CRC screening, and the intervention should last 15 minutes or less. CONCLUSIONS: Given that companions of patients undergoing a colonoscopy wait about two hours for test completion, developing a brief CRC screening intervention for them addresses an overlooked educational opportunity. The brief intervention should address the most commonly reported barriers, the benefits of screening, men and women of different races/ethnicities, doctors and nurses, testimonials from individuals who completed screening, and should activate companions to talk to their doctor about CRC screening. Citation Format: Darrell M Gray II, Menaka Reddy, Abigail Shoben, Paul L Reiter, Mira L Katz. Colorectal cancer knowledge and screening status among companions of patients undergoing a colonoscopy: An opportunity for a targeted intervention [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C109.

Abstract B118: Using a multimodal strategy to engage Latino communities and improve colorectal cancer screening disparities

Abstract Introduction: Colorectal cancer (CRC) is one of the most commonly diagnosed and one of the leading causes of cancer deaths in both Latino men and women. Latino adults also have disproportionately lower CRC screening rates than their white peers. Methods: To improve CRC education and screening rates, we at UT Health San Antonio used a variety of culturally tailored activities and partnerships to engage the majority-Latino local community to promote and implement the national Screen to Save (S2S): NCI Colorectal Cancer Outreach and Screening Initiative. Our local S2S efforts focused on one-on-one patient encounters at the clinic level, community-wide outreach events, training and incorporating community health workers, and airing powerful Latino role model stories and education through partnerships with local Spanish-language TV station Univision, as well as digitally via the Salud America! Latino health and social media platform. Results: For one-on-one outreach, we partnered with CommuniCare, a local Federally Qualified Health Center situated in high-risk and underserved parts of town, to deliver CRC education via flipchart and screening via FIT kit. Pre- and post-survey data showed increased knowledge and strong intention to get screened for CRC. At 3-month follow-up, strong positive behavior change was observed with majority of patients (73.4%) talking to their doctor about CRC screening and half of patients (51.1%) completing CRC screening as a result of the initiative. We also partnered with the Mays Cancer Center to host tours of a giant inflatable colon, where we educated more than 250 individuals, and invited partners such as the American Cancer Society to participate in educational outreach. Because stories are a proven and powerful tool to motivate people to get screened, we recruited real-life community role models and CRC survivors to help us reach the broader community. Our role models, including a Latina mother diagnosed at age 33 and a Latino husband and wife each diagnosed with CRC, shared their experience with screening, early detection, treatment, and survivorship. We shared these role models' stories of resiliency and hope on multimedia platforms—blogs, social media, and weekly TV segments on Univision. Overall, through our in-person and digital implementation of S2S, we were able to educate more than 450 individuals and distribute 244 FIT kits. Conclusion: We observed increased CRC knowledge, attitudes, positive behavior change, intent for screening, and screening thanks to our culturally tailored, bilingual in-person educational intervention and multimedia approach. Citation Format: Sneha Prabhu, Armida Flores, Kipling J. Gallion, Edgar Munoz, Laura Tenner, Amelie G. Ramirez. Using a multimodal strategy to engage Latino communities and improve colorectal cancer screening disparities [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B118.

Abstract C112: Implementing a colorectal cancer screening intervention in Texas FQHCs: A qualitative evaluation of provider perceptions

Abstract Background: Federally qualified health centers (FQHCs) are well positioned to increase colorectal cancer screening (CRCS) in underserved populations who most often have low screening rates, including racial/ethnic minorities, the uninsured, and low SES individuals. To optimize effectiveness and promote sustainability of CRCS programs in FQHCs, we assessed provider/staff perceptions of the facilitators and barriers to implementing the Alliance for Colorectal Cancer Testing (ACT) program in Texas FQHCs, funded by the Cancer Prevention & Research Institute of Texas (CPRIT). Methods: UTHealth School of Public Health research staff conducted in-depth, face-to-face, semi-structured interviews in English with providers/staff at ACT FQHCs. Interviews lasted 30-45 minutes and elicited perceptions about facilitators and barriers to implementation of ACT. They were audio recorded, transcribed, and coded by hand deductively, using thematic content analysis to identify key themes. Results: We interviewed 20 individuals across 5 ACT FQHCs. Most were non-Hispanic white (38%) and female (88%). Years worked at clinic ranged from 11 months to 11 years (mean 6.2 years) and hours worked per week ranged from 12-60 hours (mean 42.2). Participants’ positions ranged from clinic CEO to provider to clerical staff. Seven themes emerged as facilitators to implementation: 1) external support (e.g., large cancer center facilitated implementation); 2) external funding (e.g., covered screening and diagnostic services); 3) patient tracking and monitoring (e.g., patient list review, FIT distribution/follow-up); 4) clinic leadership and staff support (e.g., clinic level prioritization of CRCS, understanding/acceptance of roles, active leadership support); 5) staff training; 6) same day FIT return (e.g., completing FIT at clinic or at home and returning same day); and 7) community outreach (e.g., newsletters, FIT distribution at community events). Four themes emerged as barriers: 1) CRCS completion and return process/structure (e.g., USPS refusal to pickup/deliver samples, patient inability to return FIT, FIT completion errors, lab delays); capacity (e.g., perception that patients and providers lack time); education (e.g., perception of patient lack of understanding of risk); and clinic resources (e.g., need for simple, bilingual educational materials). Conclusion: In addition to maintaining program facilitators, increased CRCS patient education/awareness, simple and bilingual educational materials, processes to support FIT return, a contact person coordinating CRCS tasks, ongoing staff training, and a clinic manual describing all roles/responsibilities are important for improved implementation and sustainability of ACT. Findings from this evaluation will help inform development of strategies to facilitate FQHCs’ implementation of ACT and other intervention strategies to increase CRCS by reducing two key factors, financial and structural barriers. Citation Format: Lynn N Ibekwe, Paula M Cuccaro, Lara S Savas, Melissa A Valerio, Lewis E Foxhall, Maria E Fernandez. Implementing a colorectal cancer screening intervention in Texas FQHCs: A qualitative evaluation of provider perceptions [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C112.

Association of Neighborhood Measures of Social Determinants of Health With Breast, Cervical, and Colorectal Cancer Screening Rates in the US Midwest

Despite advances in cancer treatment and cancer-related outcomes, disparities in cancer mortality remain. Lower rates of cancer prevention screening and consequent delays in diagnosis may exacerbate these disparities. Better understanding of the association between area-level social determinants of health and cancer screening may be helpful to increase screening rates. To examine the association between area deprivation, rurality, and screening for breast, cervical, and colorectal cancer in patients from an integrated health care delivery system in 3 US Midwest states (Minnesota, Iowa, and Wisconsin). In this cross-sectional study of adults receiving primary care at 75 primary care practices in Minnesota, Iowa, and Wisconsin, rates of recommended breast, cervical, and colorectal cancer screening completion were ascertained using electronic health records between July 1, 2016, and June 30, 2017. The area deprivation index (ADI) is a composite measure of social determinants of health composed of 17 US Census indicators and was calculated for all census block groups in Minnesota, Iowa, and Wisconsin (11 230 census block groups). Rurality was defined at the zip code level. Using multivariable logistic regression, this study examined the association between the ADI, rurality, and completion of cancer screening after adjusting for age, Charlson Comorbidity Index, race, and sex (for colorectal cancer only). Completion of recommended breast, cervical, and colorectal cancer screening. The study cohorts were composed of 78 302 patients eligible for breast cancer screening (mean [SD] age, 61.8 [7.1] years), 126 731 patients eligible for cervical cancer screening (mean [SD] age, 42.6 [13.2] years), and 145 550 patients eligible for colorectal cancer screening (mean [SD] age, 62.4 [7.0] years; 52.9% [77 048 of 145 550] female). The odds of completing recommended screening were decreased for individuals living in the most deprived (highest ADI) census block group quintile compared with the least deprived (lowest ADI) quintile: the odds ratios were 0.51 (95% CI, 0.46-0.57) for breast cancer, 0.58 (95% CI, 0.54-0.62) for cervical cancer, and 0.57 (95% CI, 0.53-0.61) for colorectal cancer. Individuals living in rural areas compared with urban areas also had lower rates of cancer screening: the odds ratios were 0.76 (95% CI, 0.72-0.79) for breast cancer, 0.81 (95% CI, 0.79-0.83) for cervical cancer, and 0.93 (95% CI, 0.91-0.96) for colorectal cancer. Individuals living in areas of greater deprivation and rurality had lower rates of recommended cancer screening, signaling the need for effective intervention strategies that may include improved community partnerships and patient engagement to enhance access to screening in highest-risk populations.

Faecal immunochemical test-based colorectal cancer screening in Mexico: an initial experience.

BackgroundIn middle-income countries, the burden of colorectal cancer (CRC) is increasing in parallel with resources for diagnosis and treatment. There is a potential benefit of CRC screening programs in Mexico.ObjectiveSince there are no organized screening programs in the country, we explored the willingness of individuals to complete a faecal immunochemical testing (FIT) based CRC screening program and its potential benefit in Mexico.MethodsWe conducted a CRC screening program pilot in Veracruz, Mexico, during 2015–16 using FIT. Individuals with FIT results >100 ng of haemoglobin/ml buffer were referred for diagnostic colonoscopy.ResultsOf 473 FIT kits distributed to adults aged 50–75, 85.8% (406) were completed by participants and analysed in the laboratory. Of these, 5.9% (24/406) of test results showed >100 ng haemoglobin/ml. Twenty-one participants completed colonoscopy. The positive predictive value of FIT >100 ng haemoglobin/ml for premalignant lesions was 33%.ConclusionThese results provide preliminary evidence of the willingness of individuals to complete FIT-based CRC screening program in Mexico. However, further evaluation of health systems resources will be needed prior to large-scale implementation of CRC screening programs.

The Effects of a Multicomponent Colorectal Cancer Screening Intervention on Knowledge, Recommendation, and Screening among Underserved Populations.

This trial tested a multicomponent intervention to increase colorectal cancer (CRC) screening among underserved patients. Participants were randomized to: (1) physician + patient intervention, (2) physician-only intervention, or (3) usual care (UC). Study outcomes included patient knowledge, physician recommendation of CRC screening, and screening completion via colonoscopy or stool tests. Among 538 participants, those exposed to the physician + patient intervention had significantly increased knowledge over patients in physician-only (p=.0008) or UC arms (p=.0003). However, there were no statistically significant differences in completion of CRC screening, with 10%, 20%, and 16% of UC, physician-only, and physician + patient participants screened, respectively. In UC, all completed screenings were colonoscopy, whereas in the physician-only and physician + patient arms, 39% and 46% of completed tests were via stool test, respectively. The multicomponent intervention did not increase overall CRC screening, yet results underscore the need to provide patients options for completing CRC screening.

Effectiveness of a mailed fecal immunochemical test outreach: a Medicare Advantage pilot study.

Background:Mailed fecal immunochemical test (FIT) outreach effectively increases colorectal cancer (CRC) screening but is underutilized. This pilot aimed to determine the use of FIT for CRC screening among Medicare Advantage enrollees when offered via mailed outreach and the factors associated with FIT return.Methods:Our pilot study included Medicare Advantage enrollees who were 50–75-years old, not up to date with CRC screening, and had a billable primary care encounter in the prior 3 years. Eligible patients received a letter containing information about CRC screening and a FIT kit, screening status by FIT was then assessed using the electronic health record.Results:Of the 1142 patients identified, 945 were eligible for outreach. On 12-month follow up, 29% of patients (n = 276) completed CRC screening via FIT, with a median return time of 140 days [interquartile range (IQR) 52–257]; 6% (n = 17) of the completed tests were positive, and 53% (n = 9) of patients have completed a diagnostic colonoscopy. Patients with primary encounter <12 months prior to mailed outreach were most likely to complete a FIT. Over the 12-month study period, CRC screening rates increased by 5% (63–68%).Conclusions:Mailed FIT outreach in a Medicare Advantage population was feasible and led to a 5% increase in CRC screening completion. Our pilot revealed rare incorrect patient addresses and high lab discard rate; both important factors that were addressed prior to larger-scale implementation of a mailed FIT program. Further research is needed to understand the potential impact of multilevel interventions on CRC screening in this healthcare system.

Impact of Tailored Interventions on Receipt of a Preference-Concordant Colorectal Cancer Screening Test.

Background. Individuals at average risk for colorectal cancer (CRC) have multiple test options. Preference for a specific test modality may affect decision making about CRC screening. The current study examined 1) the sociodemographic and health belief characteristics of average-risk participants with a test preference for stool blood test (SBT) versus those with a preference of colonoscopy, and following receipt of a tailored CRC screening intervention, 2) the percentage of participants who completed a preference-concordant CRC screening test, and 3) the sociodemographic, health care experience, and health belief characteristics and intervention group(s) associated with completion of a preference-concordant screening test. Methods. Participants (N = 603) were female, aged 50 to 75 years, at average CRC risk, not currently up-to-date with CRC screening recommendations, had Internet access, and were randomized to receive 1 of 3 tailored CRC screening promotion interventions. Multivariable logistic regression analyses were conducted. Results. Most women (64%) preferred SBT, whereas 36% preferred colonoscopy. There were significant differences in test preference by age, stage of change for the specific tests, perceived benefits of CRC screening, perceived barriers to both tests, and self-efficacy for colonoscopy. Two hundred thirty participants completed CRC screening at 6 months post-intervention. Of those, most (84%) completed a test concordant with their preference. Multivariable analyses revealed that compared with participants completing a preference-discordant test, those completing a preference-concordant test were older (P = 0.01), had health insurance (P < 0.05), and were in the phone counseling-only group (P < 0.01). Conclusions. High levels of completion of preference-concordant CRC screening can be achieved by educating average-risk patients about the multiple screening test options, soliciting their preferences, and offering testing that is concordant with their preference.

233 Managing Fecal Immunochemical Test (FIT) at Population Health Level in an Urban Safety Net Hospital

INTRODUCTION: Annual fecal immunochemical test (FIT) is a non-invasive screening method recommended for individuals at average risk of colorectal cancer (CRC). Lack of FIT orders is perceived as a barrier to complete CRC screening. We aimed to evaluate bulk ordering FIT as a population health level methodology in improving CRC screening rates. METHODS: Individuals 50–75 years old, who visited a primary care provider (PCP) in the MetroHealth System within the preceding 2 years were reviewed between 10/2018 and 04/2019. Individuals at average-risk of CRC who neither completed FIT in the preceding 11 months nor were assigned to the colonoscopy screening track were identified via querying of the electronic health record (EHR). Bulk orders were placed on eligible individuals once a month, using PCP as the authorizing provider or residency program director for residents. Individuals were informed of the order via the most appropriate channel: personal health record message (MyChart), email, or secure text message mediated by third-party texting services (Clintell). An automated daily process canceled any obsolete bulk FIT orders when patients turned 76 years old, switched to colonoscopy track, or had another FIT order resulted. FIT orders were released when the patient visited the clinic or requested the kit to be mailed. Individuals with a positive FIT were contacted by designated staff to schedule a follow-up colonoscopy. FIT numbers at each step of the bulk order method were compared to regular orders in usual care (FIT orders placed by a provider during an outpatient visit) to analyze differences in outcome. RESULTS: From 10/2018 to 04/2019, 27,212 bulk orders and 13,756 regular orders were placed. Only 8.5% of bulk orders were released compared to regular orders (91.6%) but the released orders were completed at similar rates in either group. Among those with a positive FIT, a significantly higher number had a follow-up colonoscopy within 120 days in the bulk order (67.8%) compared to usual care (53.2%), P = 0.04. 33.9% of positive bulk FIT detected an adenoma compared to 29.5% of positive routine care FIT, P = 0.50. CONCLUSION: Managing FIT at population health level provides a time-efficient way to identify patients due for CRC screening in an urban safety-net hospital. Bulk ordering bypasses the need for a PCP encounter for order placement. Bulk ordering FIT has shown better follow up rates compared to the traditional method and may ultimately improve CRC detection.