Colorectal Cancer Screening Knowledge Research Articles

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 B025: “Kulu the Colon”: An assessment of a colorectal cancer education intervention in Guam

Abstract Background. The island of Guam is a U.S. territory where a large proportion of Pacific Islanders and Filipinos reside. CHamoru, the indigenous people of Guam, have the overall highest incidence and mortality rates in colorectal cancer (CRC). CRC is the third leading cause of cancer death for both men and women on island. CRC screening data indicate 44.2% of persons age 50 and above have met USPSTF screening standards for CRC compared to 67.3% of the same cohort in the U.S. (CDC, 2019). In addition, CRC diagnoses often occur in the late stages with recent data revealing that 75.0% of these occur at Stage 3, while 18.0% occur at Stage 1 (Pacific Regional Central Cancer Registry, 2018). These late stage diagnoses have implications for early detection and CRC screening education interventions. The aim of this study was to provide CRC education via a giant inflatable colon and to assess changes in CRC knowledge, intent to screen for CRC, and willingness to discuss CRC with others. Methods. A pre- and post-test study design was used to assess changes in knowledge, beliefs, likelihood of discussing CRC screening with family members, and intent to screen after a guided tour through a giant inflatable colon. Participant response to whether the inflatable colon was a culturally appropriate education tool was also evaluated. We recruited participants at a health fair in a mall and an island-wide university event, through flyers, and convenience sampling. At the launch of the inflatable colon, we held a name-the-colon contest to engage community. The winning entry was “Kulu,” which is the CHamoru word for a conch shell and symbolizes a “call to action” to get screened for CRC. Results. A total of 201 participants completed a pre/post assessment. Majority of participants were CHamoru (40.8%) and Filipino (33.8%), female (65.0%), had a college degree (31.8%), and had health insurance (89.6%). Mean age was 36.6. Preliminary results at baseline indicate half of participants reported knowing what CRC (53.0%) and a polyp (50.5%) are. Overall, 72.4% reported knowing what a colonoscopy is and 42.4% indicated they knew what a stool test was. Prior to participating in the guided tour, 73.5% rated their general knowledge about CRC as neutral or unknowledgeable. At baseline, participants reported intent to discuss CRC screening with others (parents = 84.0%; spouses/partners = 90.3%). Conclusion. We hypothesize that using an inflatable colon to deliver CRC information: 1) increases CRC and related screening knowledge; 2) is a culturally appropriate way to provide CRC education; and 3) facilitates increased willingness to talk to others about CRC, especially among families. Pre-/post-test comparisons regarding CRC knowledge, willingness to talk to others about CRC, and intention to screen among persons 50 and above will be presented. Findings may provide insight toward more interactive CRC education for Pacific Islanders, and potentially improve CRC screening participation in Guam. Citation Format: Tressa P. Diaz, Maurissa Sayama, Lilnabeth Somera, Angelina Mummert. “Kulu the Colon”: An assessment of a colorectal cancer education intervention in Guam [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 B025.

Abstract PR12: CRC screening in rural community clinics using the fecal immunochemical test (FIT): Issues with repeat screening

Abstract Introduction: Colorectal cancer (CRC), the second leading cause of cancer death in the United States, can be significantly reduced if it is detected early. Although overall CRC screening rates have increased significantly, disparities persist among low-income individuals, adults with low literacy and those living in rural areas. These groups all have screening completion rates below 50%. Objectives: To assess patient knowledge, beliefs, and self-efficacy about CRC screening and compare the effectiveness of two health literacy informed telephone follow-up strategies to improve annual screening over a three-year period with fecal immunochemical test (FIT) in rural community clinics. Methods: A two-arm, randomized controlled trial is being implemented in four community clinics. Clinics reported CRC baseline screening rates of 3% to 5%. Eligible patients, age 50-75, were recruited at the clinic prior to a scheduled appointment. A research assistant (RA) conducted a baseline structured interview measuring CRC screening knowledge, beliefs, and self-efficacy. The RA then recommended screening and gave brief literacy and culturally appropriate education using a pamphlet (4th-grade level), the FIT kit with preaddressed envelope, simplified instructions (3rd-grade level) and a demonstration of how to use it. At four weeks patients who had not returned their kit received either 1) a personal follow-up call (PC) from a central prevention coordinator using motivational interviewing skills and reminding them to complete and mail FIT kits, or 2) an automated follow-up call (AC) using plain language and motivational messages encouraging patients to complete and mail the FIT. Outcomes include FIT completion after intervention, and again at 12 and 24 months. Results: 620 patients not up-to-date were enrolled: 308/AC and 306/PC; 66% were African American, 55% women; 40% had limited literacy. During Year 1, 69% completed screening in AC arm versus 67% in PC arm. During Year 2, percentage screened decreased: 40% screened in AC arm and 37% in PC arm. Number of patients who needed at least one follow-up call increased: 74% in both arms needed at least 1 reminder call. Among those called, 19% in the AC arm completed their kit versus 15% in the PC arm. To date in Year 3, 32% screened in AC and 34% in PC. Conclusions: Simplified instructions accompanied by a face-to-face demonstration of FIT, and use of “teach back” to confirm understanding with a follow-up call if needed, facilitated completion rates of all patients, particularly those with limited literacy. Providing FIT + literacy appropriate education at regularly scheduled clinic visit with follow-up call (if needed) increased CRC screening rates of low-income, rural patients. Sustaining annual screening with FIT is challenging. In year 2 < 40% completed FIT. Follow-up calls were essential. Only 1/4 completed FIT without phone prompt. Lower-cost automated call has proven to be just as effective as personal call in both years 1 and 2. FIT is only effective if completed annually. This abstract is also being presented as Poster B099. Citation Format: Connie L. Arnold, Terry C. Davis, James Morris, Peggy Murphy, Glenn Mills. CRC screening in rural community clinics using the fecal immunochemical test (FIT): Issues with repeat screening [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 PR12.

Differences in Knowledge of Colorectal Cancer Screening and Its Contribution to Screening Practices by Ob/Gyns [27F

INTRODUCTION: Colorectal cancer is the second most commonly diagnosed cancer in women. Surveys show that physicians have an influence in the rates of colorectal screening. This study investigates whether a lack of colorectal screening knowledge prevents Ob/Gyns of different academic levels and practice types from effectively screening colorectal cancer. METHODS: An IRB approved, validated survey eliciting colorectal screening guidelines, practices, and potential barriers to screening was circulated online, at the National Medical Association national conference, ACOG District II conference, and the New York City Health + Hospitals/Metropolitan Dept of Ob/Gyn between October 2018 to January 2019. RESULTS: A total of 142 respondents answered the survey. Only one out of 142 respondents (0.7%) answered correctly the question which identified all of the risk factors for colorectal cancer. A significant difference was noted in correctly identifying risk factors when comparing attendings (36.6%) and residents (75%) P=.004. Most respondents were able to correctly identify age to start screening (93.6%), but fewer were able to correctly identify age to stop screening (23.2%). For screening intervals, 76.8% correctly answered for colonoscopy, 66.9% correctly answered for flexible sigmoidoscopy. A significant difference was noted after stratifying for age (ages 20-40 vs 50-70s P=.003), gender (women vs men P=.01), and academic level (resident vs attending P=.03): younger, resident, and female physicians provided more correct answers. CONCLUSION: Difference in colorectal cancer screening knowledge between residents and attendings contributes to less than effective screening. Education on colorectal cancer should focus on attendings through maintenance of certification and continued integration in residency education.

A Teachable Moment: Colorectal Cancer Screening Among Companions Waiting for Outpatients Undergoing a Colonoscopy.

To determine colorectal cancer (CRC) screening knowledge, attitudes, behaviors, and preferences for a future CRC screening educational intervention among adults (companions) waiting for outpatients undergoing a colonoscopy. We approached 384 companions at three endoscopy centers associated with one healthcare system to complete a survey from March to July 2017. The survey assessed CRC and CRC screening knowledge, attitudes, behaviors, and preferences for a future CRC screening educational intervention. There were 164 companions at average risk for CRC that completed a self-administered survey. Among average-risk companions, 23% were not within screening guidelines. Additionally, 74% of those not within guidelines reported that they had never completed a CRC screening test. The most frequently reported barriers to CRC screening were the perception of not needing screening because they were asymptomatic and lack of a provider recommendation for screening. Companions suggested that a future CRC screening intervention include a brochure and/or a brief video, featuring men and women from different races/ethnicities, a CRC survivor, and a healthcare professional. Almost one-fourth of average-risk companions waiting at endoscopy centers were not within CRC screening guidelines, providing a teachable moment to recruit companions to participate in an educational intervention to encourage screening. Companions provided suggestions (e.g., content and channel) for a future intervention to promote CRC screening in this population.

Giant Inflatable Colon Model Enhances Lebanese Community Knowledge and Intention for Colorectal Cancer Screening

PURPOSETo assess the knowledge and intention for colorectal cancer (CRC) screening within the Lebanese community before and after a guided tour through an inflatable colon model.METHODSThe Cancer Prevention and Control Program, Naef K. Basile Cancer Institute at the American University of Beirut Medical Center in collaboration with AMALOUNA educational nongovernmental organization launched awareness campaigns during which a walk-through inflatable colon was displayed. Pre- and post-surveys related to the age of screening, risk factors, symptoms, and CRC prevention were collected anonymously before and after touring the inflatable colon to assess the effectiveness of this educational tool.RESULTSCompiled data collected from 782 participants revealed that older age and higher education were predictors of favorable CRC screening knowledge and behaviors before entering the inflatable colon. Interestingly, touring the inflatable colon model significantly improved participants’ awareness and knowledge about CRC. Most importantly, it increased their willingness for screening and social engagement and comfort discussing and promoting CRC screening.CONCLUSIONOverall, these results indicate that the interactive colon is an effective educational tool that can make a positive impact by improving the community CRC awareness and interest in CRC screening. They also highlight the importance of such educational efforts conducted in the community to create more awareness about CRC and emphasize the importance of its prevention.

An Interventional Study to Improve Colorectal Cancer Screening Knowledge and Health Perceptions among Jordanians' Average Risk Population

Context: Globally, Colorectal Cancer (CRC) is the second most commonly occurring cancer in women and the third most commonly occurring cancer in men. Aims: This study was conducted to investigate the current levels of Jordanians' CRC knowledge and health perceptions; and to test the effects of a health education intervention on them. Settings and Design: A descriptive quasi-experimental design was used to recruit a convenience sample of 197 Jordanian adult participants from two governmental hospitals in Amman. Methods and Material: A rolling enrolment strategy was used to randomly assign participants into intervention (n=98) and control (n=99) groups. An education intervention included a 1-hour Power Point presentation about CRC. Results: The mean knowledge scores were (6.51±1.60) and (6.91± 1.83) for females and males, respectively. The mean of the knowledge level in the intervention group subsequent to the intervention was significantly higher than that for the control group. More than half of the study participants (53.8%) did not believe they were susceptible to CRC, while about one third (37.4%) of the participants believed that CRC is a severe disease. 42.2% of study participants believed there were barriers preventing them from participating in CRC screening. The most frequently perceived barrier among them was the cost of screening tests. The means of the perceived susceptibility and severity subscales of the intervention group was significantly higher than that of the control group. Conclusion: Correcting the knowledge gap and improper health perceptions toward CRC could play an important role in facilitating early detection as a primary prevention measure. Findings may enhance health strategies to better address the needs of the average-risk population.

The Role of Health Literacy in Explaining the Relation between Educational Level and Decision Making about Colorectal Cancer Screening.

Little is known about why educational inequalities exist in informed decision making in colorectal cancer (CRC) screening. Insight into the role and impact of health literacy is essential for intervention development. This study investigates associations between health literacy and informed decision making in CRC screening and explores to what extent health literacy mediates the association between education and informed decision making in CRC screening. In total, 696 individuals eligible for CRC screening (55–75 years of age) were recruited from online panels and filled in an online questionnaire at T0 (n = 696), T1 (n = 407) and T2 (n = 327). A hypothetical mediation model was tested using structural equation modelling. Outcomes included CRC knowledge, CRC screening knowledge, attitude, injunctive norm, descriptive norm, risk perception, self-efficacy, decisional conflict and decisional certainty. Health literacy domains included Comprehension, Application, Numeracy and Communication. Comprehension, Application and Numeracy, were found to mediate the association between education and knowledge about CRC and CRC screening, injunctive norm, descriptive norm, decisional conflict and decisional certainty. In light of these findings, targeting multiple health literacy domains in decision-support interventions is essential for facilitating informed decision making in CRC screening.

Knowledge and practice of colorectal cancer screening in an urban setting: cross-sectional survey of primary care physicians in government clinics in Malaysia.

Colorectal cancer (CRC) was the third most commonly diagnosed cancer worldwide in 2008 (1.23 million cases, 9.7%). CRC screening was shown to be effective in reducing 70% of CRC mortality. However, the screening rate for CRC remains poor. A cross-sectional survey was conducted among primary care physicians (PCPs) in public primary care clinics in Kuala Lumpur, Malaysia. A 30-item self-administered questionnaire was used to assess the knowledge and practice of CRC screening. The response rate was 86.4% (n = 197/228). Less than half (39.1%) of the respondents answered correctly for all risk stratification scenarios. Mean knowledge score on CRC screening modalities was 48.7% ± 17.7%. The knowledge score was positively associated with having postgraduate educational qualification and usage of screening guidelines. Overall, 69.9% of PCPs reported that they practised screening. However, of these, only 25.9% of PCPs screened over 50% of all eligible patients. PCPs who agreed that screening was cost-effective (odds ratio [OR] 3.34, 95% confidence interval [CI] 1.69‒6.59) and those who agreed that they had adequate resources in their locality (OR 1.92, 95% CI 1.01‒3.68) were more likely to practise screening. Knowledge score was not associated with the practice of screening (p = 0.185). Knowledge and practice of CRC screening was inadequate among PCPs. Knowledge of screening did not translate into its practice. PCPs' perceptions about cost-effectiveness of screening and adequate resources were important determinants of the practice of screening.

Reaching Rural Residents to Identify Colorectal Cancer Education and Intervention Targets.

Disparities in cancer screening and care in rural communities warrant the need to determine effective ways to reach, engage, and educate the community residents. The purpose of this cross-sectional study was to pilot methods to engage rural residents in colorectal cancer (CRC) research and education activities and assess knowledge of CRC guidelines, symptoms, and screening behaviors in this sample. The community-engaged research approach was employed to develop and distribute a CRC knowledge and screening behavior assessment using various methods such as email and community drop boxes placed throughout the community. Bivariate analysis assessed the relationship between age and CRC knowledge items. Three hundred ninety-one surveys were returned with most received from community drop boxes (60%) followed by educational events (23%). The most ineffective method to distribute surveys was through community events. Most individuals were knowledgeable of CRC symptoms (70%) and screening facts (67%). Bivariate analysis showed that individuals 50 years or older had significantly more knowledge of CRC risks and screening than those under the age of 50. This study highlights the potential of community drop boxes as an effective method for engaging rural communities. Further, findings from the survey highlight the need to focus CRC education on younger individuals in which CRC incidence has increased.

Follow-up approaches to a health literacy intervention to increase colorectal cancer screening in rural community clinics: A randomized controlled trial.

Significant disparities exist in colorectal cancer (CRC) screening rates among those of low socioeconomic status, with fewer years of education, lacking health insurance, or living in rural areas. A randomized controlled trial was conducted to compare the effectiveness of 2 follow-up approaches to a health literacy intervention to improve CRC screening: automated telephone call or personal call. Patients aged 50 to 75years residing in 4 rural community clinics in Louisiana were given a structured interview that assessed demographic, health literacy and CRC screening barriers, knowledge, and attitudes. All were given health literacy-informed CRC education, a patient-friendly CRC screening pamphlet, simplified fecal immunochemical test (FIT) instructions, and a FIT kit, and a "teach-back" method was used to confirm understanding. Patients were randomized to 1 of 2 telephone follow-up arms. If they did not mail their FIT kit within 4weeks, they received a reminder call and were called again at 8weeks if the test still was not received. A total of 620 patients were enrolled. Approximately 55% were female, 66% were African American, and 40% had limited literacy. The overall FIT completion rate was 68%: 69.2% in the automated telephone call arm and 67% in the personal call arm. Greater than one-half of the patients (range, 58%-60%) returned the FIT kit without receiving a telephone call. There was no difference noted with regard to the effectiveness of the follow-up calls; each increased the return rate by 9%. Providing FIT kits and literacy-appropriate education at regularly scheduled clinic visits with a follow-up telephone call when needed was found to increase CRC screening among low-income, rural patients. The lower cost automated call was just as effective as the personal call.

Colorectal cancer screening: Understanding the health literacy needs of hispanic rural residents.

PurposeHispanics residing in rural areas are among those who are least likely to be screened for colorectal cancer (CRC) and more likely to present with late stage CRC than other racial or ethnic groups. We conducted a pilot study utilizing a mixed-method approach to explore perceptions of CRC and CRC screening among Hispanic adults residing in South Texas rural communities and to identify health literacy needs associated with CRC screening uptake.MethodsA convenience sample of 58 participants, aged 35–65, were recruited to complete questionnaires and participate in focus groups, ranging in size from 4 to 13 participants. Six focus groups were conducted across 3 adjacent rural counties. A semi-structured moderator's guide was designed to elicit discussion about participants' experiences, knowledge, and perceptions of CRC and CRC screening.FindingsLack of knowledge of CRC and CRC screening as cancer prevention was a common theme across focus groups. A majority, 59%, reported never been screened. Thirty-nine percent reported they had been screened for colon cancer and 5% reported they did not know if they had been screened. Participants with lower educational levels perceived themselves at high risk for developing CRC polyps, would not want to know if they had CRC, and if they did have CRC, would not want to know until the very end. Limited information about CRC and CRC screening, a lack of specialized providers, limited transportation assistance, and compromised personal privacy in small-town medical facilities were perceived to be barriers to CRC screening.ConclusionsLow screening rates persist among rural Hispanics. Improving CRC screening literacy and addressing factors unique to rural Hispanics may be a beneficial strategy for reducing screening disparities in this at-risk population.

Knowledge and utilization of colorectal cancer screening in Saudi society

Knowledge and utilization of colorectal cancer screening in Saudi society

Using a Culturally Tailored Intervention to Increase Colorectal Cancer Knowledge and Screening among Hispanics in a Rural Community.

Background: Disparities in colorectal cancer incidence and mortality rates exist among racial/ethnic minorities, especially those living in rural areas. There is an urgent need to implement interventions to improve colorectal cancer screening behaviors among such groups, particularly those living in rural areas in the United States.Methods: From a rural community of Hispanics, we recruited participants to attend home-based promotor(a)-led "home health parties" in which participants were taught about colorectal cancer screening; participants ages 50 and older were given a free fecal occult blood test (FOBT) kit to complete on their own. A pre- and posttest design was used to assess changes in colorectal cancer awareness, knowledge, and screening at baseline and at 1-month follow-up after the intervention.Results: We observed a statistically significant increase in colorectal cancer screening awareness and knowledge among participants. Colorectal cancer screening rates with FOBT increased from 51.0% to 80%. There was also a statistically significant increase in social engagement, that is, the intent to speak to friends and relatives about colorectal cancer screening.Conclusions: Findings indicate that culturally tailored colorectal cancer education facilitated by promotores in a rural environment, coupled with free stool-based test for colorectal cancer screening, is an effective way to increase colorectal cancer screening awareness, knowledge, and screening among Hispanics living in a rural area in Washington State. Impact: Culturally tailored home health interventions have the potential to achieve Healthy People 2020 colorectal cancer screening goals in Hispanic rural communities. Cancer Epidemiol Biomarkers Prev; 27(11); 1283-8. ©2018 AACR.

Poor Knowledge of Colorectal Cancer Screening and Surveillance Guidelines in a National Cohort of Digestive Disease Specialists.

Colorectal cancer (CRC) screening is cost-effective and prevents death from CRC if used appropriately. Physicians do not recommend CRC screening according to guidelines. Physician-related factors associated with CRC screening knowledge are unknown. We tested the accuracy of CRC screening knowledge in a nationwide cohort of practicing and trainee physicians and assessed respondent's interest in a mobile app to improve appropriate CRC screening use. An electronic survey was emailed to practicing gastroenterology professionals and medical and surgical trainees. We assessed accuracy of responses compared to CRC screening and surveillance guidelines. We assessed factors associated with higher accuracy of knowledge, frequency of workplace smartphone use, and interest in a smartphone app to aid CRC screening and surveillance recommendations. In total, 1432 responses were received. Hundred percent accuracy was noted in 22% of respondents for screening and 37% for surveillance. Factors associated with higher accuracy of screening guidelines included more recent training completion; academic practice; performing 21-100 colonoscopies per month (vs. < 21 or > 100). Higher accuracy of surveillance guidelines was associated with more recent training completion; academic practice; being a third-year fellow. In total, 53% use smartphones at least "often" in patient care. In total, 87% would use a CRC screening and surveillance smartphone app. Accuracy in applying CRC screening guidelines by gastroenterologists is poor. Smartphone use for patient care is prevalent. Our data show a high interest in a CRC screening/surveillance mobile app. Mobile tools appear an opportunity for rapid access and an increased adherence to CRC screening guidelines.

Abstract C65: Feasibility and preliminary impact of the Screen to Save Initiative on colorectal cancer screening knowledge

Abstract Background: In response to the ten recommendations of the Blue Ribbon Panel for the Cancer Moonshot, the National Cancer Institute (NCI) Center to Reduce Cancer Health Disparities (CRCHD) introduced the national Screen to Save (S2S): NCI Colorectal Cancer Outreach and Screening Initiative. The S2S intervention aimed to increase colorectal cancer (CRC) screening rates among racially and ethnically diverse communities nationwide. To carry out this initiative, the CRCHD called upon NCI-funded Community Health Educators (CHEs) from the Partnerships to Advance Cancer Health Equity (PACHE) to deliver culturally tailored, evidence-based CRC education and screening resources within their respective catchment communities. Under the San Diego State University/UC San Diego Moores Cancer Center Partnership, the Juntos Contra el Cáncer team and the CHE identified specific Latino communities in San Diego County, California to which the S2S initiative was delivered. Objectives: The aims were to assess the feasibility of implementing the S2S program and to evaluate the preliminary impact of the S2S program on knowledge of CRC screening. It was hypothesized that CRC knowledge would increase significantly after implementation of the intervention. Methods: The S2S educational materials were culturally tailored for Latinos and offered in both English and Spanish. The sample included 42 Latinos (men=9 and women=33) ages 50-75 who participated in a 15-minute one-on-one or group educational intervention. Participants were recruited from community settings such as libraries, senior centers, and health fairs. The educational intervention strategies included a presentation using either a flipchart or a PowerPoint slideshow, both of which delivered information on CRC, risk factors, and screening methods. All enrolled participants were administered a consent form and a pretest before the intervention. Following the educational components, participants completed a post-test assessing knowledge and a qualitative survey evaluating the program, and received a $15 gift card as well as educational materials on colorectal cancer from the American Cancer Society. Analysis: A paired-samples t-test was conducted to evaluate the preliminary influence of the intervention on participants' scores on CRC knowledge measured by 14-item questionnaire in a pretest/post-test intervention study. Results: The results showed a statistically significant increase in CRC knowledge from the pretest [M=11.74 (3.04)] to the post-test [M=14.10 (3.40), t (41) = -6.29, p &amp;lt; .0005 (two-tailed)]. The results of the qualitative survey indicated that most participants expressed satisfaction with the S2S program and found the visuals and recommendations to be helpful. Overall, participants reported having learned about CRC, polyps, and screening methods. Some participants provided recommendations to improve the program, such as: (1) increasing awareness of CRC through other communication channels, (2) allocating more time to provide the health education, and (3) simplifying medical terminology. One participant reported that providing this information in a public setting was inconvenient due to the nature of the topic. Discussion: The present study's results suggest that the S2S program showed preliminary efficacy in increasing CRC knowledge among participants. Also, our findings suggest that the S2S program was feasible to implement in a community setting. Based on participants' feedback, it is recommended that the terminology used in the S2S program be simplified. Research suggests that increasing CRC knowledge and awareness is a crucial component to increasing CRC screening rates among racially and ethnically diverse communities. Future research should examine the impact of the S2S program on the screening practices of participants who receive program using a rigorous study design. Citation Format: Carolina López De la Torre, Sumayah Nuhaily, Jesse Dubin, Jessica Haughton, Elva M. Arredondo. Feasibility and preliminary impact of the Screen to Save Initiative on colorectal cancer screening knowledge [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C65.

Abstract B11: Sustaining annual colorectal cancer screening in rural community health clinics using the fecal immunochemical test (FIT)

Abstract Introduction: Colorectal cancer (CRC), the second leading cause of cancer death in the United States, can be significantly reduced if it is detected early. Although overall CRC screening rates have increased significantly, disparities persist among low-income individuals, adults with low literacy, and those living in rural areas. These groups all have screening completion rates below 50%. Objectives: To assess patient knowledge, beliefs, and self-efficacy about CRC screening and compare the effectiveness of two health literacy informed telephone follow-up strategies to improve annual screening over a three-year period with fecal immunochemical test (FIT) in rural community clinics. Methods: A two-arm, randomized controlled trial is being implemented in four community clinics. Clinics reported CRC baseline screening rates of 3% to 5%. Eligible patients, age 50-75, were recruited at the clinic prior to a scheduled appointment. A research assistant (RA) conducted a baseline structured interview measuring CRC screening knowledge, beliefs, and self-efficacy. The RA then recommended screening and gave brief literacy and culturally appropriate education using a pamphlet (4th-grade level), the FIT kit with preaddressed envelope, simplified instructions (3rd-grade level), and a demonstration of how to use it. At four weeks patients who had not returned their kit received either 1) a personal follow-up call (PC) from a central prevention coordinator using motivational interviewing skills and reminding them to complete and mail FIT kits, or 2) an automated follow-up call (AC) using plain language and motivational messages encouraging patients to complete and mail the FIT. Outcomes include FIT completion after intervention, and again at 12 and 24 months. Results: 620 patients not up to date with screening were enrolled: 64% African American, 56% women, 40% inadequate literacy. Although 90% reported having heard of CRC, only 64% knew a test to check for CRC. 70% reported that a provider had recommended CRC screening in the past and 91% reported they would want to know if they have CRC. Self-efficacy was high, with over 90% indicating they would return the kit to the lab. Screening results: 620 patients enrolled (AC: n=308 / PC: n=306); 418 (68%) completed tests (AC: n=213 (69%) / PC: n=205 (67%)). Follow-up calls for unreturned kits--AC: 124 (40%) people called--29 returned FIT (9.4% of people called completed FIT). PC: 127 (41%) people called--26 returned FIT (9.4% of people called completed FIT). 2nd-year screening: 255 second kits mailed out to date (AC: n=128/PC: n=125); 98 (38.5%) completed tests (AC: n=49 (38%) / PC: n=49 (39%)). Follow-up calls for unreturned kits--AC: 89 (70%) people called—19 returned FIT (14.8% of people called completed FIT). PC: 82 (66%) people called—17 returned FIT (13.6% of people called completed FIT). Discussion: Implementing health literacy influenced CRC education, and screening strategies using the FIT and phone reminders dramatically increased FIT completion in rural community clinics. The less costly and time-consuming automated call was equally effective as a personal call. Citation Format: Connie L. Arnold, Terry C. Davis, Alfred Rademaker, James Morris, Glenn Mills. Sustaining annual colorectal cancer screening in rural community health clinics using the fecal immunochemical test (FIT) [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B11.

Implementation and Evaluation of a Novel Colorectal Cancer Decision Aid Using a Centralized Delivery Strategy

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States; however, CRC screening reduces both incidence and mortality rates. Patient decision aids (DAs) are an evidence-based strategy to support patients making health-related decisions. CRC screening DAs can be unsuccessful due to provider preferences for colonoscopy and lack of effective DA implementation strategies within clinical settings. A hybrid implementation-effectiveness study was conducted testing the feasibility of using an existing centralized preventive health screening outreach infrastructure to implement a novel CRC DA across a health care system. Participants included primary care patients at one of three study clinics. Implementation was assessed by determining whether patients remembered receiving the DA and were aware of CRC screening options. Effectiveness was measured by comparing overall screening rates between the control and intervention groups. Using a centralized delivery system was a feasible and efficient method for implementing DAs to a large academic health system. More than 90% of the intervention group remembered receiving the DA, and 80% found it helpful in their decision-making process. The DA was successful in improving CRC screening knowledge; however, overall CRC screening rates significantly decreased between the control and intervention periods (50.8% vs. 39.2%, respectively; p = 0.03). Centralized delivery is a feasible method for DA implementation. Although DAs increase knowledge, the true effectiveness of CRC DAs in clinical settings is unknown, as a result of the number in screening tests, diversity in DA format, and the variability in dissemination and implementation practices.

Improving Internal Medicine Residents' Colorectal Cancer Screening Knowledge Using a Smartphone App: Pilot Study.

BackgroundColorectal cancer (CRC) is the third most common type of cancer and the second leading cause of cancer death in the United States. About one in three adults in the United States is not getting the CRC screening as recommended. Internal medicine residents are deficient in CRC screening knowledge.ObjectiveThe objective of our study was to assess the improvement in internal medicine residents’ CRC screening knowledge via a pilot approach using a smartphone app.MethodsWe designed a questionnaire based on the CRC screening guidelines of the American Cancer Society, American College of Gastroenterology, and US Preventive Services Task Force. We emailed the questionnaire via a SurveyMonkey link to all the residents of an internal medicine department to assess their knowledge of CRC screening guidelines. Then we designed an educational intervention in the form of a smartphone app containing all the knowledge about the CRC screening guidelines. The residents were introduced to the app and asked to download it onto their smartphones. We repeated the survey to test for changes in the residents’ knowledge after publication of the smartphone app and compared the responses with the previous survey. We applied the Pearson chi-square test and the Fisher exact test to look for statistical significance.ResultsA total of 50 residents completed the first survey and 41 completed the second survey after publication of the app. Areas of CRC screening that showed statistically significant improvement (P<.05) were age at which CRC screening was started in African Americans, preventive tests being ordered first, identification of CRC screening tests, identification of preventive and detection methods, following up positive tests with colonoscopy, follow-up after colonoscopy findings, and CRC surveillance in diseases.ConclusionsIn this modern era of smartphones and gadgets, developing a smartphone-based app or educational tool is a novel idea and can help improve residents’ knowledge about CRC screening.

Improving Internal Medicine Residentsʼ Colorectal Cancer (CRC) Screening Knowledge via Smart Phone Application: A Novel Approach

Introduction: Colo-Rectal cancer is the third most common type of cancer and the second leading cause of cancer death in the United States. The incidence and mortality of CRC have declined in the last decade, but still there is a room for improvement. About one in three adults in US is not getting the CRC screening as recommended. Internal medicine residents are deficient in CRC screening knowledge as shown by previous studies. we conducted this IRB approved study [UT IRB# 201713] to improve the residents CRC screening knowledge via smart phone application. Methods: A questionnaire was designed based on CRC screening guidelines of ACS, ACG and USPSTF. The questionnaire was emailed via SurveyMonkey link to all the residents of internal medicine department. The responses were analyzed after 4 weeks. Then a smart phone application was designed and was published on Play Store and App Store for android users and I phone users respectively. All the residents were introduced to the application. The survey was repeated and the responses were compared with the previous one. Pearson Chi square test and the fisher exact test was applied to look for statistical significance.Table: Number of Responders Correctly Identifying Appropriate Exams for CRC Screening.Table: Number of Responders Correctly Identifying Appropriate Exams for CRC Screening.Table: Number of Responders Correctly Identifying Appropriate Exams for CRC Screening.Results: 50 residents completed the first survey and 41 completed the second survey after publication of the application. There was no significant difference in knowledge by the residency years at baseline and knowledge improved equally across all the residency years. Survey was divided into seven domains to test various aspects of CRC screening knowledge. Some of the areas which showed statistically significant improvement (P value <0.05) included age to start CRC screening in African Americans, ordering preventive tests first, identification of CRC screening tests, identification of preventive and detection methods, positive tests to be followed by colonoscopy, follow up after colonoscopy findings and CRC surveillance in diseases. Conclusion: In this modern era of smart phones and gadgets, developing a smartphone based application or educational tool is a novel idea and can help in improving the knowledge of residents about colorectal cancer screening as shown by our study. Such smart phone based educational tool can be a part of residents' orientation before the start of residency to emphasize further on CRC screening.