Abstract C123: The San Francisco Cancer Initiative: Addressing disparities in colorectal cancer screening in community health centers
Authors: Hiatt Robert , Rachocki Carly , Potter Michael B. , Somsouk Ma , Ofman David 
Published: September 2020

Abstract
Background: Despite being among the wealthiest cities in the United States, San Francisco continues to suffer from disparities in colorectal cancer (CRC) screening and diagnostic follow up among low-income and ethnically diverse residents served by community health centers (CHCs). The San Francisco Cancer (SF CAN) Initiative, a collaborative effort to reduce cancer in San Francisco, is dedicated to decreasing these and other cancer-related disparities. Purpose: To describe the approach and preliminary outcomes of the SF CAN’s CRC Task Force. Methods: Using principles of community engagement and implementation science, we developed a logic model to address CRC screening disparities. As inputs, the logic model features a partnership with the San Francisco Community Clinic Consortium (SFCCC) and its partner nonprofit community health centers. The goal is to increase screening with fecal immunochemical testing (FIT) and when needed, follow up colonoscopy, for its patient population. Continuous program evaluation utilizes the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework. Results: The SFCCC has created a quarterly reporting system to track CRC screening rates and facilitate collaborative goal setting for its partner CHCs. Six SFCCC clinical sites serving 18,815 adults aged 50-75 have used SF CAN’s technical assistance and Quality Improvement Stipends (QIS) to engage in an analysis of barriers and facilitators to screening and implement multi-level evidence-based interventions tailored to their identified specific needs. Barriers include low literacy, language, economic, and social obstacles to CRC screening such as lack of transportation or reliable access to housing or a private bathroom. The Task Force has assisted with staff training, patient education materials, and strategies for FIT distribution and collection. We have helped several sites switch from multi-sample FIT kits to evidence-based, user-friendly single sample FIT, and encouraged the development of tracking and navigation systems for abnormal FIT. In the first six months of QIS program, 5,199 patients were provided with FIT, and 3,932 (75.6%) successfully completed it. In addition, a first-ever review of 298 patients with abnormal FIT at these sites revealed that only 144 (48%) completed colonoscopy within 6 months, a finding that may lead to new initiatives to improve patient navigation. Additional SFCCC clinical sites will join the QIS program in the coming year. Conclusion: The SF CAN CRC Task Force has provided a model of academic and community partnership through which interventions to address CRC screening disparities in medically underserved communities can be implemented.
Citation Format: Robert Hiatt, Carly Rachocki, Michael B. Potter, Ma Somsouk, David Ofman. The San Francisco Cancer Initiative: Addressing disparities in colorectal cancer screening in community health centers [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 C123.