Abstract A137: Enrolling a diverse sample of community health center patients for a multi-level intervention to increase colorectal cancer screening uptake and follow-up
Authors: May Folasade P. , Tuan Jessica J. , Brodney Suzanne , Syngal Sapna , Chan Andrew T. , Glenn Beth , Johnson Gina , Chang Yuchiao , Drew David A. , Moy Beverly , Rodriguez Nicolette J. , Warner Erica T. , Anyane-Yeboa Adjoa , Ukaegbu Chinedu , Davis Anjelica Q , Schoolcraft Kimberly , Kuney Samantha , Le Beaux Kelley , Jeffries Catherine , Haas Jennifer S. 
Published: September 2024

Abstract
Colorectal cancer (CRC) screening is underutilized, especially in community health centers (CHCs) that provide care to marginalized communities, including low-income, uninsured, and racial/ethnic minority populations. Stool-based tests, such as the fecal immunochemical test (FIT) and FIT-DNA, can be effective CRC screening methods if individuals with abnormal results undergo colonoscopy. The Community Collaboration to Advance Racial/Ethnic Equity in CRC Screening (CARES) study aims to enroll a diverse sample of individuals at average risk for CRC for a multi-level intervention to increase CRC screening uptake and colonoscopic follow-up after abnormal FIT or FIT-DNA results in CHCs in 3 U.S. regions. Our overall goal is to conduct a two-arm, pragmatic randomized trial that includes patients in 4 Boston and 4 Los Angeles (LA) CHCs. Two clinics in the Great Plains Tribal Leaders Health Board in South Dakota (SD) will be included in a parallel pilot study. Pre-implementation activities included qualitative interviews with providers and administrators at each CHC to understand barriers to screening and current clinic workflows, development of a central database, and tailoring intervention components for each site: study invitation letters, text message reminders, infographics, instructional videos, QR codes to informational videos, and navigation for patients with abnormal results. In the 63 semi-structured pre-implementation interviews, stakeholders reported patient barriers to screening included lack of motivation due to the absence of symptoms and difficultly understanding test instructions, while provider barriers were lack of electronic health record (EHR) past-due screening reminders, and system-level barriers included challenges referring patients for colonoscopy in outside facilities. For each clinic, we queried EHR data to identify patients ages 45-75 with a recent primary care visit and an indicated preference for English or Spanish language. In the Boston clinics, 38.3% were Non-Hispanic White, 62.1% preferred English, and 65.1% were privately insured. In LA, 91.3% were Hispanic, 86.8% preferred Spanish, and 72.4% were Medicaid insured. The mean baseline CRC screening rate was significantly higher in the Boston clinics than in the LA clinics (69.1% v. 21.2%; p&lt;0.0001). Of those screened, the most common screening modality was colonoscopy in Boston (84.3%) and FIT in LA (92.2%) (p&lt;0.001). Higher baseline screening and colonoscopy rates in Boston may be due to multiple factors, including differences in patient demographics, prevalence of immigrant populations, language barriers, and/or healthcare access and capacity. We randomized each CHC to either mailed FIT or FIT-DNA and enrolled 2429 patients in the FIT-arm (Boston: n=936; LA: n=1493) and 2798 patients in the FIT-DNA arm (Boston: n=1303; LA: n=1495). We intend to enroll 800 patients in a similar manner in SD. To increase CRC screening through targeted interventions among populations with limited resources, it is crucial to consider local systems, barriers and facilitators to care.
Citation Format: Folasade P. May, Jessica J. Tuan, Suzanne Brodney, Sapna Syngal, Andrew T. Chan, Beth Glenn, Gina Johnson, Yuchiao Chang, David A. Drew, Beverly Moy, Nicolette J. Rodriguez, Erica T. Warner, Adjoa Anyane-Yeboa, Chinedu Ukaegbu, Anjelica Q Davis, Kimberly Schoolcraft, Samantha Kuney, Kelley Le Beaux, Catherine Jeffries, Jennifer S. Haas. Enrolling a diverse sample of community health center patients for a multi-level intervention to increase colorectal cancer screening uptake and follow-up [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A137.