1. SAMPLE – Preliminary Results
Patient, provider and system level factors to consider when implementing evidence based colorectal cancer prevention & early detection in a federally qualified health center
Jasmine Carey1, Paulina Mendoza2, MPH, Gregory A. Talavera2, MD, MPH, Samir Gupta3, MD, Sheila F. Castañeda2, PhD
1San Diego State University, 2South Bay Latino Research Center, Graduate School of Public Health, San Diego State University, 3Division of Gastroenterology, Department of Internal Medicine, Moores Cancer Center, University of California San Diego
BACKGROUND
CONCLUSIONS
METHODS
LESSONS LEARNED
Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the third leading cause of cancer death in both men and women in the United States.
Regular CRC screening reduces CRC mortality by decreasing the incidence of disease and by increasing the likelihood of survival.
The most common barriers to CRC screening adherence are cost, lack of health insurance and lack of provider recommendation.
Populations that are most likely to have lower screening rates include Hispanics/Latinos, immigrants, and those with limited English language proficiency.
The overall aim of the study is to conduct a RCT to compare different CRC strategies (Outreach, Inreach, Both, versus UC) in a federally qualified health setting.
Eligibility criteria:
Self-identify as Latino
Be an established patient at San Ysidro Health Center
Age 50-75
Not currently up-to-date with CRC screening
Setting
Sample
N= 305
Outreach, n=162
Mailed FIT invitation; available in Spanish and English (example mailed material in Table 2, see below)
Telephone reminder
Inreach, n=162
In clinic education during usual care/ primary care visit
Inreach + Outreach, n=162
Usual Care, n=162
Opportunistic screening by primary care provider during usual care
Measures:
Focus groups
One-on-one meetings with providers
Reviews of clinical protocols, study-related documents, materials and data processes
Data Issues
Colonoscopies not completely mapped from the EHR into the i2i software
Contextual Issues
Provider and clinic staff buy-in for research
Provider preference for colonoscopy referral over FIT
Lack of clinic-wide protocol for follow up for positive FITs
Material Issues
Instructions needed the SYHC logo to promote trust
Instructions needed a family picture to symbolize a representation of the participants in the study
Solutions:
Medical chart abstraction to confirm eligibility for “non-up-to-date”
Randomization – oversample by 50% to achieve adequate representation of males
Increase recruitment to reach target sample size
Planning regular presence at provider meetings
Modify patient navigator protocol to adapt messaging to accommodate preference for colonoscopy and delineate F/U process
REFERENCES
American Cancer Society. Colorectal Cancer Facts & Figures Atlanta: American Cancer Society, 2014.
Gupta, S., Sussman, D. A., & Doubeni, C. A. (2014). Challenges and Possible Solutions to Colorectal Cancer Screening for the Underserved | JNCI: Journal of the National Cancer Institute | Oxford Academic.
Jones, R. M., Devers, K. J., Kuzel, A. J., & Woolf, S. H. (2010). Patient-reported barriers to colorectal cancer screening: a mixed-methods Analysis.
SPECIFIC AIMS
The specific aim for this study is to conduct a process evaluation and determine implementation issues related to the trial in this setting.
ACKNOWLEDGEMENTS
Thank you to San Ysidro Health Center’s staff and it’s patients for making this study possible.
SAMPLE – Preliminary Results
Outreach
(N=77)
Inreach
(N=76)
Combined
Usual Care (N=76) n
(%)
Demographics
Age (SD) 70
(7) 59
(6) 61
Insurance (yes) 74
(96) 69
(91)
(92)
Gender (Female) 42
(55) 26
(43)
Ethnicity (Hispanic/ Latino) 77
(100) 76
Primary Language (Spanish) 62
(81) 58
(76) 63
(83) 64
(84)
FOR MORE INFORMATION:
Jasmine Carey
Research reported in this poster was supported by the National Cancer Institute of the National Institutes of Health under award numbers:
U54CA & U54CA132379