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. 2024 Jun 3;5(1):60.
doi: 10.1186/s43058-024-00598-5.

Supporting ColoREctal Equitable Navigation (SCREEN): a protocol for a stepped-wedge cluster randomized trial for patient navigation in primary care

Jessica N Rivera Rivera  1 , Katarina E AuBuchon  2 , Laura C Schubel  1 , Claire Starling  1 , Jennifer Tran  3 , Marjorie Locke  4 , Melanie Grady  5 , Mihriye Mete  6   7 , H Joseph Blumenthal  8 , Jessica E Galarraga  9 , Hannah Arem  10   11
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Supporting ColoREctal Equitable Navigation (SCREEN): a protocol for a stepped-wedge cluster randomized trial for patient navigation in primary care

Jessica N Rivera Rivera et al. Implement Sci Commun. .

Abstract

Background: Black individuals in the United States (US) have a higher incidence of and mortality from colorectal cancer (CRC) compared to other racial groups, and CRC is the second leading cause of death among Hispanic/Latino populations in the US. Patient navigation is an evidence-based approach to narrow inequities in cancer screening among Black and Hispanic/Latino patients. Despite this, limited healthcare systems have implemented patient navigation for screening at scale.

Methods: We are conducting a stepped-wedge cluster randomized trial of 15 primary care clinics with six steps of six-month duration to scale a patient navigation program to improve screening rates among Black and Hispanic/Latino patients. After six months of baseline data collection with no intervention we will randomize clinics, whereby three clinics will join the intervention arm every six months until all clinics cross over to intervention. During the intervention roll out we will conduct training and education for clinics, change infrastructure in the electronic health record, create stakeholder relationships, assess readiness, and deliver iterative feedback. Framed by the Practical, Robust Implementation Sustainment Model (PRISM) we will focus on effectiveness, reach, provider adoption, and implementation. We will document adaptations to both the patient navigation intervention and to implementation strategies. To address health equity, we will engage multilevel stakeholder voices through interviews and a community advisory board to plan, deliver, adapt, measure, and disseminate study progress. Provider-level feedback will include updates on disparities in screening orders and completions.

Discussion: Primary care clinics are poised to close disparity gaps in CRC screening completion but may lack an understanding of the magnitude of these gaps and how to address them. We aim to understand how to tailor a patient navigation program for CRC screening to patients and providers across diverse clinics with wide variation in baseline screening rates, payor mix, proximity to specialty care, and patient volume. Findings from this study will inform other primary care practices and health systems on effective and sustainable strategies to deliver patient navigation for CRC screening among racial and ethnic minorities.

Trial registration: NCT06401174.

Keywords: Colorectal cancer disparities; Colorectal cancer screening; Patient navigation; Primary care; Stepped-wedge design.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
PRISM-based Conceptual Framework for SCREEN
Fig. 2
Fig. 2
Stepped-wedge study design: Schedule of events for clusters to start the intervention
See this image and copyright information in PMC

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References

    1. Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965–77. doi: 10.1001/jama.2021.6238. - DOI - PubMed
    1. 2030; HP. Increase the proportion of adults who get screened for colorectal cancer — C–07: U.S. Department if Health and Human Services; 2023 Available from: https://health.gov/healthypeople/objectives-and-data/browse-objectives/c....
    1. Zavala VA, Bracci PM, Carethers JM, Carvajal-Carmona L, Coggins NB, Cruz-Correa MR, et al. Cancer health disparities in racial/ethnic minorities in the United States. Br J Cancer. 2021;124(2):315–32. doi: 10.1038/s41416-020-01038-6. - DOI - PMC - PubMed
    1. U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on 2022 submission data (1999–2020): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. 2023 Available from: https://www.cdc.gov/cancer/dataviz.
    1. 2030 Healthy People. Increase the proportion of adults who get screened for colorectal cancer — C–07: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion; 2023. Available from: https://health.gov/healthypeople/objectives-and-data/browse-objectives/c....

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