Community Collaboration to Advance Racial/Ethnic Equity in Colorectal Cancer Screening: Protocol for a Multilevel Intervention to Improve Screening and Follow-up in Community Health Centers

Contemp Clin Trials. 2024 Oct:145:107639. doi: 10.1016/j.cct.2024.107639. Epub 2024 Jul 26.

Abstract

Introduction: Colorectal cancer (CRC) screening utilization is low among low-income, uninsured, and minority populations that receive care in community health centers (CHCs). There is a need for evidence-based interventions to increase screening and follow-up care in these settings.

Methods: A multilevel, multi-component pragmatic cluster randomized controlled trial is being conducted at 8 CHCs in two metropolitan areas (Boston and Los Angeles), with two arms: (1) Mailed FIT outreach with text reminders, and (2) Mailed FIT-DNA with patient support. We also include an additional CHC in Rapid City (South Dakota) that follows a parallel protocol for FIT-DNA but is not randomized due to lack of a comparison group. Eligible individuals in participating clinics are primary care patients ages 45-75, at average-risk for CRC, and overdue for CRC screening. Participants with abnormal screening results are offered navigation for follow-up colonoscopy and CRC risk assessment.

Results: The primary outcome is the completion rate of CRC screening at 90 days. Secondary outcomes include the screening completion rate at 180 days and the rate of colonoscopy completion within 6 months among participants with an abnormal result. Additional goals are to enhance our understanding of facilitators and barriers to CRC risk assessment in CHC settings.

Conclusions: This study assesses the effectiveness of two multilevel interventions to increase screening participation and follow-up after abnormal screening in under-resourced clinical settings, informing future efforts to address CRC disparities.

Trial registration: NCT05714644.

Keywords: cancer prevention; cancer screening; disparities; equity; multilevel intervention.

Publication types

  • Clinical Trial Protocol

MeSH terms

  • Aged
  • Colonoscopy* / statistics & numerical data
  • Colorectal Neoplasms* / diagnosis
  • Community Health Centers* / organization & administration
  • Early Detection of Cancer* / methods
  • Female
  • Healthcare Disparities
  • Humans
  • Male
  • Middle Aged
  • Multicenter Studies as Topic
  • Occult Blood
  • Patient Navigation / organization & administration
  • Pragmatic Clinical Trials as Topic
  • Randomized Controlled Trials as Topic
  • Reminder Systems

Associated data

  • ClinicalTrials.gov/NCT05714644