Methods for scaling up an outreach intervention to increase colorectal cancer screening rates in rural areas

被引：2
作者：
Coury J. [1 ]
Coronado G. [2 ]
Currier J.J. [3 ]
Kenzie E.S. [1 ,5 ]
Petrik A.F. [2 ]
Badicke B. [1 ]
Myers E. [1 ]
Davis M.M. [1 ,4 ,5 ]
机构：
[1] Oregon Rural Practice-Based Research Network, Oregon Health & Science University (OHSU), 3181 SW Sam Jackson Park Rd, Portland, 97239, OR
[2] Kaiser Permanente Center for Health Research, Portland
[3] Division of Oncological Sciences, Knight Cancer Institute, OHSU, Portland
[4] OHSU-PSU School of Public Health, OHSU, Portland
[5] Department of Family Medicine, OHSU, Portland
来源：
Implementation Science Communications | / 5卷 / 1期
基金：
美国国家卫生研究院;
关键词：
Colorectal cancer screening; Implementation science; Mailed fecal immunochemical testing; Multilevel intervention; Patient navigation; Rural health; Scaling-up interventions;
D O I：
10.1186/s43058-023-00540-1
中图分类号：
学科分类号：
摘要：
Background: Mailed fecal immunochemical test (FIT) outreach and patient navigation are evidence-based practices shown to improve rates of colorectal cancer (CRC) and follow-up in various settings, yet these programs have not been broadly adopted by health systems and organizations that serve diverse populations. Reasons for low adoption rates are multifactorial, and little research explores approaches for scaling up a complex, multi-level CRC screening outreach intervention to advance equity in rural settings. Methods: SMARTER CRC, a National Cancer Institute Cancer Moonshot project, is a cluster-randomized controlled trial of a mailed FIT and patient navigation program involving 3 Medicaid health plans and 28 rural primary care practices in Oregon and Idaho followed by a national scale-up trial. The SMARTER CRC intervention combines mailed FIT outreach supported by clinics, health plans, and vendors and patient navigation for colonoscopy following an abnormal FIT result. We applied the framework from Perez and colleagues to identify the intervention’s components (including functions and forms) and scale-up dissemination strategies and worked with a national advisory board to support scale-up to additional organizations. The team is recruiting health plans, primary care clinics, and regional and national organizations in the USA that serve a rural population. To teach organizations about the intervention, activities include Extension for Community Healthcare Outcomes (ECHO) tele-mentoring learning collaboratives, a facilitation guide and other materials, a patient navigation workshop, webinars, and individualized technical assistance. Our primary outcome is program adoption (by component), measured 6 months after participation in an ECHO learning collaborative. We also assess engagement and adaptations (implemented and desired) to learn how the multicomponent intervention might be modified to best support broad scale-up. Discussion: Findings may inform approaches for adapting and scaling evidence-based approaches to promote CRC screening participation in underserved populations and settings. Trial registration: Registered at ClinicalTrials.gov (NCT04890054) and at the NCI’s Clinical Trials Reporting Program (CTRP no.: NCI-2021–01032) on May 11, 2021. © 2024, The Author(s).
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