Adaptation of colorectal cancer screening tailored navigation content for American Indian communities and early results using the intervention

Usha Menon; Peter Lance; Laura A Szalacha; Dianna Candito; Emily P Bobyock; Monica Yellowhair; Jennifer Hatcher

doi:10.1186/s43058-022-00253-x

Adaptation of colorectal cancer screening tailored navigation content for American Indian communities and early results using the intervention

Implement Sci Commun. 2022 Jan 28;3(1):6. doi: 10.1186/s43058-022-00253-x.

Authors

Usha Menon¹, Peter Lance², Laura A Szalacha^{3

4}, Dianna Candito², Emily P Bobyock², Monica Yellowhair², Jennifer Hatcher²

Affiliations

¹ College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd, MDC Box 22, Tampa, FL, 33612, USA. umenon@usf.edu.
² University of Arizona Cancer Center, 1515 N. Campbell Ave, Tucson, AZ, 85724, USA.
³ College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd, MDC Box 22, Tampa, FL, 33612, USA.
⁴ Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL, 33612, USA.

Abstract

Background: American Indians (AI) experience major colorectal cancer (CRC) screening disparities with commensurate inequity in CRC mortality and other outcomes. The purpose of this report is to describe the methods and early results of adapting a previously successful intervention for the AI community.

Methods: The educational content and delivery strategy of the parent intervention were adapted for AIs guided by an adaptation framework and cultural consultations with the community and clinicians. As part of the environmental scanning, we identified the need to substantively revise our data entry, collection, and tracking system and develop a REDCap database for this purpose. In this study, we staggered the implementation of the intervention in each facility to inform the process from one clinic to the next, and assess both the clinical outcomes of the tailored intervention and the implementation processes across two clinic settings, Facilities A and B.

Results: The REDCap database is an indispensable asset, and without it we would not have been able to obtain reliable aggregate screening data while improvements to facility electronic health records are in progress. Approximately 8% (n = 678) of screening-eligible patients have been exposed to the navigator intervention. Of those exposed to the navigator intervention, 37% completed screening.

Conclusions: With the small numbers of patients exposed so far to the intervention, it would be premature to draw any broad conclusions yet about intervention effects. However, early screening completion rates are substantial advances on existing rates, and we have demonstrated that a tailored navigator intervention for facilitating CRC screening was readily adapted with provider and community input for application to AIs. A REDCap database for tracking of CRC screening by navigators using tablets or laptops on- or offline is easy to use and allows for generation of aggregate, anonymized screening data.

Trial registration: There was no health intervention meeting the criteria of a clinical trial. The University of Arizona Institutional Review Board granted exemption from obtaining informed consent from patients undergoing CRC screening after administration of the tailored navigation intervention as usual care.

Keywords: American Indian (AI); Colorectal cancer screening; Implementation science; Tailored patient navigation.

Abstract

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