Multilevel Interventions to Improve Colorectal Cancer Screening in an Urban Native American Community: A Pilot Randomized Clinical Trial

Aasma Shaukat; Jack Wolf; Kyle Ryder; Jennifer P Wisdom; Timothy R Church

doi:10.1016/j.cgh.2024.01.044

Multilevel Interventions to Improve Colorectal Cancer Screening in an Urban Native American Community: A Pilot Randomized Clinical Trial

Clin Gastroenterol Hepatol. 2024 Feb 15:S1542-3565(24)00197-6. doi: 10.1016/j.cgh.2024.01.044. Online ahead of print.

Authors

Aasma Shaukat¹, Jack Wolf², Kyle Ryder², Jennifer P Wisdom³, Timothy R Church⁴

Affiliations

¹ Division of Gastroenterology, Department of Medicine, New York University Grossman School of Medicine, New York, New York. Electronic address: Aasma.shaukat@nyulangone.org.
² Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota; Division of Biostatisitcs, University of Minneosta School of Public Health, Minneapolis, Minnesota.
³ Wisdom Consulting, New York, New York.
⁴ Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota.

PMID: 38365095
DOI: 10.1016/j.cgh.2024.01.044

Abstract

Native Americans have the highest burden of colorectal cancer (CRC) and the lowest rates of CRC screening across the United States.¹ The disparities in CRC screening were made worse during the pandemic, creating an unmet need to implement evidence-based, multilevel interventions to improve CRC screening uptake. This can be achieved through an organized outreach program with identification of screen-eligible individuals using health records from the clinic; and a screening program with the following: (1) a mailed invitation, (2) a package of materials so patients can complete a fecal immunochemical test (FIT) kit from their homes, (3) reminder calls and a letter, and (4) navigation to a diagnostic colonoscopy.^2-5 We conducted a pilot randomized controlled trial of a program of outreach vs usual care for completion of CRC screening at an urban clinic serving the Native American community. Applying the Consolidated Framework for Implementation Research (CFIR),⁶ we also conducted patient and provider interviews to understand barriers and facilitators to the organized program and CRC screening in general.