Recruiting patients into the CDC's Colorectal Cancer Screening Demonstration Program

Abstract

BACKGROUND In 2005, the Centers for Disease Control and Prevention (CDC) funded 5 sites as part of the Colorectal Cancer Screening Demonstration Program (CRCSDP) to provide colorectal cancer screening to low-income, uninsured, and underinsured individuals. Funded sites experienced unexpected challenges in recruiting patients for services. METHODS The authors conducted a longitudinal, qualitative case study of all 5 sites to document program implementation, including recruitment. Data were collected during 3 periods over the 4-year program and included interviews, document review, and observations. After coding and analyzing the data, themes were identified and triangulated across the research team. Patterns were confirmed through member checking, further validating the analytic interpretation. RESULTS During early implementation, patient enrollment was low at 4 of the 5 CRCSDP sites. Evaluators found 3 primary challenges to patient recruitment: overreliance on in-reach to National Breast and Cervical Cancer Early Detection Program patients, difficulty keeping colorectal cancer screening and the program a priority among staff at partnering primary care clinics responsible for patient recruitment, and a lack of public knowledge about the need for colorectal cancer screening among patients. To address these challenges, site staff expanded partnerships with additional primary care networks for greater reach, enhanced technical support to primary care providers to ensure more consistent patient enrollment, and developed tailored outreach and education. CONCLUSIONS Removing financial barriers to colorectal cancer screening was necessary but not sufficient to reach the priority population. To optimize colorectal cancer screening, public health practitioners must work closely with the health care sector to implement evidence-based, comprehensive strategies across individual, environmental, and systems levels of society.

Population‐based programs for increasing colorectal cancer screening in the United States

“…Uninsured, low‐income populations were the primary target of the program. Descriptions and evaluations of the CDC demonstration program were published in 2013 . DeGroff et al identified facilitating and challenging factors for the initiation and launch of this program through interviews and document review .…”

“…Three sites (St. Louis, Nebraska, and Seattle) initially chose guaiac fecal occult blood testing (gFOBT) as the screening test of choice (with follow‐up CS for any positive result); the remaining sites (Baltimore and Suffolk County) chose CS as the primary screening method. The 5 sites drew on existing delivery systems, especially those that already were organized to deliver services supported by the CDC‐funded National Breast and Cervical Cancer Early Detection Program . An example of this is using a shared outreach or in‐reach system or tailoring program components to be integrated into clinical structures that were already in place.…”

Clinical costs of colorectal cancer screening in 5 federally funded demonstration programs

“…Funds were provided to support both clinical (screening, surveillance, and diagnostic services) and associated services (office visits and patient navigation) activities for patients aged ≥50 years. These activities are described elsewhere in this supplement to Cancer . The local programs contracted with a variety of providers and health care systems, including primary care providers (PCPs), gastroenterologists, surgeons, pathologists, gastroenterology centers, laboratories, hospitals, and community health clinics, to create provider networks required for CRC screening .…”

“…The sites in Baltimore City and Suffolk County, New York used colonoscopy as their primary screening test throughout the demonstration. Each site has been described in detail in previous articles, and each is also described elsewhere in this supplement to Cancer …”

Moving forward: Using the experience of the CDCs' Colorectal Cancer Screening Demonstration Program to guide future colorectal cancer programming efforts

“…From 2005 to 2009, the Centers for Disease Control and Prevention (CDC) established and supported a 4‐year Colorectal Cancer Screening Demonstration Program (CRCSDP) for low‐income, under‐ or uninsured men and women 50‐64 years of age living in the United States at or below 250%‐350% of the federal poverty level . Five sites received funding for this initiative: 1) the Maryland Department of Health and Mental Hygiene (referred to as the Baltimore city site), 2) the Missouri Department of Health and Senior Services (referred to as the St. Louis site), 3) the Nebraska Department of Health and Human Services (referred to as the Nebraska site), 4) Public Health—Seattle & King County (referred to as the greater Seattle site), and 5) the Stony Brook University Medical Center (referred to as the Suffolk County, New York, site).…”