Multilevel Intervention Improves CRC Screening Rates
Clinical Summary
- Per an ACG Scientific Meeting abstract, an RCT enrolled 2007 adults aged 45–75 across 5 New York City FQHCs serving predominantly Black and Hispanic low-income populations. Participants received usual care or mailed education/FIT kits, patient navigation, and colonoscopy scheduling/follow-up support.
- Colorectal cancer screening completion within 6 months was 35.9% with intervention versus 23.6% with usual care (OR, 1.75; P<.001); improvements occurred in both age groups, 45–49 and 50–75 years.
- All 10 patients with abnormal stool tests completed follow-up colonoscopy. Patients and providers found the interventions acceptable; cost-effectiveness results were not reported.
A double award-winning abstract showed that mailed education and fecal immunochemical test (FIT) kits, patient navigation, and support for colonoscopy scheduling and follow-up significantly improved completion of colorectal cancer screening among patients who receive care at federally qualified health care centers (FQHCs) in New York City.
The abstract was presented by Dr Aasma Shaukat, the Robert M. and Mary H. Glickman Professor of Medicine, professor of Population Health, and director of GI Outcomes Research at NYU Langone Health in New York, New York. The abstract received the Outstanding Research Award in the Colorectal Cancer Prevention Category and was also given an ACG Health Equity Research Abstract of Distinction Award, which recognizes high-impact research on health equity, disparities, and quality improvement in gastroenterology.
Dr Shaukat and her colleagues set out to evaluate the overall effectiveness as well as the cost effectiveness of a multilevel outreach effort to improve screening rates for colorectal cancer among underserved adults in Brooklyn. Rates for CRC screening are low among patients receiving care at multiple federally qualified health care centers (FQHCs) in New York City, Dr Shaukat reported.
Her team conducted a randomized controlled trial across 5 FQHCs serving predominantly Black and Hispanic low-income populations. Adults aged 45–75 who were eligible for CRC screening were randomized to usual care or a multilevel intervention, which included education and FIT kits mailed to prospective patients, patient navigation, and support for colonoscopy scheduling and follow-up. The primary outcome was CRC screening completion by FIT or colonoscopy within 6 months. Secondary outcomes included screening completion in 45-49- and 50-75-year-olds; colonoscopy completion after a positive FIT; implementation barriers and facilitators; and cost-effectiveness.
A total of 2007 eligible individuals were randomized to usual care (n=1116) or interventions (n=891). The average age of participants was 57 years; 69% were Black, 25% Hispanic, and 66% were women.
Completion of screening within 6 months was higher in the intervention group compared to usual care (35.9% vs. 23.6% respectively; OR 1.75; 1.44-2.13; p< 0.001). Screening completion rates were higher in the intervention group compared to usual care for 45-49-year-olds (31.9% vs. 20.1%; p=0.02) and 50-75-year-olds (36.9 vs. 24.3%; p< 0.01). Factors associated with higher screening completion were older age (OR 1.014; 1.002-1.027) and Spanish speaking (OR 1.43; 1.07-1.91). Low completion of screening was associated with unemployment (OR 0.79; 0.64-0.94).
Ten patients had abnormal stool tests, for whom the follow-up colonoscopy completion rate was 100%. The interventions were acceptable by patients and providers.
This trial addresses a critical gap in CRC prevention by testing a scalable, multilevel outreach model tailored to underserved populations.
Reference:
Shaukat A, Hu J, Zhao Y, et al. A randomized clinical trial of multi-level intervention to improve colorectal cancer screening rates at multiple federally qualified health care centers in New York City. Presented at: American College of Gastroenterology Scientific Meeting. October 12-14. Nashville, Tennessee.
