Abnormal Colorectal Cancer Test Follow-Up: A Quality Improvement Initiative at a Federally Qualified Health Center

INTRODUCTION/OBJECTIVES

Colonoscopy completion rates after an abnormal fecal immunochemical test (FIT) are suboptimal, resulting in missed opportunities for early detection and prevention of colorectal cancer. Patient navigation and structured follow-up may improve colonoscopy completion, but implementation of these strategies is not widespread.

METHODS

We conducted a quality improvement study using a Plan-Do-Study-Act (PDSA) Model to increase colonoscopy completion after abnormal FIT in a large federally qualified health center serving a diverse and low-income population. Intervention components included patient navigation, and a checklist to promote completion of key steps required for abnormal FIT follow-up. Primary outcome was proportion of patients achieving colonoscopy completion within 6 months of abnormal FIT, assessed at baseline for 156 patients pre-intervention, and compared to 208 patients during the intervention period from April 2017 to December 2019. Drop offs at each step in the follow-up process were assessed.

RESULTS

Colonoscopy completion improved from 21% among 156 patients with abnormal FIT pre-intervention, to 38% among 208 patients with abnormal FIT during the intervention (P < .001; absolute increase: 17%, 95% CI: 6.9%-25.2%). Among the 130 non-completers during the intervention period, lack of completion was attributable to absence of colonoscopy referral for 7.7%; inability to schedule a pre-colonoscopy specialist visit for 71.5%; failure to complete a pre-colonoscopy visit for 2.3%; the absence of colonoscopy scheduling for 9.2%; failure to show for a scheduled colonoscopy for 9.2%.

CONCLUSIONS

Patient navigation and structured follow-up appear to improve colonoscopy completion after abnormal FIT. Additional strategies are needed to achieve optimal rates of completion.

Abstract D037: Training the next generation of undergraduate URM cancer scientists: Results and lessons learned from a cancer research Partnership Scholar Program

Background: To improve cancer disparities among underrepresented minority (URM) populations, better representation of URM individuals in cancer research is needed. The San Diego State University (SDSU) and University of California San Diego (UCSD) Moores Cancer Center Partnership is addressing cancer disparities through an educational program targeting undergraduate URM students. Aims: To increase the proportion of URM individuals participating in cancer research by providing a range of research education opportunities supported by the Partnership Scholar Program Methods: The Partnership provides a paid intensive summer research internship enriched with year-round activities that include educational sessions, a journal club, mentorship, social activities, and poster sessions and presentations. Program evaluation through follow-up surveys, focus groups and other formal and informal feedback, including advisory and program steering committees are used to improve the program. Long-term follow-up among scholars (minimum of 10 years) provides data to evaluate the program’s long-term impact on scholars’ education and career path. Results: Since 2016, 63 URM undergraduate students participated in the scholar program. At the Year 2 follow-up (2016 cohort; n=12), 50% had completed their GRE and/or applied to graduate school or medical school. Lessons learned during the course of the program led to changes that were implemented to provide a better learning experience and increase overall program satisfaction, which include: 1) Lengthening the recruitment timeline to improve reach of eligible students and to provide more time for scholar selection and onboarding. 2) Improving the recruitment processes by collaborating with organizations serving URM students. 3) Refining the program contracts and onboarding meetings to help clarify expectations for scholars and faculty mentors. 4) Program coordinator skills and responsibilities (e.g., communication with scholars and mentors) are key to scholar satisfaction and retention. The coordinator organizes and communicates program activities, holds one-on-one in-person meetings, and provides ongoing mentorship to increase retention and scholar success in their ongoing academic development. 5) Adjustments to program components, such as scheduling and curricula of the summer education sessions, pairing scholars with clinicians, and the addition of social events were implemented to improve scholars’ learning experience. 6) Efficient tracking of the multitude of evaluation metrics requires a well-mapped and scheduled evaluation plan that includes automated publication notification systems and LinkedIn groups to evaluate scholars’ satisfaction and achievements post-program completion. Conclusions: The Partnership identified best practices and lessons learned for implementing lab-based internship scholar programs in biomedical and public health fields that could be considered in other programs. (U54CA132384 & U54CA132379)

Citation Format: Elinor Gaida, Elva M Arredondo, Anthony J Barrios, Sanford I Bernstein, Richard M Cripps, Sheila E Crowe, Jill Dumbauld Nery, Maria Elena Martinez, Bilge Pakiz, Mercedes A Quintana Serrano, Roland Wolkowicz, Hala Madanat. Training the next generation of undergraduate URM cancer scientists: Results and lessons learned from a cancer research Partnership Scholar Program [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D037.

Strategies addressing barriers to clinical trial enrollment of underrepresented populations: a systematic review

BACKGROUND

Underrepresentation of racial and ethnic minorities in clinical trials remains a reality while they have disproportionately higher rates of health disparities.

OBJECTIVE

The purpose of this study was to identify successful community-engaged interventions that included health care providers as a key strategy in addressing barriers to clinical trial enrollment of underrepresented patients.

DESIGN

A systematic review of the literature on interventions addressing enrollment barriers to clinical trials for racial and ethnic minorities was performed in Ovid MEDLINE, EBSCO Megafile, and EBSCO CINAHL. The systematic review identified 360 studies, and 20 were selected using the inclusion criteria. An iterative process extracted information from the eligible studies.

RESULTS

The 20 selected studies were analyzed and then grouped by first author, nature of the clinical research initiative, priority populations, key strategies, and study outcomes. Nine of the studies addressed cancer clinical trials and 11 related to chronic medical conditions, including diabetes, hypertension management, and chronic kidney disease. The key strategies employed were categorized according to their presumed impact on barriers incurred at distinct steps in study recruitment: clinical trial awareness, opportunity to participate, and acceptance of enrollment. The strategies were further categorized by whether they would address barriers associated with minority perceptions of the research process and barriers related to how studies were designed and implemented.

CONCLUSION

Multiple and flexible strategies targeting providers and participants at provider sites and within communities might be needed to enroll underrepresented populations into clinical trials.