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

Strategies and challenges across 5 sites

Authors

  • Jennifer E. Boehm MPH,

    Corresponding author
    1. Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    • Corresponding author: Jennifer Boehm, MPH, 4770 Buford Hwy, MS K-52, Atlanta, GA 30341; Fax: (770) 488-3230; JBoehm@cdc.gov

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  • Elizabeth A. Rohan PhD, MSW,

    1. Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Judith Preissle EdD,

    1. Qualitative Research Program, University of Georgia, Athens, Georgia
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  • Amy DeGroff PhD, MPH,

    1. Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Rebecca Glover-Kudon PhD, MSPH

    1. University Health Center, University of Georgia, Athens, Georgia
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  • The articles in this supplement were commissioned based on participation in evaluating the Centers for Disease Control and Prevention–funded Colorectal Cancer Screening Demonstration Program.

  • The opinions or views expressed in this supplement are those of the authors and do not necessarily reflect the opinions or recommendations of the journal editors, the American Cancer Society, John Wiley & Sons, Inc., or the Centers for Disease Control and Prevention.

  • Participants in the case study evaluation provided verbal, informed consent for participation in interviews.

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. Cancer 2013;119(15 suppl):2914–25. © 2013 American Cancer Society.

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