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Maximizing the impact of community outreach and engagement at US cancer centers.

ABSTRACT: In 2016, the National Cancer Institute-designated cancer centers funding opportunity was expanded to require community outreach and engagement (COE), with explicit attention to cancer inequities, community engagement, and implementation science in the centers' catchment areas. Resource limitations constrain these activities, and we conducted a qualitative study to understand what COE leaders see as critical needs and supports to increase impact. In the spring of 2021, we interviewed leaders from 56 of 64 cancer centers with COE programs and analyzed the data using a reflexive, thematic approach. We identified 6 categories of needs: 1) centering community engagement among leadership and non-COE researchers, 2) increasing training on implementation science/practice, 3) improving integration into cross-center networks, 4) increasing funding for staffing and sustainment, 5) revising funder guidance and reporting, and 6) facilitating data utilization. COEs need long-term, systems-focused investments to engage communities, increase research translation, and advance health equity.

SUBMITTER: Ramanadhan S

PROVIDER: S-EPMC11245743 | biostudies-literature | 2024 Jul

REPOSITORIES: biostudies-literature

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Maximizing the impact of community outreach and engagement at US cancer centers.

Ramanadhan Shoba S Daly James J Lee Rebekka M RM Mallick Kamini K Augenbraun Samantha L SL Emmons Karen M KM

JNCI cancer spectrum 20240701 4

In 2016, the National Cancer Institute-designated cancer centers funding opportunity was expanded to require community outreach and engagement (COE), with explicit attention to cancer inequities, community engagement, and implementation science in the centers' catchment areas. Resource limitations constrain these activities, and we conducted a qualitative study to understand what COE leaders see as critical needs and supports to increase impact. In the spring of 2021, we interviewed leaders from ...[more]

PMID: 38924531

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Project description:ImportanceColorectal cancer (CRC) screening is effective but remains underused in federally qualified health centers (FQHCs).ObjectiveTo assess the effectiveness of a centralized CRC screening outreach intervention involving mailed fecal immunochemical testing (FIT) outreach and patient navigation to colonoscopy after abnormal results of FIT.Design, setting, and participantsA pragmatic randomized clinical trial was conducted, using intention-to-treat analysis. Participants were enrolled from July 6, 2020, to September 17, 2021, and analyses were performed from July 6, 2023, to January 31, 2024. The study was conducted at independent FQHCs comprising 12 clinical delivery sites in North Carolina. The outreach intervention was centralized at an academic cancer center. Active individuals aged 50 to 75 years at average risk for CRC and not current with screening per US Preventive Services Task Force recommendations were included.InterventionIn addition to usual care, intervention participants received mailed screening outreach materials including an introductory letter, FIT kit packet with instructions and return postage, and 2 reminder letters if needed. Intervention participants with positive results of mailed FIT were offered navigation to facilitate follow-up colonoscopy completion. Control participants received usual care alone.Main outcomes and measuresThe primary outcome was completion of a US Preventive Services Task Force-recommended CRC screening test within 6 months determined by electronic health record review. Secondary outcomes were colonoscopy completion within 6 months after positive FIT results and detection of advanced colorectal neoplasia, defined as advanced adenoma or CRC.ResultsA total of 4002 participants were included (mean [SD] age, 59.6 [6.8] years; 2256 [56.4%] female; 364 (9.1%) Hispanic; 1082 [27.0%] non-Hispanic Black; 2288 [57.2%] non-Hispanic White; 1198 [29.9%] commercially insured; 617 [15.4%] Medicaid; 1227 [30.7%] Medicare; and 960 [24.0%] uninsured), with 2001 randomized to each group. Compared with controls, intervention participants were more likely to complete screening within 6 months of randomization (30.0% vs 9.7%; difference, 20.29 percentage points; 95% CI, 17.85-22.73 percentage points). The intervention was effective in all insurance types. In the intervention arm, 33 of 48 participants with positive FIT results (68.8%) completed follow-up colonoscopy within 6 months compared with 8 of 18 participants (44.4%) in the control arm (difference, 24.3 percentage points; 95% CI, -2.13 to 50.74 percentage points). Advanced colorectal neoplasia was detected in 29 intervention participants (1.4%) and 15 control participants (0.7%) (difference, 0.68 percentage points; 95% CI, 0.05-1.35 percentage points).Conclusions and relevanceIn this randomized clinical trial of centralized screening outreach intervention in diverse patients served by independent FQHCs, CRC screening completion and advanced colorectal neoplasia detection were substantially increased. Future studies should examine the cost and scalability of this intervention in this context.Trial registrationClinicalTrials.gov Identifier: NCT04406714.

Project description:BackgroundConvenience, privacy, and cost-effectiveness associated with web-based data collection have facilitated the recent expansion of web-based survey research. Importantly, however, practical benefits of web-based survey research, to scientists and participants alike, are being overshadowed by the dramatic rise in suspicious and fraudulent survey submissions. Misinformation associated with survey fraud compromises data quality and data integrity with important implications for scientific conclusions, clinical practice, and social benefit. Transparency in reporting on methods used to prevent and manage suspicious and fraudulent submissions is key to protecting the veracity of web-based survey data; yet, there is limited discussion on the use of antideception strategies during all phases of survey research to detect and eliminate low-quality and fraudulent responses.ObjectiveThis study aims to contribute to an evolving evidence base on data integrity threats associated with web-based survey research by describing study design strategies and antideception tools used during the web-based administration of the Garnering Effective Outreach and Research in Georgia for Impact Alliance-Community Engagement Alliance (GEORGIA CEAL) Against COVID-19 Disparities project surveys.MethodsGEORGIA CEAL was established in response to the COVID-19 pandemic and the need for rapid, yet, valid, community-informed, and community-owned research to guide targeted responses to a dynamic, public health crisis. GEORGIA CEAL Surveys I (April 2021 to June 2021) and II (November 2021 to January 2022) received institutional review board approval from the Morehouse School of Medicine and adhered to the CHERRIES (Checklist for Reporting Results of Internet E-Surveys).ResultsA total of 4934 and 4905 submissions were received for Surveys I and II, respectively. A small proportion of surveys (Survey I: n=1336, 27.1% and Survey II: n=1024, 20.9%) were excluded due to participant ineligibility, while larger proportions (Survey I: n=1516, 42.1%; Survey II: n=1423, 36.7%) were flagged and removed due to suspicious activity; 2082 (42.2%) and 2458 (50.1%) of GEORGIA CEAL Surveys I and II, respectively, were retained for analysis.ConclusionsSuspicious activity during GEORGIA CEAL Survey I administration prompted the inclusion of additional security tools during Survey II design and administration (eg, hidden questions, Completely Automated Public Turing Test to Tell Computers and Humans Apart verification, and security questions), which proved useful in managing and detecting fraud and resulted in a higher retention rate across survey waves. By thorough discussion of experiences, lessons learned, and future directions for web-based survey research, this study outlines challenges and best practices for designing and implementing a robust defense against survey fraud. Finally, we argue that, in addition to greater transparency and discussion, community stakeholders need to be intentionally and mindfully engaged, via approaches grounded in community-based participatory research, around the potential for research to enable scientific discoveries in order to accelerate investment in quality, legitimate survey data.

Project description:IntroductionLittle is known about what clinic-level factors differentiate community health centers that achieve high performance on cancer-preventive care metrics. This study aims to describe the longitudinal trends in the delivery of 3 cancer-preventive care metrics (cervical and colorectal cancer screenings and tobacco-cessation intervention) and define and compare community health centers with high cancer-preventive care performance with those with low cancer-preventive care performance.MethodsThis observational study used 2012-2019 community health center data (N=933) from the Uniform Data System. High/low performance was based on Healthy People 2020 targets and sample distribution. For each cancer-preventive care metric, the percentage of community health centers that met high (≥70.5% at cervical or colorectal cancer screening or >80% tobacco-cessation intervention) and low thresholds at 1, 2, and all the 3 screenings was estimated. Multivariable generalized estimating equations logistic regression modeling was used to assess the community health center‒level factors associated with screening performance.ResultsThe community health centers' performance for tobacco-cessation intervention remained at ≥80%, with a small increase over time. Performance for cervical cancer screening remained unchanged with about 50% of patients screened. Colorectal cancer screening performance increased from around 30% in 2012 to 44% in 2019. Very few community health centers reached high performance (3%) in all the 3 indicators, and 13% of community health centers were high in any 2 of the outcomes in 2019. Higher patient volume, a greater proportion of Hispanic patients, fewer uninsured patients, and community health centers located in the Northeast region were associated with high performance in 2019.ConclusionsVery few community health centers meet all Healthy People 2020 goals in cancer screenings and may struggle to achieve the 2030 goals. Very few indicators differentiated high performers from low performers.

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Maximizing the impact of community outreach and engagement at US cancer centers.

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Maximizing the impact of community outreach and engagement at US cancer centers.

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