Adapting and Implementing a Remote, Digital CRC Screening Intervention for Primary Care Practice in Response to COVID-19

项目总结 在实施研究综合框架(CFIR)的指导下，拟议的总体目标是 补充是调整Meet Alex干预措施，以满足患者对结直肠癌筛查安全性的担忧 新冠肺炎，在2个新的初级保健诊所进行试点测试，并检查在 大流行后的临床环境。新冠肺炎大流行预计将加剧癌症筛查 脆弱患者群体中的不平等现象。通过父母的资助，研究团队已经在6个 UF Gainesville诊所开发高效的工作流程和支持基础设施，以解决CRC筛查问题 弱势患者群体的需求。现在建议进行基于大便的检测，以减少 即将积压的内窥镜和放射学CRC筛查检查。与亚历克斯会面的干预措施是 地理位置理想，可帮助缓解脆弱患者群体的结直肠癌筛查不公平现象 病人教育和家庭粪便检测。 在具体目标1中，我们将扩展父母赠款干预的实施，称为Meet Alex(代理 利用同理心进行考试)到两家以黑人/非洲人为主的加州大学杰克逊维尔分校诊所 美国和拉丁裔患者群体。我们还将对一种解决患者担忧的修改进行试点测试 关于新冠肺炎相关的结直肠癌筛查安全。我们将研究是否为患者量身定做干预措施 对新冠肺炎的担忧改变了自我报告的对结直肠癌筛查方式(如结肠镜检查、家庭检查)的偏好 大便测试)和行为(通过查看图表进行评估)与接受现有 干预。 在具体目标2中，我们将描述与实施《与亚历克斯会面》相关的促进者和障碍 通过对关键利益相关者(即医疗保健提供者和诊所经理)的深入采访，了解新冠肺炎 来自所有实施诊所(N=8)，以了解组织流程和偏好的变化 CRC筛查、远程咨询的可用性以及与实施数字化相关的障碍和促进者 由于大流行而采取的干预措施。 本附录的结果将导致制定实施数字癌症的最佳实践 筛查干预措施以减少受新冠肺炎影响的初级保健机构中的结直肠癌不平等现象。

PROJECT SUMMARY Guided by the Consolidated Framework for Implementation Research (CFIR), the overall goal of this proposed supplement is to adapt the Meet ALEX intervention to patient concerns about CRC screening safety as a result of COVID-19, pilot test in 2 new primary care clinics, and examine implementation of a remote intervention in a post-pandemic clinical environment. The COVID-19 pandemic is expected to exacerbate cancer screening inequities among vulnerable patient populations. Through the parent grant, the research team has worked in 6 UF Gainesville clinics to develop an efficient workflow and support infrastructure to address the CRC screening needs of vulnerable patient populations. Stool-based testing is now being recommended to reduce the forthcoming backlog of endoscopic and radiological CRC screening exams. The Meet ALEX intervention is ideally situated to help mitigate CRC screening inequities for vulnerable patient populations by providing patient education and in-home stool testing. In Specific Aim 1, we will expand implementation of the parent grant intervention, called Meet ALEX (Agent Leveraging Empathy for Exams) to 2 UF Jacksonville clinics that serve a predominantly Black/African American and Latinx patient population. We will also pilot test a modification that addresses patient concerns about CRC screening safety related to COVID-19. We will examine whether tailoring the intervention to patient concerns about COVID-19 alters self-reported preferences for CRC screening modality (ie, colonoscopy, home stool testing) and behavior (assessed via chart review) compared with patients who receive the existing intervention. In Specific Aim 2, we will describe facilitators and barriers associated with implementing Meet ALEX as a result of COVID-19 through in-depth interviews with key stakeholders (ie, health care providers and clinic managers) from all implementing clinics (N=8) to understand changes to organizational processes and preferences for CRC screening, availability of remote counseling, and barriers and facilitators related to implementing digital interventions as a result of the pandemic. The results of this supplement will lead to the development of best practices for implementing digital cancer screening interventions to reduce CRC inequities in primary care settings affected by COVID-19.