Optimizing Colorectal Cancer Screening among Patients with Diabetes in Safety-Net Primary Care Settings: Targeting Implementation Approaches

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ABSTRACT Patients with diabetes mellitus have an estimated 27% elevated risk of developing colorectal cancer (CRC) and are disproportionately Non-Hispanic blacks (NHBs) and Hispanic. At the point that CRC is diagnosed in patients with diabetes opportunities to implement CRC screening tests demonstrated to be effective in preventing CRC and reducing cancer mortality have been missed. Federally qualified health centers (FQHCs) struggle to implement CRC programs for average risk patients and primarily serve as primary care for priority populations (low income and racial/ethnic minorities). Thus, targeted implementation strategies are needed that emphasize CRC screening tests that prevent CRC for patients at elevated risk in safety-net settings. Herein, the main goal of the proposal is to identify and overcome multi-level factors affecting optimal use of CRC preventive screening options for patients with diabetes in FQHCs. The applicant set out to examine racial/ethnic differences of specific CRC screening test use among patients with diabetes comparing individuals who receive majority of their care in FQHCs vs patients receiving care in traditional primary care settings (Aim 1). To optimize and adapt implementation strategies, an implementation planning group will be assembled. Using a community-based participatory research method, data inputs from multiple sources (Aim 1 findings, scoping review) will inform a local multi-method organizational implementation assessment (e.g. survey and key implementation actor interviews). These findings will guide implementation toolkit and strategy development (Aim 2). In the R00 phase, the implementation toolkit and strategy to optimize CRC preventive test use targeting patients with diabetes in FQHCs will be evaluated using a hybrid effectiveness-implementation feasibility pilot (Aim 3). The candidate has assembled an exceptional mentoring team, in an outstanding training environment to help her achieve her training goals and career transition. Her mentors include: Dr. Anita Kinney (health disparities, cancer prevention), Dr. Shawna Hudson (implementation science, practice-based research), Dr. Benjamin Crabtree (mixed methods, organizational assessment), and Dr. Jeanne Ferrante (practice-based research network recruitment, primary care). The training period will allow the candidate to gain applied learning and formal training in cancer prevention, implementation science and practice-based research. In the future, the proposed model can be utilized to investigate the development of targeted cancer prevention strategies in additional chronically ill priority populations. The research program aligns with the candidate’s long-term goal of developing an independent research program focused on implementing targeted cancer prevention strategies for underserved patients with comorbidities in safety-net settings.