Reducing CRC Screening Disparities by Engaging … CRC Screening Disparities by Engaging Stakeholders Ronald E. Myers, ... Albert Einstein Health Network, ... University of Texas-Houston

Reducing CRC Screening Disparities by Engaging Stakeholders

Ronald E. Myers, PhD

Professor and Director

Division of Population Science

Department of Medical Oncology

Sidney Kimmel Medical Center

Thomas Jefferson University

Possible conflicts of interest

• No possible conflicts to report

Name of presenter Ronald E. Myers, PhD

Literature Review on CRC Screening Interventions

The RCaDES Initiative

Center for Health Decisions at Jefferson

Cancer

Disparities

Title Abstract Review of RCTs published

2010-2015 n=89

Full text review n=36

Full text review n=8

Articles selected n=6

Excluded articles (n=53)

Non-US population Non-minority population

Incorrect scope

Articles excluded (n=2) • Study focused on

rescreening • Study focused on referral

for colonoscopy and dispensing FOBT

Excluded articles (n=28) Sample size≥400

Journal impact factor ≥2.5 >1 practice settings

Statistically significant Effect size≥10%

Summary of Literature Review Findings



Cancer

Disparities

1. Mailed, telephone, in-person patient education

2. Telephone, in-person decision support and navigation

3. Mailed, telephone, electronic reminders

Greiner et al., 2014

Lasser et al., 2011

Myers et al., 2014

Gupta et al., 2013

Inadomi et al., 2012

Menon et al., 2011

Study 1 - A Randomized Controlled Trial of

Tailored Navigation and Standard Interventions

in CRC Screening in a General Population

Cancer Epidemiology, Biomarkers & Prevention 22(1):109–17, 2012.

Ronald E. Myers, PhD 1 Heather Bittner-Fagan, MD, FAAFP, MPH 2

Constantine Daskalakis, ScD 3 Randa Sifri, MD 4

Sally W. Vernon, PhD 5 James Cocroft, MA

Melissa DiCarlo, MPH, MS 1 Nora Katurakes, RN, MSN, OCN 2

Jocelyn Andrel, MSPH 3

(1) Department of Medical Oncology, Division of Population Science, Thomas Jefferson University

(2) Helen F. Graham Cancer Center, Christiana Care Health System, Wilmington, DE

(3) Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University

(4) Department of Family & Community Medicine, Thomas Jefferson University

(5) Center for Health Promotion and Prevention Research, University of Texas-Houston School of Public Health

This study was funded by the National Cancer Institute (R01 CA116576)


Control

Group

(n=317)

Standard

Mailed

Intervention

(n=316)

Tailored

Navigation

Intervention

(n=312)

Study 1 - Design

Consented, Surveyed, Randomized (N=945)

Endpoint

Survey and

Chart Audit

Endpoint

Survey and

Chart Audit

Endpoint

Survey and

Chart Audit

Both SBT

and CX

Preferred

test + call

No

Test


Screening Adherence by Study Group

Control Group

SI

Group

TNI

Group

n (%) screened 38 (12%) 103 (33%) 117 (38%)

Adjusted OR (95% CI) 1.00

3.69 (2.42, 5.64)

4.60 (3.02, 7.02)

P-value Ref 0.001 0.001


Study 2 - A Randomized Controlled Trial of Tailored Navigation and Standard Interventions in

CRC Screening among African Americans

Journal of the National Cancer Institute, 106(12) 2014 (ISSN: 1460-2105)

Ronald E. Myers, PhD 1 Randa Sifri, MD 4

Constantine Daskalakis, ScD 3 James Cocroft, MA 1

Praveen R. Geethakumari, MD2 Christoper Minnick, MSW2

Melissa DiCarlo, MPH, MS 1 Nancy Brisbon, MD 4

Jocelyn Andrel, MSPH 3 Sally W. Vernon, PhD 5

(1) Department of Medical Oncology, Division of Population Science, Thomas Jefferson University

(2) Albert Einstein Health Network, Philadelphia, PA

(3) Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University

(4) Department of Family & Community Medicine, Thomas Jefferson University

(5) Center for Health Promotion and Prevention Research, University of Texas-Houston School of Public Health

This study was funded by the American Cancer Society (RSGT -08-017-01-CPPB))


Standard

Mailed

Intervention

(n=317)

Tailored

Navigation

Intervention

(n=312)

Study 2 -Design

Consented, Surveyed, Randomized (N=761)

Endpoint

Survey and

Chart Audit

Endpoint

Survey and

Chart Audit

Both SBT

and CX

Preferred

test + call


CRC Screening Adherence by Study Group

SI

Group

TNI

Group

n (%) 90 (24%) 145 (38%)

Adjusted OR (95% CI) 1.00

2.04 (1.47, 2.84)

P-value Ref 0.001


Conclusions

• Providing CRC screening test choice increased screening rates compared with usual care.

• Providing test choice, assistance in clarifying test preference, and navigation through performance of the preferred test produced higher screening rates than providing test choice or usual care.

• To increase overall CRC screening rates and reduce disparities, the most effective evidence-based interventions should be applied in health systems.

• Implementation science research is needed to identify cost-effective strategies that may be used to achieve this goal.


● Patient Centered Outcomes Research Institute/ Jefferson funded “collective impact learning community” project (2015-2017)

− Develop a scalable model to create health system

learning communities that can translate evidence-based interventions into practice in order to reduce cancer screening disparities

Reducing Cancer Disparities by Engaging Stakeholders (RCaDES) Initiative



Cancer

Disparities


RCaDES Model for Creating Health Systems Learning Communities

Determine System Context, Capacity, and

Commitment

Specify Health Problem and Identify Evidence-Based Intervention(s)

Deploy Adapted Intervention in Systems

1 and 2

Intervention Design Adaptation (IDeA)

Champions in Systems 1 and 2

Coordinating

Team

System 2

PASAC

System 1

PASAC

Steering

Committee

Synthesis & Translation Support Delivery

Partner Support Evaluation


RCaDES Learning Community to Reduce CRC Screening Disparities

Center for

Health Decisions (CHD)

Coordinating Team

• Director

• Staff

• Advisors

Steering Committee (SC)

• Health Systems/PASACs

• Insurers/Employers

• Public Health Departments

• Advocacy & Community

Organizations

Patient and Stakeholder Advisory Committees (PASACs)

Lehigh Valley Delaware Valley Albert Einstein

Health Network ACO Health Network

• Patients Patients Patients

• Providers Providers Providers

• Administrators Administrators Administrators

System 1: Lehigh Valley

Health Network (LVHN)

• Patients

• Providers

• Administrators

System 2: Delaware Valley

Accountable Care Organization

• Patients

• Providers

• Administrators

Common Purpose

and Agenda

Communication

and Evaluation

Evidence-based

Approaches

Adaptation &

Implementation

n

Jefferson

College of

Population

Health

Communication

Partners

Cancer

Disparities


Center for Health Decisions

at Jefferson Ronald E. Myers, PhD

RCaDES Learning Community Systems and Objectives for Reducing CRC Screening Disparities

Engagement

• Methods for patient education, delivery of screening

tests, assessment of test preference. and linkage to

decision support/ navigation

Education and Preference Clarification

• Educate patients and deliver screening tests

• Identify preferred screening test

• Link patient to decision support/navigation

Intervention

• Methods for verifying preferred screening test,

determining likelihood of performance, and

developing/implementing personal screening plan

Decision Support and Navigation

• Verify preferred screening test

• Determine likelihood of test performance

• Develop/implement personal screening plan

Dissemination

• Methods for developing health system learning

community, training PASACs in adaptation, and

implementing/assessing processes/outcomes

Implementation and Evaluation

• Develop health system learning community

• Train PASACs in intervention adaptation

• Implement and assess processes/outcomes

Objectives Systems



Cancer

Disparities


Thank You!

Questions?


Documents

Reducing CRC Screening Disparities by Engaging … CRC Screening Disparities by Engaging Stakeholders Ronald E. Myers, ... Albert Einstein Health Network, ... University of Texas-Houston