title: Implementing the CDC's Colorectal Cancer Screening Demonstration Program: wisdom from the field.
abstract: BACKGROUND
  Colorectal cancer, as the second leading cause of cancer-related deaths among men and women in the United States, represents an important area for public health intervention. Although colorectal cancer screening can prevent cancer and detect disease early when treatment is most effective, few organized public health screening programs have been implemented and evaluated. From 2005 to 2009, the Centers for Disease Control and Prevention funded 5 sites to participate in the Colorectal Cancer Screening Demonstration Program (CRCSDP), which was designed to reach medically underserved populations.
  
  
  METHODS
  The authors conducted a longitudinal, multiple case study to analyze program implementation processes. Qualitative methods included interviews with 100 stakeholders, 125 observations, and review of 19 documents. Data were analyzed within and across cases.
  
  
  RESULTS
  Several themes related to CRCSDP implementation emerged from the cross-case analysis: the complexity of colorectal cancer screening, the need for teamwork and collaboration, integration of the program into existing systems, the ability of programs to use wisdom at the local level, and the influence of social norms. Although these themes were explored independently from 1 another, interaction across themes was evident.
  
  
  CONCLUSIONS
  Colorectal cancer screening is clinically complex, and its screening methods are not well accepted by the general public; both of these circumstances have implications for program implementation. Using patient navigation, engaging in transdisciplinary teamwork, assimilating new programs into existing clinical settings, and deferring to local-level wisdom together helped to address complexity and enhance program implementation. In addition, public health efforts must confront negative social norms around colorectal cancer screening.
authors.affiliation: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. erohan@cdc.gov
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Rohan
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Boehm
authors.forename: Amy
authors.initials: A
authors.lastname: DeGroff
authors.forename: Rebecca
authors.initials: R
authors.lastname: Glover-Kudon
authors.forename: Judith
authors.initials: J
authors.lastname: Preissle
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D014481:United States
keywords: cancer screening tests; collaboration; colorectal cancer screening; early detection of cancer; interdisciplinary communication; program evaluation; program implementation; qualitative evaluation; taboo