title: Recruiting patients into the CDC's Colorectal Cancer Screening Demonstration Program: strategies and challenges across 5 sites.
abstract: BACKGROUND
  In 2005, the Centers for Disease Control and Prevention (CDC) funded 5 sites as part of the Colorectal Cancer Screening Demonstration Program (CRCSDP) to provide colorectal cancer screening to low-income, uninsured, and underinsured individuals. Funded sites experienced unexpected challenges in recruiting patients for services.
  
  
  METHODS
  The authors conducted a longitudinal, qualitative case study of all 5 sites to document program implementation, including recruitment. Data were collected during 3 periods over the 4-year program and included interviews, document review, and observations. After coding and analyzing the data, themes were identified and triangulated across the research team. Patterns were confirmed through member checking, further validating the analytic interpretation.
  
  
  RESULTS
  During early implementation, patient enrollment was low at 4 of the 5 CRCSDP sites. Evaluators found 3 primary challenges to patient recruitment: overreliance on in-reach to National Breast and Cervical Cancer Early Detection Program patients, difficulty keeping colorectal cancer screening and the program a priority among staff at partnering primary care clinics responsible for patient recruitment, and a lack of public knowledge about the need for colorectal cancer screening among patients. To address these challenges, site staff expanded partnerships with additional primary care networks for greater reach, enhanced technical support to primary care providers to ensure more consistent patient enrollment, and developed tailored outreach and education.
  
  
  CONCLUSIONS
  Removing financial barriers to colorectal cancer screening was necessary but not sufficient to reach the priority population. To optimize colorectal cancer screening, public health practitioners must work closely with the health care sector to implement evidence-based, comprehensive strategies across individual, environmental, and systems levels of society.
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. JBoehm@cdc.gov
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Boehm
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Rohan
authors.forename: Judith
authors.initials: J
authors.lastname: Preissle
authors.forename: Amy
authors.initials: A
authors.lastname: DeGroff
authors.forename: Rebecca
authors.initials: R
authors.lastname: Glover-Kudon
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control*; D003625:Data Collection / Q000379:methods; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D018579:Patient Selection; D011203:Poverty; D014481:United States
keywords: colorectal cancer screening; patient recruitment; program evaluation; program implementation; qualitative evaluation