title: Rationale and design of Mi-CARE: The mile square colorectal cancer screening, awareness and referral and education project.
abstract: Although colorectal cancer (CRC) is largely preventable through identification of pre-cancerous polyps through various screening modalities, morbidity and mortality rates remain a challenge, especially in African-American, Latino, low-income and uninsured/underinsured patients. Barriers to screening include cost, access to health care facilities, lack of recommendation to screen, and psychosocial factors such as embarrassment, fear of the test, anxiety about testing preparation and fear of a cancer diagnosis. Various intervention approaches to improve CRC screening rates have been developed. However, comparative effectiveness research (CER) to investigate the relative performance of different approaches has been understudied, especially across different real-life practice settings. Assessment of differential efficacy across diverse vulnerable populations is also lacking. The current paper describes the rationale and design for the Mile Square Colorectal Cancer Screening, Awareness and Referral and Education Project (Mi-CARE), which aims to increase CRC screening rates in 3 clinics of a large Federally Qualified Health Center (FQHC) by reducing prominent barriers to screening for low-income, minority and underserved patients. Patients attending these clinics will receive one of three interventions to increase screening uptake: lay patient navigator (LPN)-based navigation, provider level navigation, or mailed birthday CRC screening reminders. The design of our program allows for comparison of the effectiveness of the tailored interventions across sites and patient populations. Data from Mi-CARE may help to inform the dissemination of tailored interventions across FQHCs to reduce health disparities in CRC.
authors.affiliation: DePaul University, Chicago, IL, United States. Electronic address: jbuscem2@depaul.edu.
authors.forename: Joanna
authors.initials: J
authors.lastname: Buscemi
authors.affiliation: University of Illinois Cancer Center, University of Illinois at Chicago, United States.
authors.forename: Yazmin San
authors.initials: YS
authors.lastname: Miguel
authors.affiliation: University of Illinois Cancer Center, University of Illinois at Chicago, United States.
authors.forename: Lisa
authors.initials: L
authors.lastname: Tussing-Humphreys
authors.affiliation: University of Illinois Cancer Center, University of Illinois at Chicago, United States.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Watts
authors.affiliation: University of Illinois Cancer Center, University of Illinois at Chicago, United States.
authors.forename: Marian L
authors.initials: ML
authors.lastname: Fitzgibbon
authors.affiliation: University of Illinois Cancer Center, University of Illinois at Chicago, United States. Electronic address: kswatson@uic.edu.
authors.forename: Karriem
authors.initials: K
authors.lastname: Watson
authors.affiliation: University of Illinois Cancer Center, University of Illinois at Chicago, United States.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Winn
authors.affiliation: University of Illinois Cancer Center, University of Illinois at Chicago, United States.
authors.forename: Kameron L
authors.initials: KL
authors.lastname: Matthews
authors.affiliation: University of Illinois Cancer Center, University of Illinois at Chicago, United States.
authors.forename: Yamile
authors.initials: Y
authors.lastname: Molina
mesh_terms: D001741:Black or African American; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D057186:Comparative Effectiveness Research; D055088:Early Detection of Cancer; D005006:Ethnicity; D005243:Feces / Q000737:chemistry; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities / Q000208:ethnology*; D006454:Hemoglobins / Q000032:analysis; D006630:Hispanic or Latino; D006801:Humans; D007120:Immunochemistry; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D009780:Occult Blood; D010353:Patient Education as Topic / Q000379:methods*; D062526:Patient Navigation / Q000379:methods*; D011203:Poverty; D012017:Referral and Consultation; D035862:Vulnerable Populations
chemical_list: D006454:Hemoglobins
keywords: Colorectal cancer; Federally qualified health center; Health disparities; Screening