Implementation successes and challenges in participating in a pragmatic study to improve colon cancer screening: perspectives of health center leaders.
Little is known about the challenges faced by community clinics who must address clinical priorities first when participating in pragmatic studies. We report on implementation challenges faced by the eight community health centers that participated in Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC), a large comparative effectiveness cluster-randomized trial to evaluate a direct-mail program to increase the rate of colorectal cancer (CRC) screening. We conducted interviews, at the onset of implementation and 1 year later, with center leaders to identify challenges with implementing and sustaining an electronic medical record (EMR)-driven mailed program to increase CRC screening rates. We used the Consolidated Framework for Implementation Research to thematically analyze the content of meeting discussions and identify anticipated and experienced challenges. Common early concerns were patients' access to colonoscopy, patients' low awareness of CRC screening, time burden on clinic staff to carry out the STOP CRC program, inability to accurately identify eligible patients, and incompatibility of the program's approach with the patient population or organizational culture. Once the program was rolled out, time burden remained a primary concern and new organizational capacity and EMR issues were raised (e.g., EMR staffing resources and turnover in key leadership positions). Cited program successes were improved CRC screening processes and rates, more patients reached, reduced costs, and improved patient awareness, engagement, or satisfaction. These findings may inform any clinic considering mailed fecal testing programs and future pragmatic research efforts in community health centers.
The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA. Gloria.d.coronado@kpchr.org.
Gloria D
GD
Coronado
The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
Jennifer L
JL
Schneider
The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
Amanda
A
Petrik
The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
Jennifer
J
Rivelli
Center for Global Health, National Cancer Institute, Rockville, MD, USA.
Stephen
S
Taplin
Group Health Research Institute, Seattle, WA, USA.
Beverly B
BB
Green
D001291:Attitude of Health Personnel; D001364:Awareness; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D003113:Colonoscopy; D065246:Culturally Competent Care; D055088:Early Detection of Cancer / Q000379:methods; D057286:Electronic Health Records; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D015279:Organizational Culture; D036301:Qualitative Research; D017010:Reminder Systems; D013997:Time Factors
Colorectal cancer screening; Federally Qualified Health Center; Implementation challenges; Pragmatic trial; Safety net clinics