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Implementation successes and challenges in participating in a pragmatic study to improve colon cancer screening: perspectives of health center leaders

  • Original Research
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Translational Behavioral Medicine

Abstract

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.

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Author information

Authors and Affiliations

  1. The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA

    Gloria D Coronado PhD, Jennifer L Schneider MPH, Amanda Petrik MS & Jennifer Rivelli MA

  2. Center for Global Health, National Cancer Institute, Rockville, MD, USA

    Stephen Taplin MD, MPH

  3. Group Health Research Institute, Seattle, WA, USA

    Beverly B Green MD, MPH

Authors
  1. Gloria D Coronado PhD
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  2. Jennifer L Schneider MPH
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  3. Amanda Petrik MS
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  4. Jennifer Rivelli MA
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  5. Stephen Taplin MD, MPH
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  6. Beverly B Green MD, MPH
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Corresponding author

Correspondence to Gloria D Coronado PhD.

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Acknowledgments

Grant Support: Research reported in this publication was supported by the National Institutes of Health through the National Center for Complementary and Alternative Medicine under Award Number UH2AT007782 and the National Cancer Institute under Award Number 4UH3CA18864002. The work has not been published before nor is it under consideration for publication anywhere else. The manuscript has been approved by all co-authors.

Conflict of interest

The authors declare they have no conflicts of interest.

Research involving human participants and/or animals

The study was approved by the Institutional Review Board of Kaiser Permanente Northwest (Protocol # 4364; Trial Registration: ClinicalTrials.gov NCT01742065). All procedures performed in studies involving human participants were in accordance with the ethical standards of the responsible committee on human experimentation at Kaiser Permanente Northwest and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Implications

Practice: Electronic health record tools can facilitate improvements in colorectal cancer screening processes and rates, but their implementation can be challenging.

Policy: Effective and sustainable colorectal cancer screening programs must consider organizational capacity and on-site electronic health record expertise as well as patients’ awareness of colorectal cancer screenings and access to follow-up colonoscopy.

Research: Future research is needed to identify external and internal factors that drive STOP CRC implementation using quantitative data.

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Coronado, G.D., Schneider, J.L., Petrik, A. et al. Implementation successes and challenges in participating in a pragmatic study to improve colon cancer screening: perspectives of health center leaders. Behav. Med. Pract. Policy Res. 7, 557–566 (2017). https://doi.org/10.1007/s13142-016-0461-1

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  • DOI: https://doi.org/10.1007/s13142-016-0461-1

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