Integrated Approaches to Delivering Cancer Screenings to Address Disparities

CDC’s Colorectal Cancer Control Program (CRCCP) focuses on increasing colorectal cancer screening in populations that have traditionally been medically underserved. To guide CRCCP recipients, CDC scientists wrote a series of three papers describing assessments of integrated cancer screening approaches that CRCCP recipients implemented.

Lessons Learned from Assessing Integrated Approaches to Improve Cancer Screening

This commentary provides an overview of three papers covering the following topics:

• Integrated interventions and supporting activities to increase uptake of multiple cancer screenings: conceptual framework, determinants of implementation success, measurement challenges, and research priorities.
• Factors that support readiness to integrate cancer screening.
• Improving the efficiency of integrated cancer screening delivery for multiple cancers: case studies from Idaho, Rhode Island, and Nebraska.

Key Takeaways

• Integrated approaches could be cost-effective solutions that help decrease disparities in health care.
• More systematic evaluations are needed to ensure integrated approaches are optimized and cost-efficient models are scaled up.

Citation: Subramanian S, Tangka FKL, DeGroff A, Richardson LC. Integrated approaches to delivering cancer screenings to address disparities: lessons learned from the evaluation of CDC’s Colorectal Cancer Control Program. Implementation Science Communation 2022;3(1):110.

Framework, Measurements, and Research Priorities

This study illustrates how CRCCP award recipients and their partners integrated approaches and evidence-based interventions to promote colorectal, breast, and cervical cancer screening. The authors gathered information through site visits, document reviews, data analyses, and follow-up phone interviews. They developed a conceptual model to show how strategies were integrated. They reviewed the US Preventive Services Task Force’s recommendations for colorectal, breast, and cervical cancer screening. Using the Consolidated Framework for Implementation Research, the authors polled a sample of recipients to learn which factors were significant to implementing interventions.

Key Takeaways

• Multilevel and integrated interventions are hard to implement and evaluate. Measures are needed to evaluate the intervention processes, costs, screening outcomes, and implementation outcomes (feasibility and sustainability of interventions).
• More studies are needed to assess gaps in knowledge, such as patient and provider preferences on integrated cancer screenings and health systems’ readiness to integrate cancer screenings with chronic disease management.

Citation: Subramanian S, Tangka FKL, Hoover S, DeGroff A. Integrated interventions and supporting activities to increase uptake of multiple cancer screenings: conceptual framework, determinants of implementation success, measurement challenges, and research priorities. Implementation Science Communation 2022;3(1):105.

Factors That Support Implementation Readiness

This study explored factors that support readiness for integrated implementation of evidence-based interventions (EBIs) and supporting activities to promote colorectal cancer screening with other screening and chronic disease management activities in primary care clinics. Using the Consolidated Framework for Implementation Research, the authors conducted a literature review and identified factors that support readiness for integrated implementation of EBIs, including funding environment, governance, information sharing, and leadership. The authors conducted 23 qualitative interviews with four current and former CRCCP award recipients. Staff, health system and clinic partners, and implementation partners were interviewed. The authors found that flexible funding mechanisms, effective data sharing systems, coordination across clinical staff, and supportive leadership strengthen clinic readiness to implement integrated EBIs and supporting activities to increase cancer screening.

Key Takeaways

• Strategies that can support readiness to integrate cancer screening promotions include flexible funding streams, provider training, leadership support, and investment in sharing patient data so multiple screening needs can be monitored and coordinated.
• Lessons learned from integrated implementation of cancer screenings might be applied to enhance other public health and primary care partnership programs.

Citation: Soloe C, Arena L, Schlueter D, Melillo S, DeGroff A, Tangka F, Hoover S, Subramanian S. Factors that support readiness to implement integrated evidence-based practice to increase cancer screening. Implementation Science Communation 2022;3(1):106.

Improving the Efficiency of Integrated Cancer Screening Delivery: Case Studies

In this paper, the authors used case studies to describe challenges and benefits of implementing integrated approaches with three CRCCP recipients (two current and one former, at the time of study).

• The authors assessed a baseline checklist that the Idaho Department of Health and Welfare created to determine readiness for interventions that could promote multiple cancer screenings at clinics.
• The authors worked with a nurse patient navigator in Rhode Island to assess the costs of the integrated cancer screening program and patient navigation activities. Most patient navigator activities in Rhode Island focused on colorectal cancer screenings because integrating colorectal, breast, and cervical cancer screenings was challenging.
• The authors described how Nebraska implemented an integrated payment system for breast, cervical, and colorectal cancer screenings and reported on cost. Results were mixed for improvement in cancer screenings.

Key Takeaways

• Integrated cancer screenings can be efficient.
• More research can help explain if these integrated programs are viable and practical.

Citation: Tangka FKL, Subramanian S, Hoover S, Cariou C, Creighton B, Hobbs L, Marzano A, Marcotte A, Norton DD, Kelly-Flis P, Leypoldt M, Larkins T, Poole M, Boehm J. Improving the efficiency of integrated cancer screening delivery across multiple cancers: case studies from Idaho, Rhode Island, and Nebraska. Implementation Science Communation 2022;3(1):133.