Researchers at the UNC Lineberger Comprehensive Cancer Center and Oregon Health & Science University (OHSU) have received a multi-phase UG3/UH3 award from the National Cancer Institute within the National Institutes of Health (NIH) to help address the many barriers that prevent patients from receiving cancer screenings.
The grant, which will provide $4 million over six years, will help researchers create and implement new ways to combine or "bundle" outreach for multiple cancer screenings at safety-net community clinics across North Carolina and Oregon, helping patients overcome barriers to screening and follow-up care through multi-pronged outreach efforts and patient navigation support.
The grant will be led by Stephanie Wheeler, PhD, MPH and Alison Brenner, PhD, MPH at UNC and Melinda Davis, PhD, MCR at OHSU.
"We are aiming to address common barriers to cancer screening among those populations most in need," said Wheeler, who is an expert on health care access in vulnerable populations at UNC Lineberger Comprehensive Cancer Center. "This bundling strategy can not only help people approach multiple cancer screenings as one singular healthcare issue to tackle on their to-do list, but it also allows us to use more innovative approaches, like mailing HPV and colorectal screening kits to people's homes, to help expand reach and mitigate transportation barriers."
Stephanie Wheeler, PhD, MPH
Safety-net community clinic populations generally have low screening rates.
In North Carolina safety-net populations, only 53% of eligible women in federally qualified health centers have been screened for cervical cancer, and only 44% of eligible people have been screened for colorectal cancer. In Oregon, only 52.4% of eligible state Medicaid patients completed colorectal cancer screenings and only 60.7% of eligible patients completed mammogram screenings.
These numbers warrant improvement, especially in rural areas, where numbers may be even lower. Factors such as poor health literacy, lack of personal or public transportation, long wait times, associated out-of-pocket medical expenses, and more can contribute to lower cancer screening rates.
"The American health system can be exceedingly difficult to navigate," said Wheeler. "It can be intimidating, and for many people, especially those who have a lot of competing demands, when you've got that much piling up, it's easier just to push it off and not worry about it. Our approach attempts to streamline those actions to make it more straightforward."
The project will employ a patient-centered approach that uses proactive outreach strategies like population-level reminders, mailed screening kits, and one-on-one patient navigation to support individuals in overcoming barriers to screening. These are known-effective strategies for reaching patients who are due for individual cancer screening tests - but this project will combine outreach for multiple screening tests.
Alison Brenner, PhD, MPH
The team will also be conducting interviews with patients, clinic staff, and physicians to better understand how to improve screening rates in their clinics and to seamlessly work these interventions into the existing healthcare system workflows.
"Right now, the system is not optimized," said Brenner, a health services researcher at the UNC School of Medicine. "We wanted to figure out how we can grease the wheels of the healthcare system. The wheels are there, they're just cumbersome, and not everybody on the inside, outside, middle, up, and down knows which wheel to go to next."
Davis is director of the Oregon Rural Practice-based Research Network (ORPRN) and an expert in participatory implementation scientist focused on improving access to and quality of care in rural and low resourced settings.
"This is a really exciting study that is responsive to the needs of our clinical and patient partners," said Davis. "Screening for multiple cancers is more challenging given the varied age range and modalities available, but as one partner said when we were writing this grant, 'This is the bread and butter of primary care. This is what we do every day!'"
