Reducing Disparities in Colorectal Cancer Screening through Proactive Outreach and Navigation in federally qualified health care centers in Brooklyn

Colorectal Cancer (CRC) is the third most common cancer in men and women and the second leading cause of cancer related death. Screening for CRC reduces CRC incidence and mortality, and is recommended for average risk men and women between the ages of 45 and 75 by the US Preventive Services Task Force guidelines; which were updated recently to include 45-49 year olds, an additional 20 million individuals in the US. In New York City screening rates are 78% in Manhattan but only 26-55% in federally qualified Health Centers (FQHC) across the city that provide free and subsidized health services to underrepresented minorities. Currently, invitations to screen are offered only when a patient is seen by his or her provider. Consequently, many eligible individuals, particularly 45-55 year olds who do not regularly access healthcare, are under-screened. Hence, there is an unmet need for improving screening practices. We hypothesize that patient care (rates of CRC screening) will improve in under- served populations with the implementation of a proactive approach that incorporates a mailed outreach invitation to screen, followed by active assistance to a colonoscopy completion including overcoming financial and logistical barriers. To address this hypothesis, we seek to improve CRC screening in a hybrid type I trial by assessing the effectiveness and implementation of a proactive outreach colorectal cancer screening program in multiple federally qualified health centers (FQHCs) in Brooklyn, serving primarily Black patients. This proposed work will provide critical, foundational information for scaling up long-term, sustained implementation of screening program across other FQHCs in NYC. We propose to perform a randomized trial of proactive invitation at five FQHCs with aims to study the effect of a proactive outreach program that identifies those due for screening, mail a fecal immunochemical test and provide navigation and financial support for cost of preparation and transport to usual care in improving CRCc screening rates, understand barriers and facilitators to proactive outreach by surveying patients and providers, and perform a cost analysis of the program