Advancing Access in Cancer Care: Investigating Health-Related Social Needs and Colonoscopy Follow-Up Among FQHC Patients

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths among both men and women in the US, with screening recommended by the US Preventive Services Task Force (USPSTF) to reduce incidence and mortality. Despite national targets, CRC screening rates, especially among patients receiving services in low-resourced settings, remain below these goals. Federally Qualified Health Centers (FQHCs) primarily serve people from low socioeconomic status (SES) groups and have some of the lowest screening rates. Health-related social needs (HRSNs), such as housing instability and transportation issues, play a significant role in CRC screening completion disparities. However, their impact on patients' CRC screening completion remains underexplored. This administrative supplement proposal will investigate the associations between HRSNs and follow-up colonoscopy receipt among FQHC patients with abnormal stool-based test results. This population will be reached by leveraging outreach to safety-net settings such as The Ohio State University Wexner Medical Center, KPNC/KPSC and the American Academy of Family Physicians National Research Network partnership—all strategies for aim 3 of the parent grant. This supplement complements the proposed work in the parent grant, primarily through its support of its first specific aim. For parent grant Aim 1, the supplement will contribute a qualitative approach to understanding the CRC screening continuum through the lens of a particularly low-SES population (FQHC patients), paying special attention to patients' HRSNs. The supplement will further contribute to the understanding of recommendation-concordant CRC treatment timeline adherence for members of this population who receive abnormal stool test results. The results of the supplement will provide covariates of interest (e.g., specific HRSNs or social determinants of health) for the statistical analyses proposed in Aims 2 and 4 of the parent grant. Data will be collected that may ultimately influence the development of interventions targeting HRSNs to enhance CRC screening completion rates in populations in low SES. Drawing from existing literature on other cancer types, we hypothesize that patient-level HRSNs strongly influence screening completion and subsequent outcomes. Dr. Aldenise Ewing, the DS candidate, aspires to become an independent investigator focusing on addressing cancer-related health disparities. This supplemental application will provide a mentored experience in cancer health disparities and cancer control for Dr. Aldenise Ewing. The study findings will provide preliminary data on social determinants of CRC-related outcomes and strengthen her K01 submission within 2 years of funding and R01 or equivalent grant submission within 5 years of funding. Moreover, it will contribute crucial insights into addressing social determinants of health in low-resource settings, ultimately improving health outcomes for all populations.