Colorectal cancer screening can prevent cancer deaths. Federally qualified health centers serve a unique patient population that often is not screened. Knowing who in this environment is getting screened via fecal testing and via colonoscopy can assist in tailoring intervention to raise rates of colorectal cancer screening. We examined patient-level and neighborhood-level characteristics associated with being up to date with colorectal cancer screening guidelines. We also examined associations between these factors and being screened with a fecal test. We observed an increase in colorectal cancer screening rates from 2010 to 2015. Adjusted analyses revealed that the following factors were significantly associated with colorectal cancer screening: aged 65 or older, having any type of insurance, previous outpatient visits, and current or other preventive screenings. Among adults aged 50–75 who were up to date with colorectal cancer screening, factors associated with use of fecal testing, as opposed to colonoscopy, were: being younger, speaking a non-English language, being uninsured, having prior office visits, and having had a flu shot in past year. Our findings may inform clinic-based effort to raise rates of colorectal cancer screening, especially in the community clinic setting. Trial Registration: ClinicalTrials.gov , NCT01742065.

Background: Despite the efficacy of colorectal cancer (CRC) screening, many adults are not screened at recommended intervals or screened at all. Federally qualified health centers (FQHCs) serve a unique patient population that often experience barriers to CRC screening. Yearly fecal testing and colonoscopy follow-up for positive test results can reduce CRC incidence and mortality. However, many patients with positive fecal test results forgo follow-up colonoscopy, nullifying the potential benefits of fecal testing. Methods: As part of the Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) study, we qualitatively explored factors associated with referral to and completion of follow-up colonoscopy after a positive fecal test. Through interviews with gastroenterologist (GI) providers and office staff, we sought to elucidate system-level barriers to colonoscopy completion and identify areas for improvement for patients referred from FQHCs. Specialists and their staff were recruited via email, and interviews were conducted in-person or by phone using an interview guide. Interviews were recorded, transcribed, coded and content-analyzed by trained qualitative staff, resulting in refined themes. Results: We completed 15 in-depth interviews with GI providers (n = 8) and office staff (n = 7). The most frequently cited challenges by all interviewees related to increase in demand following the Affordable Care Act, complexity and time delay issues with insurance requirements, and inadequate staffing at the specialist office. GI providers emphasized capacity issues, including long wait times and limited appointment options. Office staff highlighted lack of complete referral and medical review documentation and language barriers. Improving communication and electronic referral documentation between the FQHC and GI office was identified by participants as vitally important. GI providers also advised on the need to reduce no-show rates and improve scheduling; and office staff desired preparation instructions in additional languages and skilled interpreters to attend the colonoscopy procedure with the patient. Conclusion: The life-saving benefits of CRC screening can be maximized by identifying challenges to follow-up colonoscopy after a positive fecal test. Uncovering system-level issues and possible areas for improvement in referral coordination and procedure completion can further contribute to increasing CRC screening rates for patients receiving care in FQHCs.

Background: Evidence shows that reminders can improve rates of patient adherence to completion of cancer screening tests. Less is known about the efficacy of reminders in relation to direct-mail fecal testing programs. As part of the Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) study, we sought to compare the effectiveness of multimodal reminders for a direct-mail fecal testing program. Methods: We tested screening reminders in four clinics at Sea Mar, a community health center in Washington State. Adults aged 50–75 years who had a primary care visit in the previous year and were not up to date with colorectal cancer screening received an informational letter and fecal immunochemical test (FIT) kit by mail. Patients who did not return their FIT kits within 3 weeks were sent a message through the patient portal or randomized to receive: 1) a reminder letter; 2) three automated phone calls; 3) three text messages; 4) a live phone call; 5) a text message and a live phone call; 6) a reminder letter and a live phone call; or 7) an automated and live phone call. We recorded rates of screening completion and rates of patients reached by reminder. Results: On initial data analysis, reach among combined strategies was highest for automated and live phone call (27%). For single-modal reminder strategies, reach was highest for live phone call (30%) and lowest for text message (13%). We are currently receiving data on the last clinics. Final results will be presented in the poster. Conclusion: To date, in the federally qualified health center setting, automated and live phone call reminders to a direct-mail fecal testing program substantially increase colorectal cancer screening rates.