OBJECTIVE:Explore Spanish-preferring participants' experiences with and perceptions of communication of genomic results through professional medical interpreters via multiple modes in the Clinical Sequencing Evidence-Generating Research consortium. METHODS:In this cross-site analysis, we described self-reported data from Spanish-preferring participants (n = 334) who completed a survey after genomic results sessions conducted with a professional medical interpreter present regarding their understanding of results, perceptions of results communication quality, perceived cultural concordance, and satisfaction with and perceptions of interpretation across interpreter modes (in-person, video, phone). RESULTS:Overall, most respondents who had a Spanish interpreter present during their genomic results session reported: understanding the genomic results 'quite a bit' or 'extremely' well (68%), satisfaction with the language interpretation provided (94%), perceiving good quality interpretation (96%), and that the interpreter and clinical team worked well together (98%). Regarding cultural concordance, most respondents reported feeling equal respect (94%), cultural understanding (91%), ease (82%), and personal connection (67%) with both the interpreter and the clinical team. Across all interpreter modes, respondents' satisfaction and perceived quality of genomic results communication and of Spanish interpretation were high, and their perceived cultural concordance with interpreters and clinicians was similar. In open-ended responses, the factors most frequently described as influencing respondents' perceptions of interpretation centered on interpretation understandability and perceived accuracy, interpreters' kind demeanor and attentiveness to respondents' needs, and challenges with remote technology. CONCLUSIONS:From the perspectives of Spanish-preferring patients and parents (of minors) across diverse settings, communication of genomic results through professional medical interpreters using in-person and remote (video and phone) modalities was well-received and involved both information exchange and interpersonal facets. PRACTICE IMPLICATIONS:Remote interpretation with professional interpreters can promote quality, culturally-concordant communication in genomic settings. Attentiveness to maintaining call quality in remote sessions, along with providing interpreters of any mode with genetics-specific resources, may help facilitate patient satisfaction.

PURPOSE Health care systems increasingly incorporate social risk data into electronic health records (EHRs) to address needs like food, housing, and transportation insecurity. This study evaluated whether EHR-integrated social clinical decision support (SCDS) tools improved control of blood pressure (BP) and hemoglobin A1c (HbA1c) and increased social risk-informed care and documentation in community-based clinics. METHODS We conducted a cluster randomized trial in a large primary care network. This pragmatic trial was designed to assess tool impact in real-world clinic conditions. Six clinics received SCDS tools embedded in the EHR; 44 clinics served as controls. The tools supported clinic-wide workflows and targeted decision support. A screening alert was triggered for adult patients lacking up-to-date social risk screening. Additional components were activated for patients with uncontrolled hypertension or diabetes, or with a diagnosis of either condition combined with a visit no-show rate of at least 50%. Primary outcomes were BP and HbA1c control. Secondary outcomes included social risk screening and documentation. Generalized linear mixed models accounted for patient clustering. We also examined use patterns of individual tool components. RESULTS Blood pressure control improved over 12 months in both arms, with significantly greater improvement in intervention clinics. Control of HbA1c showed no significant differences. Intervention clinics had significantly greater odds of social risk screening and documentation. Use of individual SCDS tool components varied widely across clinics. CONCLUSION Access to EHR-integrated SCDS tools was associated with increased documentation of social risks and greater improvements in BP control. These findings support embedding social risk data into clinical workflows to enhance chronic disease management in primary care.

AIM:To determine the pre-operative and post-operative practices of general dentists (GDs) in the community for patients taking vitamin K antagonists (VKA) and direct oral anti-coagulants (DOACs). METHODS:An online questionnaire was administered to GD members of the National Dental Practice-Based Research Network. GDs were queried about the interaction with the medical professional prior to dental treatment, use of laboratory tests to assess bleeding risk, measures to control bleeding, and comfort level with delivering dental care. RESULTS:A total of 47.6% and 41.2% of GDs "always" consult with the patient's physician prior to an extraction in a patient on VKA or DOACs, respectively. 27.1% and 8.7% of GDs use laboratory tests to assess risk for bleeding prior to a dental extraction in patients on VKA and DOAC, respectively. For VKA patients, GDs prefer INR testing (68.4%), and for DOAC patients, most GDs are "unsure" what blood test to use. The most-used hemostatic agents were cellulose (65.1%), collagen (60.6%) and epinephrine infiltration (60.6%). CONCLUSIONS:GDs are uncertain about the best approach for patients taking DOACs. INR is not routinely used by most GDs to assess the bleeding risk in patients taking VKA. The most commonly used hemostatic agents are cellulose-based, collagen-based and vasoconstrictors.

Approximately 60 million adults live in rural regions of the US, which historically have low rates of colorectal cancer (CRC) screening and follow-up. Rural residents enrolled in Medicaid have particularly low CRC screening and follow-up rates. To determine the effectiveness and implementation of a collaborative Medicaid health plan–clinic program of mailed fecal immunochemical test (FIT) outreach and patient navigation to colonoscopy following an abnormal FIT result when implemented in rural clinics as part of standard care. This cluster randomized clinical trial was conducted at 28 rural clinic units in Oregon affiliated with 3 Medicaid health plans. The clinics were randomized to the intervention (n = 14) or to usual care (n = 14). Participants were Medicaid enrollees (aged 50-75 years) due for CRC screening. The intervention was delivered from May 11, 2021, through June 4, 2022, and analyses were performed from June 2023 through September 2024. The stepwise intervention involved (1) mailed FIT outreach and (2) patient navigation to colonoscopy following an abnormal FIT result. Implementation support included practice facilitation, training, collaborative learning, and patient tracking tools. The primary effectiveness outcome was completion of any CRC screening within 6 months of eligibility determination. An additional effectiveness outcome was follow-up colonoscopy completion within 6 months of an abnormal FIT result. Implementation was measured as (1) the proportion of intervention-eligible enrollees who were mailed an FIT and who were sent an advance notification or reminder and (2) the proportion with an abnormal FIT result who were offered patient navigation. This study included 5614 Medicaid enrollees (2613 in intervention clinics and 3001 in usual care clinics). Enrollees had a mean (SD) age of 58.2 (5.5) years; most (4940 [88.0%]) were aged 50 to 64 years. A total of 2948 enrollees (52.5%) were female, 325 (6.2%) were Hispanic and 3774 (67.2%) were White, and 4457 (79.4%) lived in rural regions. Compared with Medicaid enrollees in usual care clinics, enrollees in intervention clinics had a higher adjusted 6-month proportion of any CRC screening completion (11.8% vs 4.5%; difference, 7.3 [95% CI, 5.3-9.2] percentage points). Implementation was 100% (all 1489 intervention-eligible enrollees) for mailed FIT outreach, 88.5% for advance notification, 78.1% for reminders, and 57.9% for patient navigation. In this cluster randomized clinical trial of rural clinics, mailed FIT outreach and patient navigation boosted participation in CRC screening among Medicaid enrollees. More efforts are needed to address low participation in both FIT testing and follow-up colonoscopy. ClinicalTrials.gov Identifier: NCT04890054

Supplementary Figure S1 shows the proportion completing FIT within 6-months of patient identification for each evaluation interval (baseline, year 1, and year 2), by study condition.

PURPOSE:To conduct a national survey of practicing dentists assessing their current knowledge, attitudes, and practice behaviors related to substance use screening implementation among their adolescent patients. METHODS:This study was a cross-sectional, regionally representative, electronic survey of 751 practicing dentist members of the National Dental Practice-Based Research Network. The survey instrument, the Substance Use Disorders (SUDs) Screening Survey assessed dentists' knowledge, opinions, and current practice behaviors related to screening for substance use (i.e., tobacco/nicotine, alcohol, cannabis, and illicit drug) disorders, offering brief counseling regarding substance use behaviors, and referring patients for treatment related to their substance use. RESULTS:Survey respondents were predominantly male (61%), White (67%), and in a private practice setting (81%). Fewer than half of dentists (40.5%) reported screening for adolescent nicotine/tobacco use at least annually, whereas approximately one-third of dentists reported screening at least annually for other substances of abuse. Approximately, half of dentists who screen reported never providing counseling/education regarding adolescents' positive screens for alcohol (48.5%), cannabis (52.7%), and illicit drug use (55.4%). Rates of referral to specialty care were low. Associations between barriers, stigma, and practice behaviors are reported. DISCUSSION:This is the first national study of dentists' SUD screening, counseling and referral practices among adolescent patients. Although current rates are low, a substantial proportion of dentists indicated willingness to screen, counsel and refer adolescents for SUD and endorsed surprisingly low rates of stigma and high ratings of relevance to their practice.

BACKGROUND:Patient navigation is a recommended practice of the Guide to Community Preventive Services; little is known about whether it improves colonoscopy completion for adults who have received an abnormal stool test result. OBJECTIVE:To determine whether patient navigation delivered to persons with an abnormal stool test result increased follow-up colonoscopy completion (primary) at 1 year. DESIGN:Randomized controlled trial. (ClinicalTrials.gov: NCT03925883). SETTING:A federally qualified health center (n = 32 clinics) in Washington state. PATIENTS:Persons aged 50 to 75 years with an abnormal fecal test result in the prior month. INTERVENTION:A 6-topic, telephone-based patient navigation program delivered by bilingual (English and Spanish) clinical staff. MEASUREMENTS:Receipt of follow-up colonoscopy at 1 year (primary); time to colonoscopy receipt (secondary); and program effectiveness by patient characteristics, including patients' probability of obtaining a colonoscopy without navigation, derived using health record data (secondary). RESULTS:Of 985 participants enrolled (mean age, 61 years [SD, 6.8]; 170 [18%] had a Spanish-language preference listed in the medical record), 967 were included in the primary intention-to-treat analysis (479 in patient navigation, 488 in usual care). Receipt of follow-up colonoscopy was higher in the patient navigation group than in the usual care group (55.1% vs. 42.1%; risk difference, 13.0 percentage points [95% CI, 6.5 to 19.4 percentage points]). The intervention effect was not moderated by patients' probability of obtaining a colonoscopy without navigation. LIMITATION:The study was primarily done during the height of the COVID-19 pandemic, which created additional barriers to colonoscopy at the health system and patient levels. CONCLUSION:These findings support the effectiveness of patient navigation for follow-up colonoscopy completion. PRIMARY FUNDING SOURCE:National Cancer Institute.

Supplementary Table S1 shows the text used for advance notifications (text messages and live phone calls) and reminders (automated phone calls), in English and Spanish.

Patient navigation is a recommended practice of the Guide to Community Preventive Services; little is known about whether it improves colonoscopy completion for adults who have received an abnormal stool test result.

Low diet quality is related to obesity and type 2 diabetes mellitus (T2DM) risk among Hispanic women. This cross-sectional study compared diet quality among Hispanic women with overweight/obesity based on their T2DM diagnosis (pre-diabetes/T2DM group, n = 104 vs no diagnosis, at-risk group, n = 84). It was hypothesized that having a pre-diabetes or T2DM diagnosis would be associated with better diet quality based on the Healthy Eating Index (HEI)-2020 score. Means were compared using a 2-sample t-test for parametric and Kruskal-Wallis for non-parametric variables. Women with pre-diabetes/T2DM reported a lower intake of total energy (1378 ± 557 vs 1644 ± 703 kcal; P = .004) and cholesterol (228 ± 140 vs 299 ± 216 mg; P = .007). Total HEI score was higher for pre-diabetes/T2DM than the at-risk group (64 ± 8 vs 62 ± 9; P = .027). Among all participants, adequacy subscores were excellent for whole fruits, greens & beans, total proteins, and seafood and plant proteins, good for total fruits (77%); fair for total vegetables and fatty acids (64% for both); and poor for whole grains, and dairy (20% and 53%, respectively). Moderation subscores were very good for added sugars (89%), good for saturated fats (78%), and poor for refined grains, and sodium (44% and 33%, respectively). Compared to the at-risk group, women with pre-diabetes/T2DM had higher fatty acid ratio scores (7 ± 2 vs 6 ± 3, P = .039). Multiple linear regression revealed that pre-diabetes/T2DM did not significantly impact diet quality, but energy intake and age did. Overall, HEI subscores underscore the need to improve diet quality through key food groups in Hispanic women with overweight/obesity, regardless of T2DM status.

OBJECTIVE:The objectives of this study were to: (1) describe how general dental practitioners (GDPs) in the National Dental Practice-Based Research Network ('Network') classify the severity of postoperative bleeding; and (2) examine the association between bleeding severity classification and whether the GDP had residency training. METHOD AND MATERIALS:An electronic questionnaire was developed to assess GDPs' classification of bleeding severity for various scenarios following scaling or a single-tooth simple extraction, and to collect information about respondents' experience with bleeding scenarios. A total of 1,815 GDP members of the Network were invited to participate. RESULTS:A total of 866 GDPs responded. Strong agreement (low variability) was observed for scenarios that were classified as 'severe bleeding' (94.7% to 96.8%), and lower agreement (higher variability) was observed for scenarios classified as 'moderate bleeding' (53.2% to 65.2%). The GDP's classification of bleeding severity was not correlated with training in a General Practice Residency (GPR) or Advanced Education in General Dentistry (AEGD). A minority of respondents had experience with 'major bleeding' that may lead to hemodynamic emergency (15.5%) or a referral to an emergency department (4.8%). CONCLUSION:This study identified scenarios for which there is high agreement and low agreement regarding bleeding severity classification among GDPs in the US. A small percentage of respondents had actual experience with major bleeding in their patients. Based on these results, a new tool is proposed to assess the severity of oral bleeding, intended to foster better communication between dental professionals. The new tool may assist GDPs to standardize documentation and communication with other health care professionals. (Quintessence Int 2025;56:668-679; doi: 10.3290/j.qi.b6376527).

Purpose: Clinicopathologic (CP) factors, including age, grade, and tumor size have been considered to guide the management of ductal breast carcinoma in situ (DCIS) to minimize over- or under-treatment. However, these CP factors have failed to identify a low-risk group with little to no benefit from radiation therapy (RT) or a high-risk group with a high risk of recurrence even after RT. We compare the impact of utilizing a 7-gene biosignature (DCISionRT) to risk stratify patients as compared to standard CP factors. Methods: Women (n=926) from four published international DCIS cohorts treated with BCS with negative margins +/- RT were categorized as CP low-risk or high-risk using age (>70 or <50), grade (1-2 vs 3), size (≤ or > 2.5 cm). Women were classified as DS (DCISionRT Score) Low Risk (DS≤2.8, no Residual Risk sybtype, RRt) or High Risk (DS>2.8 +/- RRt) using the 7-gene biosignature and stratified by the CP factors. Rates of ipsilateral breast recurrence (IBR) and benefit or lack of benefit with RT were evaluated for low-risk, high-risk CP as compared to DS Low Risk and DS High Risk. Results: On average, 61% of patients with individual low-risk CP factors (78%, n=133 of age >70, 56%, n=356 of size ≤ 1 cm, 51%, n=101 of grade 1, and 57%, n=218 of grade 2) were re-classified as DS High Risk. Although CP low risk patients showed significant RT benefit, when re-classified as DS Low Risk patients, no significant RT benefit was noted for age >70 (HR 1.19, p=0.71), size ≤1 cm (HR 1.09, p=0.90), grade 1 (HR 1.61, p=0.70), or grade 2 (HR 0.93, p=0.92), with a corresponding average 10-yr IBR rate of 4.9% (2.3%-6.8%) without RT vs. 5.9% (4%-7.1%) with RT. In contrast, when CP low risk patients were re-classified as DS High-Risk patients, a significant RT benefit was noted for age >70 (HR 0.15, p=.02), size ≤1 cm (HR 0.23, p<0.001), grade 1 (HR 0.22, p=0.04), or grade 2 (HR 0.32, p=0.01), with a corresponding average 10-yr IBR rate of 21% (18.3%-20.3%) without RT vs. 5.4% (3%-7.4%) with RT. On average, 27% of patients with individual high-risk CP factors (42% (n=88) of age <50, or 16% (n=10) of size >2.5 cm, 22% (n=75) of grade 3) were re-classified to DS Low Risk, and IBR rates did not differ significantly by RT receipt for these re-classified patients. High-risk CP patients with concordant DS High Risk classification did benefit from RT for age <50 (HR 0.35, p=0.04), size >2.5 cm (HR 0.17, p=0.02), and for grade 3 (HR 0.19, p<0.001), with a corresponding average 10-yr IBR rate of 34% (27.9%-38.5%) without RT vs. 11% (9.1%-12.4%) with RT. Conclusions: The 7-gene predictive DCIS biosignature more reliably identified patients with low 10-year IBR rates and no significant RT benefit than traditional CP factors as well as those with elevated long term IBR rates that benefited from RT with substantial crossover for low and high risk clinicopathologic patients, respectively. The use of DCISionRT allows for more personalized and accurate risk stratification, preventing the under- and over-treatment of patients with suspected “low-risk” or “high-risk” DCIS based on current clinicopathologic factors. Citation Format: Frank Vicini, Chirag Shah, Pat Whitworth, Rachel Rabinovich, Sheila Weinmann, Michael C. Leo, Fredrick Warnberg, G. Bruce Mann, Steven C. Shivers, Karuna Mittal, Troy Bremer. Limiting Over- and Under-Treatment of DCIS: Ten Year Breast Recurrence Rates with Personalized Management Utilizing the 7-Gene Biosignature as Compared to Clinicopathologic Factors Alone [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-03-21.

OBJECTIVE:The objective of this study was to conduct a national survey of practicing dentists to assess their current knowledge, attitudes, and practice behaviors related to substance use screening among their adult patients. The secondary objective was to identify practitioner- and practice-level facilitators and barriers to substance use screening. METHOD:This cross-sectional study consisted of an electronic survey disseminated to practicing dentists who were active members of the National Dental Practice-Based Research Network (n = 790; 61% male). RESULTS:The majority of dentists reported some level of screening for nicotine (95.7%), alcohol (87.2%), cannabis (83.9%), and illicit drug (87.7%) use among their adult patients. More than 2 in 5 dentists reported never counseling patients regarding problematic use of alcohol, cannabis, and illicit drugs. Higher screening frequency was associated with higher counseling frequency and lower endorsement of two barrier factors: beliefs regarding responsibility, relevance, and effectiveness, and lack of training and/or resources. Higher frequency of counseling was associated with higher frequency of referral behavior and lower endorsement of three barrier factors: concerns regarding patient truthfulness/discomfort; beliefs regarding responsibility, relevance, and effectiveness; and lack of training and/or resources. CONCLUSIONS:Results indicate a high level of willingness to screen, counsel, and refer patients for substance use among a majority of dentists, although current practice behaviors lag willingness. Findings regarding barriers and facilitators can guide efforts to develop, disseminate, and implement screening, brief intervention, and referral to treatment training, initiatives, and tools that are inclusive of or specifically target dental providers.

AIMS:To report findings from a national survey of dentists regarding their -naloxone distribution practices. DESIGN:Cross-sectional, national electronic survey. SETTINGS:United States, National Dental Practice-Based Research Network (National Dental PBRN). PARTICIPANTS:A national sample of 790 dentist members of the National Dental PBRN in active clinical practice. MAIN OUTCOME MEASURES:The Substance Use Disorders Screening (SUDS) survey assessed dentists' willingness to distribute naloxone to adult patients. SUDS survey data were merged with existing National Dental PBRN Enrollment Questionnaire data regarding practitioner's demographics and practice characteristics. RESULTS:A minority of dentists (8.8 percent) reported currently distributing -naloxone in their practice. Nearly half of the remaining respondents reported being either very willing (n = 121; 16.9 percent) or moderately willing (n = 235; 32.9 percent) to distribute naloxone in the future. Current distribution and future willingness were associated with younger practitioner age. Future willingness to distribute naloxone is presented as a function of additional practice and practitioner characteristics and was associated with self-reported frequency of screening, counseling, and referring for substance use disorders. CONCLUSIONS:Younger dentists and those practicing in government settings were more likely to be current distributors of naloxone, likely a result of intentional -programing currently implemented in dental school and government practice -settings to increase naloxone education and distribution. Nearly half of the dentists not currently distributing naloxone indicated a willingness to distribute naloxone in the future, and current findings aid in the identification of opportunities to scale outreach, training, and practice supports for those dental practices willing to serve as distribution points for their patients.

Supplementary Table S2 shows when each intervention component was delivered, by study year.

Introduction and Objective: Although achieving a healthy weight prior to pregnancy is recommended, data on the association between preconception weight changes and pregnancy outcomes are limited. We examined the relationship between preconception weight trajectories and risk of GDM in a large, diverse cohort. Methods: We conducted a retrospective cohort study of 257,017 pregnancies resulting in singleton, live birth at ≥28.0 weeks gestation for whom GDM screening was completed within 4 health care systems. Eligible pregnancies had ≥2 weight measurements in the electronic medical record in the 2 years prior to pregnancy with at least one in each of these periods: 0-12 months and 13-24 months prior to pregnancy onset. Preconception weight change rate was estimated using linear mixed effects trajectory models. GDM diagnosis was determined based on glucose levels from oral glucose tolerance testing. We modeled GDM as a function of preconception weight change, BMI category at the start of the preconception period (<25, 25-<30, ≥30 kg/m2) and covariates (maternal age, race and ethnicity, parity, insurance status, health care system) using a multilevel Poisson model with robust standard errors to estimate relative risk and absolute risk, accounting for multiple pregnancies within women. Results: Of included pregnancies, 62% were parous; 45% were Hispanic, 30% non-Hispanic White, 9% non-Hispanic Black, and 17% other races; and 11.7% had diagnosed GDM. Mean preconception BMI was 27 kg/m2 and 27% had a BMI≥30. Mean rate of weight change in the 2 years prior to pregnancy was +0.44 kg/yr (SD=3.73). Every kg/yr of increased weight was associated with 4.8% greater risk of GDM (RR=1.048, 95% CI [1.044, 1.052]). Adjusted risk of GDM was lower among those who lost weight prior to pregnancy compared to those who gained weight (9% risk of GDM for 5 kg/year loss vs 14.5% for 5 kg/yr gain). Conclusion: In this diverse, U.S. cohort, preconception weight change was positively associated with GDM risk. K.K. Vesco: None. E.S. LeBlanc: None. C.E. Oshiro: None. M. Lee: None. M.C. Leo: Research Support; PreludeDx. M. Mayhew: None. D.R. Young: None. C. McCracken: None. A. Owen-Smith: None. N.A. Rosenquist: None. J. Boone-Heinonen: None. Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD102477)

Genetic testing for cancer predisposition and other actionable findings aims to improve health outcomes by informing patients and practitioners about genetic disease risks and guiding decisions on risk-reducing actions. This study explored patient-initiated lifestyle changes following genetic testing in a study population who predominantly screened positive on a hereditary risk assessment cancer tool prior to genetic testing, with a large proportion of individuals from marginalized groups with historically limited access to genetic services. A survey was administered to 761 study participants 6 months after result disclosure to capture initiation of lifestyle changes (diet, exercise, smoking cessation). Initiation of changes was assessed for association with patient-specific factors. Five hundred and fifty-six individuals completed surveys; 75% met criteria for belonging to a marginalized group. Among respondents, 20.5% reported at least one lifestyle change; primarily in diet (17.1%) and exercise (13.7%). Making a lifestyle change was associated with having a personal cancer history and higher perceived personal utility but not genetic finding, being a member of a marginalized group, or gender. Most participants with a personal cancer history did not receive a positive finding in a cancer risk gene, potentially motivating them to make lifestyle changes compared with participants without a personal cancer history.

Importance Approximately 60 million adults live in rural regions of the US, which historically have low rates of colorectal cancer (CRC) screening and follow-up. Rural residents enrolled in Medicaid have particularly low CRC screening and follow-up rates. Objective To determine the effectiveness and implementation of a collaborative Medicaid health plan-clinic program of mailed fecal immunochemical test (FIT) outreach and patient navigation to colonoscopy following an abnormal FIT result when implemented in rural clinics as part of standard care. Design, Setting, and Participants This cluster randomized clinical trial was conducted at 28 rural clinic units in Oregon affiliated with 3 Medicaid health plans. The clinics were randomized to the intervention (n = 14) or to usual care (n = 14). Participants were Medicaid enrollees (aged 50-75 years) due for CRC screening. The intervention was delivered from May 11, 2021, through June 4, 2022, and analyses were performed from June 2023 through September 2024. Intervention The stepwise intervention involved (1) mailed FIT outreach and (2) patient navigation to colonoscopy following an abnormal FIT result. Implementation support included practice facilitation, training, collaborative learning, and patient tracking tools. Main Outcomes and Measures The primary effectiveness outcome was completion of any CRC screening within 6 months of eligibility determination. An additional effectiveness outcome was follow-up colonoscopy completion within 6 months of an abnormal FIT result. Implementation was measured as (1) the proportion of intervention-eligible enrollees who were mailed an FIT and who were sent an advance notification or reminder and (2) the proportion with an abnormal FIT result who were offered patient navigation. Results This study included 5614 Medicaid enrollees (2613 in intervention clinics and 3001 in usual care clinics). Enrollees had a mean (SD) age of 58.2 (5.5) years; most (4940 [88.0%]) were aged 50 to 64 years. A total of 2948 enrollees (52.5%) were female, 325 (6.2%) were Hispanic and 3774 (67.2%) were White, and 4457 (79.4%) lived in rural regions. Compared with Medicaid enrollees in usual care clinics, enrollees in intervention clinics had a higher adjusted 6-month proportion of any CRC screening completion (11.8% vs 4.5%; difference, 7.3 [95% CI, 5.3-9.2] percentage points). Implementation was 100% (all 1489 intervention-eligible enrollees) for mailed FIT outreach, 88.5% for advance notification, 78.1% for reminders, and 57.9% for patient navigation. Conclusions and Relevance In this cluster randomized clinical trial of rural clinics, mailed FIT outreach and patient navigation boosted participation in CRC screening among Medicaid enrollees. More efforts are needed to address low participation in both FIT testing and follow-up colonoscopy. Trial Registration ClinicalTrials.gov Identifier: NCT04890054

PURPOSE:Limited evidence evaluates parents' perceptions of their child's clinical genome-scale sequencing (GS) results, particularly among individuals from medically underserved groups. Five Clinical Sequencing Evidence-Generating Research consortium studies performed GS in children with suspected genetic conditions with high proportions of individuals from underserved groups to address this evidence gap. METHODS:Parents completed surveys of perceived understanding, personal utility, and test-related distress after GS result disclosure. We assessed outcomes' associations with child- and parent-related factors: child age; type of GS finding; and parent health literacy, numeracy, and education. RESULTS:A total of 1763 parents completed surveys; 83% met "underserved" criteria based on race, ethnicity, and risk factors for barriers to access. We observed high perceived understanding and personal utility and low test-related distress. Outcomes were associated with the type of GS finding; parents of children with a pathogenic or likely pathogenic finding endorsed higher personal utility and more test-related distress than those whose children had a variant of uncertain significance or normal finding. Personal utility was higher in parents who met the criteria for "underserved." CONCLUSION:Our findings shed light on correlates of parents' cognitive and emotional responses to their child's GS findings and emphasize the need for tailored support in disclosure discussions.