): Colorectal cancer (CRC) is one of the cancers that our community partners have identified as a priority. It is the second leading cause of cancer death in the United States, and one with significant disparities in screening, stage of diagnosis, and survival. Underinsured and uninsured adults are less likely to be screened, more likely to have their cancer diagnosed at a late stage, and less likely to survive CRC. In this project we will work with "safety-net" health centers serving Medicaid and uninsured patients in St. Louis City and St. Louis County in Missouri, and in East St. Louis/St. Clair County in Illinois. Working with our Colorectal Cancer Community Partnership we planned a cluster-randomized delaved start trial to test the effectiveness of offering community health centers a "Menu" of evidence-based svstems interventions for increasing rates of CRC screening. The strategies included in the Menu will be drawn from evidence-based interventions. The control condition will be usual care, but in concordance with our partners'wishes, we will offer all participating health centers access to state-of-the-art evidence-based patient education materials. The primary outcome will be CRC screening adherence as measured by self-report surveys of a random sample of health center patients. Our evaluation will also be informed by a chart audit to assess screening referral and completion, surveys of physicians and staff at intervention sites to assess implementation outcomes, and exit interviews with administration of intervention health centers to assess maintenance of the intervention strategies. We developed and will conduct our study adhering to the principles of community-based participatory research (CBPR).
The specific aims are: (1) Working with community partners, we will select and refine the evidence based intervention strategies for the trial;(2) Using a CBPR approach, we will collaborate with our partners to implement and evaluate the systems-level intervention for its effectiveness in increasing CRC screening rates. (3) Using the RE-AIM framework, we will work with our partners to evaluate implementation and maintenance of systems changes by intervention health centers and adoption of the changes by control centers. Compared to traditional clinics and healthcare providers, safety-net health centers face additional challenges in implementing evidence-based strategies for increase screening uptake;yet rigorously testing such strategies in this context is novel. Allowing health centers to select from a menu of strategies will provide a practical test of effectiveness, and will increase buy-in and representativeness of participating health centers. As a practical clinical trial with good external validity, this project has the potential for significant impact on CRC screening rates with promise for substantial impact on disparities in CRC burden. This study is responsive to community concerns about CRC and about no-intervention control groups, and is responsive to the RFA by proposing a CBPR randomized controlled trial to increase access to and utilization of CRC screening procedures.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Specialized Center--Cooperative Agreements (U54)
Project #
Application #
Study Section
Special Emphasis Panel (ZCA1-PCRB-G)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Washington University
Saint Louis
United States
Zip Code
Connors, Shahnjayla K; Goodman, Melody S; Noel, Lailea et al. (2015) Breast cancer treatment among African American women in north St. Louis, Missouri. J Urban Health 92:67-82
Hartz, Sarah M; Olfson, Emily; Culverhouse, Robert et al. (2015) Return of individual genetic results in a high-risk sample: enthusiasm and positive behavioral change. Genet Med 17:374-9
Thompson, Vetta L Sanders; Drake, Bettina; James, Aimee S et al. (2015) A Community Coalition to Address Cancer Disparities: Transitions, Successes and Challenges. J Cancer Educ 30:616-22
Johnson, Kimberly J; Gehlert, Sarah (2014) Return of Results from Genomic Sequencing: A Policy Discussion of Secondary Findings for Cancer Predisposition. J Cancer Policy 2:75-80
Griffey, Richard T; Kennedy, Sarah K; D'Agostino McGowan, Lucy et al. (2014) Is low health literacy associated with increased emergency department utilization and recidivism? Acad Emerg Med 21:1109-15
Boeke, Caroline E; Tamimi, Rulla M; Berkey, Catherine S et al. (2014) Adolescent carotenoid intake and benign breast disease. Pediatrics 133:e1292-8
Caito, Nikki; Hood, Sula; Thompson, Vetta L Sanders (2014) Discussing cancer: communication with African Americans. Soc Work Health Care 53:519-31
Morgan, Tamandra; Schmidt, Johanna; Haakonsen, Christy et al. (2014) Using the internet to seek information about genetic and rare diseases: a case study comparing data from 2006 and 2011. JMIR Res Protoc 3:e10
Gehlert, Sarah (2014) Forging an integrated agenda for primary cancer prevention during midlife. Am J Prev Med 46:S104-9
Liu, Ying; Colditz, Graham A; Gehlert, Sarah et al. (2014) Racial disparities in risk of second breast tumors after ductal carcinoma in situ. Breast Cancer Res Treat 148:163-73

Showing the most recent 10 out of 27 publications