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Background <p>Screening for gastrointestinal (GI) cancers, specifically colorectal cancer (CRC) and hepatocellular carcinoma (HCC), is often inadequately and inequitably implemented, leading to preventable morbidity and mortality. This protocol paper describes a study designed to compare the effectiveness of external facilitation with patient navigation across hospitals in the Veterans Health Administration (VA).</p> Methods <p>Two hybrid type 3, cluster-randomized trials will compare the effectiveness of patient navigation versus external facilitation for supporting HCC and CRC screening completion. Twenty-four sites will be included in the HCC trial and 32 in the CRC trial, cluster-randomizing Veterans by their site of primary care. The primary outcome of reach of cancer screening completion will be measured after intervention and during sustainment. Multi-level implementation determinants (i.e., barriers and facilitators), preconditions, and moderators will be evaluated pre- and post-intervention, using Consolidated Framework for Implementation Research (CFIR)-mapped surveys and interviews of Veteran participants and provider participants.</p> Discussion <p>Comparing findings in the two trials will allow researchers to understand how implementation barriers and strategies operate differently for a one-time screening in a relatively healthy population (CRC) vs. repeated screening in a more medically complex population (HCC).</p> Trial registration <p>This project was registered at ClinicalTrials.Gov (NCT06458998) on 6/13/24.&#xa0;</p>

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Comparing the effectiveness of implementation strategies to improve liver and colon cancer screening for Veterans: protocol for a large cluster-randomized implementation study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月9日

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  • Shari S. Rogal,
  • Vera Yakovchenko,
  • Timothy R. Morgan,
  • Jason A. Dominitz,
  • Heather McCurdy,
  • Anna Nobbe,
  • Nsikak R. Ekanem,
  • Chaeryon Kang,
  • Rachel I. Gonzalez,
  • Angela Park,
  • Jennifer Anwar,
  • Brittney Neely,
  • Sandra Gibson,
  • Carolyn Lamorte,
  • Jasmohan S. Bajaj,
  • Heather M. Patton,
  • Yiwen Yao,
  • Andrew J. Gawron

摘要

Background

Screening for gastrointestinal (GI) cancers, specifically colorectal cancer (CRC) and hepatocellular carcinoma (HCC), is often inadequately and inequitably implemented, leading to preventable morbidity and mortality. This protocol paper describes a study designed to compare the effectiveness of external facilitation with patient navigation across hospitals in the Veterans Health Administration (VA).

Methods

Two hybrid type 3, cluster-randomized trials will compare the effectiveness of patient navigation versus external facilitation for supporting HCC and CRC screening completion. Twenty-four sites will be included in the HCC trial and 32 in the CRC trial, cluster-randomizing Veterans by their site of primary care. The primary outcome of reach of cancer screening completion will be measured after intervention and during sustainment. Multi-level implementation determinants (i.e., barriers and facilitators), preconditions, and moderators will be evaluated pre- and post-intervention, using Consolidated Framework for Implementation Research (CFIR)-mapped surveys and interviews of Veteran participants and provider participants.

Discussion

Comparing findings in the two trials will allow researchers to understand how implementation barriers and strategies operate differently for a one-time screening in a relatively healthy population (CRC) vs. repeated screening in a more medically complex population (HCC).

Trial registration

This project was registered at ClinicalTrials.Gov (NCT06458998) on 6/13/24.