Project Summary

Cancer is the second leading cause of death in the United States. Guideline-concordant screening reduces cancer mortality, minimizes morbidity, and facilitates timely treatment. However, many eligible adults are not up to date for the multiple cancer screenings recommended at the A and B level by the US Preventive Services Task Force (USPSTF): 86% for lung cancer screening, 20% for breast cancer screening, 36% for colorectal cancer screening, and 26% for cervical cancer screening. Moreover, screening rates could be improved even further for some populations (for example, rural, lower-income, and uninsured patients). Population outreach interventions using text messages, mailing, and/or patient navigation increase screening. Yet, most outreach studies address a single cancer rather than all recommended by the USPSTF in alignment with whole person care and clinician preferences. The Bundled Outreach of Multiple Cancer Screenings for Under-screened Populations (BUNDLE) study will adapt our previously tested multicomponent outreach interventions for single cancer screenings to include multiple cancer screenings (the BUNDLE intervention). BUNDLE is a collaboration between the Oregon Rural Practice-based Research Network, the Knight Cancer Institute at Oregon Health & Science University, and the Lineberger Comprehensive Cancer Center at the University of North Carolina. Activities will engage at least 18 unique primary care clinics and reach more than 1600 patients in Oregon and North Carolina. In the 2-year UG3 planning phase, the study will (1) adapt the intervention and materials via user-centered design; (2) pilot and assess intervention acceptability and feasibility, and finalize UH3 effectiveness outcomes; and (3) finalize clinic recruitment and prepare for the trial. In the 4-year UH3 implementation phase, the study will (4) implement and evaluate the reach and effectiveness of the BUNDLE intervention compared with usual care on change in cancer screening in a pragmatic, 2-arm, waitlist control, cluster randomized trial; (5) assess patient and clinic experience and the cost-effectiveness (cost per screening) of the BUNDLE intervention; and (6) explore how multilevel factors (patient, clinic, and community) explain cancer screening completion using configurational analysis. Our primary outcome is completion of any USPSTF-recommended screening test (colorectal, breast, cervical, lung) with a 10% or more hypothesized increase for the intervention vs control groups. Secondary outcomes are reach, completion of 2 or more cancer screenings, completion of all eligible cancer screenings, patient and clinic experience, cost-effectiveness, and how multilevel factors explain screening outcomes. Clinic and health system leaders providing primary care for populations with lower rates of cancer screening in Oregon and North Carolina are eager to participate in BUNDLE. The findings will advance the science and practice of population outreach interventions focused on multiple cancer screenings. Bundled outreach interventions could enable primary care clinics to pool and focus limited resources in efficient ways.

NIH Project Information