Bundled Outreach of Multiple Cancer Screenings for Under-screened Populations (BUNDLE)

About This Grant

Project Summary Cancer is the second leading cause of death in the US. 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% lung, 20% breast, 36% colorectal, and 26% cervical. Moreover, screening rates could be improved even further for some populations (e.g., rural, low income or uninsured). Population outreach interventions using text, 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 and the Knight Cancer Institute at Oregon Health & Science University, and the University of North Carolina Comprehensive Cancer Center. 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 Research Planning Phase we will: 1) adapt our intervention process and materials via user centered design; 2) pilot and assess intervention acceptability, feasibility, and preliminary effectiveness; and 3) finalize clinic recruitment and prepare for the trial. In the 4-year UH3 Research Execution Phase we will: 4) implement and evaluate reach and effectiveness of the BUNDLE intervention compared to usual care on change in cancer screening in a pragmatic, two-arm, wait-list control, cluster randomized trial; 5) assess patient and clinic experience and cost-effectiveness (cost per screening) of the BUNDLE intervention; and 6) explore how multilevel factors (patient, clinic, 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 intervention versus control patients. Secondary outcomes are reach, completion of two or more cancer screenings, completion of all eligible cancer screenings, patient and clinic experience, cost-effectiveness, and multilevel screening factors. More than 31 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. Findings will advance the science and practice of population outreach interventions focused on multiple cancer screening. Bundled outreach interventions could enable primary care clinics to pool and focus limited resources in efficient ways.