Overcoming barriers to colorectal cancer screening and research enrollment by minoritized and underinsured populations.

Abstract

e13758 Background: The Texas Cancer Interception Institute (TCII) encourages participation in early detection initiatives, regardless of socioeconomics or race. Colorectal Cancer (CRC) is increasing in younger individuals, and mortality is higher in Blacks and Latinos with a higher stage at diagnosis the norm. Disparate outcomes are due to limited access to high quality care, higher uninsurance and lower screening rates. Underrepresentation of minoritized populations (MP) in research has many causes. We aimed to mitigate barriers to enrollment for low-income MP in a Cologuard test CRC screening study. Methods: Single site study performed at a large clinical care setting in South Dallas evaluating intentional patient engagement approaches to improve CRC screening using a test completed at home. Participants completed the BB-CanS, BRIEF, and questions from the Health Belief Model to explore CRC screening perceptions and barriers. Results: Our approach with supportive follow-up enrolled 167 participants, resulting in a 69% CRC screening kit return rate; 6% tested positive. Intentional steps ensured completion, including 6 home visits to drop off and pickup kits. Known barriers to screening failed to predict kit return, only preferring Spanish was predictive (Table 1). On average, kits were submitted 32 days (95% CL 24-40) after enrollment. Most returned kits before follow-up. For 47 participants who received kits but did not return them, follow-up calls resulted in 17 more returned kits, a 17% increase. Conclusions: Addressing CRC disparities in MP requires prioritizing trust-building, community engagement, and reducing logistical barriers and complexities in protocol design. Establishing long-term partnerships, creating accessible and inclusive study protocols, and fostering multilingual communications are crucial for enrolling populations historically underrepresented in research. These strategies may serve as a model for addressing healthcare disparities in underserved communities and will be utilized in future studies opening through the TCII. Total Association with Kit Return Not Returned (n=52) Returned (n=115) n % p Cramer’s V n % n % Race/Ethnicity  Latino 105 63 0.085 0.172 27 26 78 74  Black Non-Latino 57 34 24 42 33 58  White Non-Latino 5 3 1 20 4 80 Education  Some high school 86 52 0.627 0.075 29 34 57 66  High school grad 52 31 16 31 36 69  Some College + 29 17 7 24 22 76 Preferred Language  English 77 46 0.007 0.208 32 42 45 58  Spanish 90 54 20 22 70 78 Annual Household Income  $0-$19,999 81 50 0.861 0.092 26 32 55 68  $20K-$34,999 47 29 14 30 33 70  $35K-$64,999 17 10 5 29 12 71  $65K+ 4 2 2 50 2 50  Refused 14 9 3 21 11 79 Health Literacy  No Concerns 141 85 0.727 -0.027 42 30 99 70  Literacy Concerns 24 15 8 33 16 67 Insurance Status  Uninsured 123 74 0.242 0.131 35 28 88 72  Medicare 20 12 6 30 14 70  Other 24 14 11 46 13 54 Cost-Associated Care Avoidance  No 121 73 0.104 0.165 34 28 87 72  Yes 42 25 15 36 27 64  Unsure 4 2 3 75 1 25