Adapting and Implementing a Remote, Digital CRC Screening Intervention for Primary Care Practice in Response to COVID-19

PROJECT SUMMARYGuided by the Consolidated Framework for Implementation Research (CFIR), the overall goal of this proposedsupplement is to adapt the Meet ALEX intervention to patient concerns about CRC screening safety as a resultof COVID-19, pilot test in 2 new primary care clinics, and examine implementation of a remote intervention in apost-pandemic clinical environment. The COVID-19 pandemic is expected to exacerbate cancer screeninginequities among vulnerable patient populations. Through the parent grant, the research team has worked in 6UF Gainesville clinics to develop an efficient workflow and support infrastructure to address the CRC screeningneeds of vulnerable patient populations. Stool-based testing is now being recommended to reduce theforthcoming backlog of endoscopic and radiological CRC screening exams. The Meet ALEX intervention isideally situated to help mitigate CRC screening inequities for vulnerable patient populations by providingpatient education and in-home stool testing.In Specific Aim 1, we will expand implementation of the parent grant intervention, called Meet ALEX (AgentLeveraging Empathy for Exams) to 2 UF Jacksonville clinics that serve a predominantly Black/AfricanAmerican and Latinx patient population. We will also pilot test a modification that addresses patient concernsabout CRC screening safety related to COVID-19. We will examine whether tailoring the intervention to patientconcerns about COVID-19 alters self-reported preferences for CRC screening modality (ie, colonoscopy, homestool testing) and behavior (assessed via chart review) compared with patients who receive the existingintervention.In Specific Aim 2, we will describe facilitators and barriers associated with implementing Meet ALEX as a resultof COVID-19 through in-depth interviews with key stakeholders (ie, health care providers and clinic managers)from all implementing clinics (N=8) to understand changes to organizational processes and preferences forCRC screening, availability of remote counseling, and barriers and facilitators related to implementing digitalinterventions as a result of the pandemic.The results of this supplement will lead to the development of best practices for implementing digital cancerscreening interventions to reduce CRC inequities in primary care settings affected by COVID-19.