Authors:
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
University of Washington affiliated authors are displayed in bold.
✪ Open Access
Published: August 2025
Read the full text in the open access journal Implementation Science
Abstract:
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.
Contributions to the literature
- This comparative effectiveness trial will compare two evidence-based implementation strategies to improve cancer screening reach.
- Comparing a patient-facing to a clinician-facing approach will offer novel insights into what works and for whom.
- This trial will assess mechanisms and heterogeneity of treatment effects to inform the science of implementation.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**