Advancing Equity in Cancer Care: Investigating Health- Related Social Needs and Colonoscopy Follow-Up Among FQHC Patients

PROJECT SUMMARY/ABSTRACT Colorectal cancer (CRC) is the second leading cause of cancer-related deaths among both men and women in the US, with screening recommended by the US Preventive Services Task Force (USPSTF) to reduce incidence and mortality. Despite national targets, CRC screening rates, especially among patients receiving

services in low-resourced settings, remain below these goals. Federally Qualified Health Centers (FQHCs) serving predominantly underserved populations face challenges in achieving equitable screening rates. Health- related social needs (HRSNs), such as housing instability and transportation issues, play a significant role in

CRC screening completion disparities. However, their impact on patients' CRC screening completion remains underexplored. This diversity supplement (DS) proposal will investigate the associations between HRSNs and follow-up colonoscopy receipt among FQHC patients with abnormal stool-based test results. This population will be

reached by leveraging outreach to safety-net settings such as The Ohio State University Wexner Medical Center, KPNC/KPSC and the American Academy of Family Physicians National Research Network partnership—all strategies for aim 3 of the parent grant. This DS complements the proposed work in the parent

grant, primarily through its support of its first specific aim. For parent grant Aim 1, the DS will contribute a qualitative approach to understanding the CRC screening continuum through the lens of a particularly disadvantaged population (FQHC patients), paying special attention to patients' HRSNs. The DS will further

contribute to the understanding of recommendation-concordant CRC treatment timeline adherence for members of this population who receive abnormal stool test results. The results of the DS will provide covariates of interest (e.g., specific HRSNs, Social determinants of health) for the statistical analyses proposed

in Aims 2 and 4 of the parent grant. Data will be collected that may ultimately influence the development of interventions targeting HRSNs to enhance CRC screening completion rates in vulnerable populations. Drawing from existing literature on other cancer types, we hypothesize that patient-level HRSNs strongly influence

screening completion and subsequent outcomes. Dr. Aldenise Ewing, the DS candidate, aspires to become an independent investigator focusing on addressing cancer-related health disparities. This supplemental application will provide a mentored experience in cancer health disparities and cancer control for Dr. Aldenise Ewing. The study findings will provide preliminary data on

social determinants of CRC-related outcomes and strengthen her K01 submission within 2-years of funding and R01 or equivalent grant submission within 5-years of funding. Moreover, it will contribute crucial insights into addressing social determinants of health in low-resource settings, ultimately improving health outcomes for

all populations.