EP144 - Electronic motivational messaging to increase colorectal cancer screening among Hispanic patients in the Yakima Valley region of Washington State

Purpose/Background: Colorectal cancer (CRC) is one of the most prevalent yet treatable cancers in the U.S. when detected early. Despite the importance of early screening, rates remain low in historically marginalized populations. Our prior research identified a premature CRC mortality hotspot among non-white individuals in Washington’s Yakima/Tri-Cities region. This study builds on our earlier work in Alaska, where a text messaging intervention improved CRC screening rates among Alaska Native patients (Muller et al Cancer ACS 2016). We aim to adapt and test a motivational messaging intervention to address CRC disparities in Yakima Valley's predominantly Hispanic community.

Methods/Interventions: In collaboration with MultiCare’s Yakima Memorial Hospital (YMH) and with funding from biomedical organizations who are committed to improving CRC screening via various modalities, we will conduct a two-phase pilot study. Phase 1 involves qualitative interviews with 10 Latino(a) patients and listening sessions with YMH staff to ensure cultural relevance. In Phase 2, a randomized controlled trial will identify 100 eligible patients via the Electronic Health Record (EHR). Participants will receive up to four motivational messages through text, email, and the YMH patient portal over six weeks. We will incorporate new blood test screening options and tailor messaging to align with the community's cultural context.

Results/Outcomes: Protocols are being finalized through WSU Office of Research and YMH. Outcome measures for Phase 1 include coded themes analyses on transcripts translated from Spanish to English and consensus around the initial message to be sent by EHR. Phase 2 outcome measures will include the number of patients from the target population who respond to the initial EHR message inquiring for more information, the number of respondents who are eligible to receive a stool testing kit, and the number of eligible patients who successfully return the kit after completing the required steps. Phases 1 and 2 are expected to be completed by spring 2025, with data analysis available by May 2025.

Conclusion/Discussion: CRC screening disparities persist in Hispanic populations, but early detection is key to prevention. Our previous study in Alaska showed that electronic messaging can significantly increase screening rates. Expanding this approach through the EHR could offer a cost-effective solution to reduce CRC disparities in underserved communities.

Colorectal Cancer Mortality Hotspots Among Non-White Populations in Washington State by Proximity to Ambulatory Endoscopy Centers (courtesy of Edwards et al AJS 2023)
Figure 1. Geographic distribution and density of colorectal cancer deaths among non-white individuals aged 40y or older in Washington state, based on residence more than 10km from an ambulatory endoscopy center. In Southeast WA, there is a hotspot of racial disparities in colorectal cancer mortality.