***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To derive a taxonomy for  colorectal cancer screening  that advances R and omized Controlled Trials ( RCTs ) and screening uptake . DESIGN Detailed publication review , multiple interviews with principal investigators ( PIs ) and collaboration with PIs as co- authors produced a CRCS intervention taxonomy . Semi-structured interview questions with PIs ( Drs . Inadomi , Myers , Green , Gupta , Jerant and Ritvo ) yielded details about trial conduct . Interview comparisons led to an iterative process informing serial interviews until a consensus was obtained on final taxonomy structure . RESULTS These taxonomy headings ( Engagement Sponsor , Population Targeted , Alternative Screening Tests , Delivery Methods , and Support for Test Performance ( EPADS ) ) were used to compare studies . Exemplary insights emphasized : 1 ) direct test delivery to patients ; 2 ) linguistic-ethnic matching of staff to minority subjects ; and 3 ) authorization of navigators to schedule or refer for colonoscopies and /or distribute stool blood tests during screening promotion . CONCLUSION PIs of key RCTs ( 2012 - 2015 ) derived a CRCS taxonomy useful in detailed examination of CRCS promotion and design of future RCTs BACKGROUND We tested an intervention based on social learning theory ( SLT ) to improve colorectal  cancer ( CRC ) screening among Native Hawaiians , a group with low CRC screening rates . METHOD Sixteen Hawaiian civic clubs agreed to r and omization . Eight control clubs received a culturally targeted presentation , a free Fecal Occult Blood Test ( FOBT ) , and a reminder call . Eight experimental clubs also received culturally targeted education and free testing ; but , in line with SLT , education was delivered by a Native Hawaiian physician and Native Hawaiian CRC survivor , and members received an FOBT demo , were challenged to involve a family member in screening , and were telephoned multiple times to address change-related emotions and barriers . RESULTS One hundred twenty-one members age 50 and older from 16 clubs participated . At the club level , screening rates were modestly increased in four experimental clubs and six control clubs . Surprisingly , 64 % of participants reported being up to date with CRC screening at baseline . Only 13 individuals ( five in experimental arm and eight in the control arm ) were screened for the first time through this intervention , increasing the percent screened from 59 % to 67 % in the experimental group and from 69 % to 85 % in the control group . Although individuals in the experimental arm were more likely to rate the intervention as culturally appropriate , both arms realized similar and significant gains in CRC knowledge , attitudes , intent , and self-efficacy . CONCLUSIONS For Native Hawaiian individuals belonging to a network of civic clubs , an intervention based on SLT delivered by a Native Hawaiian physician and CRC survivor was less effective at further increasing compliance than was a culturally targeted educational session delivered by a non-Hawaiian nurse . That CRC screening compliance was high prior to our intervention suggests that we targeted a very health conscious segment of the Native Hawaiian population . Future work should focus on underserved segments of this indigenous group BACKGROUND Morbidity and mortality from colorectal cancer ( CRC ) are heightened among the socioeconomically disadvantaged . METHOD A r and omized controlled trial was conducted to evaluate the efficacy of a videotaped intervention using peer educators as well as a health professional to increase compliance with  fecal occult blood test  ( FOBT )  screening . Participants were 160 older individuals attending a medical outpatient clinic .  Compliance with FOBT use was the dependent measure . Demographic variables , family history of CRC , viewing the videotape , perceived risk , self-efficacy , physician recommendation , knowledge about CRC screening , and intent to use the FOBT were independent measures . RESULTS Approximately 41 % of participants complied with FOBT screening . Significant relationships were found between intent and family history of CRC , viewing the video , perceived risk , self-efficacy , and CRC knowledge . However , none of these variables was significantly related to compliance with FOBT use . CONCLUSIONS Although modest compliance rates were shown for both experimental and control groups , their compliance did not differ significantly . Further investigation of the impact of a video as part of an enhanced intervention program should be considered BACKGROUND Patient navigators may increase colorectal cancer ( CRC )  screening rates  among adults in underserved communities , but prior r and omized trials have been small or conducted at single sites and have not included substantial numbers of Haitian Creole-speaking or Portuguese-speaking patients . METHODS We identified 465 primary care patients from 4 community health centers and 2 public hospital-based clinics who were not up-to- date with CRC screening and spoke English , Haitian Creole , Portuguese , or Spanish as their primary language . We enrolled participants from September 1 , 2008 , through March 31 , 2009 , and followed them up for 1 year after enrollment . We r and omly allocated patients to receive a patient navigation-based intervention or usual care . Intervention patients received an introductory letter from their primary care provider with educational material , followed by telephone calls from a language -concordant navigator . The navigators offered patients the option of being screened by fecal occult blood testing or colonoscopy .  The primary outcome was completion of any CRC screening within 1 year . Secondary outcomes included the proportions of patients screened by colonoscopy who had adenomas or cancer detected . RESULTS During a 1-year period , intervention patients were more likely to undergo CRC screening than control patients ( 33.6 % vs 20.0 % ; P < .001 ) , to be screened by colonoscopy ( 26.4 % vs 13.0 % ; P < .001 ) , and to have adenomas detected ( 8.1 % vs 3.9 % ; P = .06 ) . In prespecified subgroup analyses , the navigator intervention was particularly beneficial for patients whose primary language was other than English ( 39.8 % vs 18.6 % ; P < .001 ) and black patients ( 39.7 % vs 16.7 % ; P = .004 ) . CONCLUSIONS Patient navigation increased completion of CRC screening among ethnically diverse patients . Targeting patient navigation to black and non-English-speaking patients may be a useful approach to reducing disparities in CRC screening . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01141114 PURPOSE More effective strategies are needed to improve rates of colorectal cancer screening , particularly among the poor , racial and ethnic minorities , and individuals with limited English proficiency . We examined whether the direct mailing of fecal occult blood testing ( FOBT ) kits to patients overdue for such screening is an effective way to improve screening in this population . METHODS All adults aged 50 to 80 years who did not have documentation of being up to date with colorectal cancer screening as of December 31 , 2009 , and who had had at least 2 visits to the community health center in the prior 18 months were r and omized to the outreach intervention or usual care .  Patients in the outreach group were mailed a colorectal cancer fact sheet and FOBT kit . Patients in the usual care group could be referred for screening during usual clinician visits . The primary outcome was completion of colorectal cancer screening ( by FOBT , sigmoidoscopy , or colonoscopy ) 4 months after initiation of the outreach protocol . Outcome measures were compared using the Fisher exact test . RESULTS Analyses were based on 104 patients assigned to the outreach intervention and 98 patients assigned to usual care . In all , 30 % of patients in the outreach group completed colorectal cancer screening during the study period , compared with 5 % of patients in the usual care group ( P < .001 ) . Nearly all of the screenings were by FOBT . The groups did not differ significantly with respect to the percentage of patients making a clinician visit or the percentage for whom a clinician placed an order for a screening test . CONCLUSIONS The mailing of FOBT kits directly to patients was efficacious for promoting colorectal cancer screening among a population with high levels of poverty , limited English proficiency , and racial and ethnic diversity . Non – visit-based outreach to patients may be an important strategy to address suboptimal rates of colorectal cancer screening among population s most at risk for not being screened Background Colorectal-cancer is a leading cause of cancer death in the United States , and Latinos have particularly low rates of screening . Strategies and Opportunities to STOP Colon Cancer in Priority Population s ( STOP CRC ) is a partnership among two research institutions and a network of safety net clinics to promote colorectal cancer screening among population s served by these clinics . This paper reports on results of a pilot study conducted in a safety net organization that serves primarily Latinos . Methods The study assessed two clinic-based approaches to raise rates of  colorectal-cancer screening among selected age-eligible patients not up-to- date with colorectal-cancer screening guidelines . One clinic each was assigned to : ( 1 ) an automated data -driven Electronic Health Record (EHR)-embedded program for mailing Fecal Immunochemical Test ( FIT ) kits ( Auto Intervention ) ; or ( 2 ) a higher-intensity program consisting of a mailed FIT kit plus linguistically and culturally tailored interventions delivered at the clinic level ( Auto Plus Intervention ) . A third clinic within the safety-net organization was selected to serve as a passive control ( Usual Care ) . Two simple measurements of feasibility were : 1 ) ability to use real-time EHR data to identify patients eligible for each intervention step , and 2 ) ability to offer affordable testing and follow-up care for uninsured patients . Results The study was successful at both measurements of feasibility . A total of 112 patients in the Auto clinic and 101 in the Auto Plus clinic met study inclusion criteria and were mailed an introductory letter . Reach was high for the mailed component ( 92.5 % of kits were successfully mailed ) , and moderate for the telephone component ( 53 % of calls were successful completed ) . After exclusions for invalid address and other factors , 206 ( 109 in the Auto clinic and 97 in the Auto Plus clinic ) were mailed a FIT kit . At 6 months , fecal test completion rates were higher in the Auto ( 39.3 % ) and Auto Plus ( 36.6 % ) clinics compared to the usual-care clinic ( 1.1 % ) . Conclusions Findings showed that the trial interventions delivered in a safety-net setting were both feasible and raised rates of colorectal-cancer screening , compared to usual care . Findings from this pilot will inform a larger pragmatic study involving multiple clinics . Trial registration Clinical Trial.gov : Opinion statementColorectal cancer ( CRC ) forms an important public health problem , especially in developed countries . CRC screening tests can be used to identify asymptomatic individuals with CRC precursors and ( early ) cancer . Removal of these lesions reduces CRC incidence and prevents CRC-related mortality . There are a range of screening tests available , each with advantages and disadvantages . Stool screening tests can broadly be divided into fecal occult blood tests ( FOBTs ) and molecular biomarker test , such as DNA/RNA marker tests , protein markers , and fecal microbiome marker tests . Guaiac fecal occult blood tests ( gFOBT ) have been demonstrated in large r and omized screening trials to reduce CRC mortality . Fecal immunochemical tests ( FIT ) have superior adherence , usability , and accuracy as compared to gFOBT . Advantage of the use of quantitative FITs in CRC screening programs is the cut-off level that can be adjusted . Molecular biomarker DNA tests have shown to detect significantly more cancers than FIT . By combining biomarker DNA tests with FIT , sensitivity for advanced adenomas can be increased significantly . However , it has lower specificity thus dem and s more colonoscopy re sources , is more cumbersome , and costly . The adherence has not been assessed in population screening trials . For these reasons , FIT is therefore at present regarded as the preferred method of non-invasive CRC screening . This chapter will review the current status of fecal test-based CRC screening The management of many health disorders often entails a sequential , individualized approach whereby treatment is adapted and readapted over time in response to the specific needs and evolving status of the individual . Adaptive interventions provide one way to operationalize the strategies ( e.g. , continue , augment , switch , step-down ) leading to individualized sequences of treatment . Often , a wide variety of critical questions must be answered when developing a high- quality adaptive intervention . Yet , there is often insufficient empirical evidence or theoretical basis to address these questions . The Sequential Multiple Assignment R and omized Trial (SMART)—a type of research design —was developed explicitly for the purpose of building optimal adaptive interventions by providing answers to such questions . Despite increasing popularity , SMARTs remain relatively new to intervention scientists . This manuscript provides an introduction to adaptive interventions and SMARTs . We discuss SMART design considerations , including common primary and secondary aims . For illustration , we discuss the development of an adaptive intervention for optimizing weight loss among adult individuals who are overweight Practice -based research networks ( PBRNs ) are organizations that involve practicing clinicians in asking and answering clinical ly relevant research questions . This review explores the origins , characteristics , funding , and lessons learned through practice -based research in the United States . Primary care PBRNs emerged in the USA in the 1970s . Early studies explored the etiology of common problems encountered in primary care practice s ( eg ,  headache , miscarriage )  , demonstrating the gap between research conducted in controlled specialty setting s and real-world practice s. Over time , national initiatives and an evolving 
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The provision of kits through the mail , use of pre-addressed stamped envelopes , client reminders and in-clinic distribution appeared most frequently in the highly effective/effective clinic-based study arms .
More robust application of guidelines to support reporting on methods to select , adapt and implement interventions can help end users determine not just which interventions work to improve CRC screening , but which interventions would work best in their setting given specific patient population s , clinical setting s , and community characteristics .