Project Summary

Over 33 million people in the United States are overdue for potentially lifesaving colon and liver cancer screening tests. Black people and people living in rural areas are less likely to get these tests and more likely to die of these common cancers than White people and people living in nonrural areas. While some healthcare sites deliver cancer screenings to four out of five patients, other sites struggle, delivering liver and colon cancer screenings to only one out of five patients who need them. However, it is unclear how to help healthcare sites that are performing poorly, resulting in tens of thousands of preventable cancer deaths each year. 

Although effective, evidence-based approaches—called implementation strategies—can improve cancer screening, we do not know how to choose between them. Patient navigation works through one-on-one patient outreach and problem-solving while implementation facilitation is site-based coaching and problem-solving for clinicians and staff to improve how they deliver healthcare. While both strategies work to improve cancer screening, it is unclear when to use navigation to help patients directly or when to use facilitation to help clinicians deliver better care. 

This study will focus on veterans, since one out of 10 of the 9 million veterans in Veterans Health Administration (VA) care is either overdue for screening or has increased risk factors for liver and colon cancer. The VA has prioritized improving screening among its high-risk veteran patient population. The difficulty is, however, knowing how to do this. No one knows how to pick which strategy will work best for a certain site and why. That makes it difficult for healthcare systems to decide how to help struggling sites improve cancer screening. 

This study will compare the effectiveness of two strategies that are used frequently in both VA and non-VA settings. The goal of this research is to determine how healthcare systems should improve cancer screenings. 

Researchers worked with veterans, clinicians and healthcare leaders to develop this research. First, they will assign 48 VA sites to either a patient navigation or facilitation program with the goal of improving delivery of liver and colon cancer screenings to the veterans who receive care at the sites. Researchers will gather information about each site (e.g., characteristics of the sites) and the veterans they serve and measure the number of screenings they deliver and to whom. By asking veterans and providers about their experiences, researchers will also learn how the two strategies impact patient-provider communication and effectiveness with engaging veterans in care. The research team will also uncover how each strategy works on barriers to improve patient care by studying the types of sites that make the most and least improvement. 

The VA will use what is learned to design the most effective and efficient approach for supporting the efforts of VA hospitals and clinics to improve the number and diversity of veterans who receive lifesaving cancer screenings. In addition, by determining why one strategy works better than another for a particular hospital, this study will improve the ability of scientists and policy makers to select the best solutions for meeting specific challenges, reducing waste and increasing effectiveness. Importantly, researchers expect findings from this study to provide useful information for healthcare systems and patient populations outside of the VA, potentially reducing illness and death from liver and colon cancer for thousands of people every year.

Project Information

Shari Rogal, M.D., MPH
Andrew Gawron, M.D., Ph.D.
University of Pittsburgh School of Medicine
$6,531,994 *

Key Dates

60 months *
November 2023

*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.


Award Type
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: January 24, 2024