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UID:HFESHCS_2025 International Symposium on Human Factors and Ergonomics i
 n Health Care_sess109_INDLEC174@linklings.com
SUMMARY:Shared Cognition – A Driver to Colorectal Cancer Screening Success
DESCRIPTION:Oral Presentations\n\nTrang Pham (University of Illinois at Ch
 icago (UIC)); Nicole Hammer, Miad Alfaqih, and Jessica Friedman (Universit
 y of Florida); Sean Pajak (Drexel University); Megan Gregory (University o
 f Florida); Keith Naylor, Masahito Jimbo, and Nathan Stackhouse (College o
 f Medicine, University of Illinois at Chicago); Yamile Molina (University 
 of Illinois at Chicago (UIC)); Sean McClellan (College of Medicine, Univer
 sity of Illinois at Chicago); and Ashley Hughes (Case Western Reserve Univ
 ersity)\n\nBackground: \nColorectal cancer (CRC), a highly treatable disea
 se, remains the third most common cancer and the third leading cause of ca
 ncer deaths in the United States (US) [American Cancer Society, 2024]. Whe
 n detected early, survival is likely. Therefore, screening for CRC is crit
 ical to reducing CRC mortality; however, 40% of Americans aged 45 and up d
 o not receive guideline-concordant screenings [Siegel, 2023]. Federally qu
 alified health centers (FQHCs), which serve as a national model for primar
 y care delivery to underserved and uninsured patient populations, care for
  nearly one-third of all US adults living in poverty [Behr, 2022]. However
 , FQHCs frequently fall short of cancer screening benchmarks despite their
  goal to provide comprehensive prevention and treatment services [Zhao, 20
 24].\n\nColorectal cancer screenings (CRCS) include stool-based (e.g. Feca
 l immunochemical test – FIT) and direct visualization methods (e.g., colon
 oscopy), both of which require effective coordination between patients and
  providers. Successful screening depends largely on effective coordination
  to schedule, administer, and manage results appropriately following CRC t
 esting, including appropriate follow-up actions (e.g., cancer treatment). 
 Patient navigation (PN) services can improve vulnerable populations' healt
 hcare access and CRC screening rates [Chen, 2024]. However, these programs
  often face challenges due to ill-defined roles, inadequate training, and 
 difficulties integrating into clinical workflows [Chan, 2023], which can n
 egatively impact patient safety. Our larger study aims to enhance patient 
 navigation services for CRCS in FQHCs, first by understanding gaps in coor
 dination needed to improve screening rates and outcomes for underserved po
 pulations. \n\nMethod\nWe conducted semi-structured interviews with member
 s of frontline staff and patients who recently underwent CRCS at an academ
 ically affiliated network of FQHCs in the US Midwest region.  For patients
 , we invited those between the ages of 45 and 75 who had done FIT tests an
 d/or colonoscopies within the past year at selected FQHC clinics. Patients
  received emails, mail, and phone calls to introduce the study. Patients w
 ho expressed interest were scheduled for a 30-minute Zoom (audio-only) int
 erview with consent sent via email. Clinicians received study information 
 via email study and clinic presentations. Interested clinicians responded 
 to the REDCap screening for eligibility survey and scheduled an interview 
 time. Visa gift cards were used to reimburse participants ($65 USD for med
 ical providers, $30 USD for clinical staff, patient navigator, or patient)
 . All interviews were conducted by trained research staff and recorded wit
 h participant consent. Recordings were transcribed verbatim and stripped o
 f identifying information before analysis. Transcripts were uploaded to At
 las.ti version 23.2.1 [Atlas.ti] for analysis. A mixed inductive-deductive
  coding approach was used, with two independent coders per transcript and 
 complete consensus resolution (i.e., 100% consensus). Given the study’s fo
 cus on coordination, Salas’s Heuristic Critical Considerations for Teamwor
 k (also known as the “C’s of Teamwork”) guided the deductive codes. [Salas
 , 2015] The qualitative team iteratively reviewed coded excerpts to identi
 fy emergent themes, including facilitators and barriers to CRCS.\n\nThe CR
 CS process starts with consultation and/or recommendation for testing from
  the provider. Once the test was placed, the patient was informed about th
 e test (for the FIT test, the patient received instructions on how to get 
 the sample and return to the clinic; for the colonoscopy, the patient was 
 instructed on bowel preparation and the requirement of having someone acco
 mpanying them home after the procedure). Sharing the test result was the l
 ast activity of the screening process. This abstract focuses on our primar
 y emerging theme: Shared cognition. This report emphasizes the importance 
 of shared cognition between patients and the care team and within the care
  team in coordinating colorectal cancer screening, where team members’ kno
 wledge helps them coordinate actions and adapt to task demands and each ot
 her (Cannon-Bowers et al. 1993) to ensure safe, high-quality care around C
 RC screening.\n\nResults: \nTwenty-five semi-structured interviews were co
 nducted with 9 clinicians and 16 patients to investigate the current CRCS 
 procedures (FIT test and colonoscopy) and the dynamics of teamwork between
  clinical teams and patients.\n\nKey findings underscore the need for shar
 ed understanding between patients, care team members, and within the care 
 team itself. For FIT tests, patient comprehension of screening importance,
  sample return, and follow-up steps was crucial. Colonoscopy success hinge
 d on clear preparation instructions. For example, one patient stated: “…if
  it's something new to a lot of people, they don't understand the dynamics
  of what actually needs to be done. And I believe one of the biggest barri
 ers for some people, is yes, how to actually take the prep.”\n\nCare teams
  emphasized the need for coordinated tracking of FIT test completion and c
 onsideration of patient preferences. For example, a provider explained: “I
  have no idea, like, what percentage of colonoscopies that I order are act
 ually being done. Like, I just, we don't have that metric, but I would be 
 curious, um, to know, yeah, and then if, if it's, if it's low, like, you k
 now, why people aren't, aren't able to get them, but I don't, it's not rea
 lly something that comes up in like follow up visits.” \n\nFor both FIT an
 d colonoscopy tests, effective intra-team communication facilitated timely
  status updates, while standardized instructions for FIT test or colonosco
 py preparation were identified as essential for enhancing patient understa
 nding the importance of getting tested and their experience. As stated by 
 one provider when discussing FIT tests: “I think what helps things go succ
 essfully is when staff definitely understand how to provide [FIT test] ins
 tructions to the patient. So when, staff are comfortable with being able t
 o provide instructions to the patient, then that's gonna make the, that's 
 gonna improve the patient's ability to understand what they need to do, ho
 w they need to bring [the FIT test] back. And so I think that that is very
  helpful…”\n\nDiscussion:\nOur study has key implications for healthcare p
 ractitioners, clinical informaticians, and academics. Firstly, demonstrati
 ng the value of HF principles in improving CRCS processes can enhance ROI 
 for healthcare institutions under Medicare’s value-based care model. Our f
 indings highlight the need for standardized workflows and communication in
  EHRs to improve colorectal cancer screening completion rates and patient 
 outcomes. Lastly, this study supports the development of evidence-based te
 am interventions to enhance teamwork, which is crucial for improving CRCS 
 rates in FQHCs and can increase patient safety by ensuring CRCS is complet
 ed accurately. That care is coordinated so that results are reported back 
 to the patient.\n\nTrack: Patient Safety and Research Initiatives (PS)\n\n
 Session Chair: Jessica Ray (St. Jude Children's Research Hospital)
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