Research

Current Research Projects

Our research focuses on the early detection and prevention of colorectal cancer through increased screening, especially among medically underserved populations. Our current projects include evaluations of novel interventions to increase adherence to colorectal cancer screening and follow-up of abnormal results.

Interventions to Improve Follow-up of Abnormal Fecal Immunochemical Test (FIT) Results in a Safety-Net Population

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Using a mixed-methods approach, this study aims to identify the potentially modifiable patient, provider, and system-level barriers to colonoscopy to inform interventions to improve colonoscopy completion in a safety-net population with abnormal FIT results. Analysis of qualitative patient data and finalization of a multilevel intervention are ongoing.

Learn more:

Perceptions on Barriers and Facilitators to Colonoscopy Completion After Abnormal Fecal Immunochemical Test Results in a Safety Net System
Barriers associated with inadequate follow-up of abnormal fecal immunochemical test results in a safety-net system: A mixed-methods analysis

Rideshare Transportation Program for Colonoscopy Completion

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Through stakeholder engagement, we determined the barriers and facilitators to implementing a rideshare transportation program for colonoscopy completion in a safety-net health system. A pilot of the rideshare transportation intervention to improve colorectal cancer screening and follow-up screening is ongoing.

Learn more:

Operationalizing a Rideshare Intervention for Colonoscopy Completion: Barriers, Facilitators, and Process Recommendations

Racial and Ethnic Disparities in Colorectal Mortality in WA State

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In Western Washington, colorectal cancer mortality is highest In American Indian/Alaska Natives and Black people. We found that delays in diagnostic evaluation after presenting with symptoms suggestive of colorectal cancer alone, unlikely explains this disparity. An evaluation of surveillance colonoscopy after patients have been diagnosed and treated for colorectal cancer  that might explain this disparity is ongoing.

Learn more:

Racial Disparities in Colorectal Cancer Mortality: The Role of Endoscopy Wait-Time and Stage at Diagnosis

Previous Publications

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Advancing diversity: the role of international medical graduates

Lancet Gastroenterol Hepatol

2021 Rachel Issaka

N/A

Perceptions on Barriers and Facilitators to Colonoscopy Completion After Abnormal Fecal Immunochemical Test Results in a Safety Net System

JAMA Netw Open

2021 Dana Atkins; Ari Bell-Brown; Rachel Issaka; Bryan Weiner; John Inadomi; Scott Ramsey

Importance: The effectiveness of stool-based colorectal cancer (CRC) screening, including fecal immunochemical tests (FITs), relies on colonoscopy completion among patients with abnormal results, but in safety net systems and federally qualified health centers, in which FIT is frequently used, colonoscopy completion within 1 year of an abnormal result rarely exceeds 50%. Clinician-identified factors in follow-up of abnormal FIT results are understudied and could lead to more effective interventions to address this issue. Objective: To describe clinician-identified barriers and facilitators to colonoscopy completion among patients with abnormal FIT results in a safety net health care system. Design, Setting, and Participants: This qualitative study was conducted using semistructured key informant interviews with primary care physicians (PCPs) and staff members in a large safety net health care system in Washington state. Eligible clinicians were recruited through all-staff meetings and clinic medical directors. Interviews were conducted from February to December 2020 through face-to-face interactions or digital meeting platforms. Interview transcripts were analyzed deductively and inductively using a content analysis approach. Data were analyzed from September through December 2020. Main Outcomes and Measures: Barriers and facilitators to colonoscopy completion after an abnormal FIT result were identified by PCPs and staff members. Results: Among 21 participants, there were 10 PCPs and 11 staff members; 20 participants provided demographic information. The median (interquartile range) age was 38.5 (33.0-51.5) years, 17 (85.0%) were women, and 9 participants (45.0%) spent more than 75% of their working time engaging in patient care. All participants identified social determinants of health, organizational factors, and patient cognitive factors as barriers to colonoscopy completion. Participants suggested that existing resources that addressed these factors facilitated colonoscopy completion but were insufficient to meet national follow-up colonoscopy goals. Conclusions and Relevance: In this qualitative study, responses of interviewed PCPs and staff members suggested that the barriers to colonoscopy completion in a safety net health system may be modifiable. These findings suggest that interventions to improve follow-up of abnormal FIT results should be informed by clinician-identified factors to address multilevel challenges to colonoscopy completion.

Financial Incentives to Improve Colorectal Cancer Screening-Time to Cut Our Losses

JAMA Netw Open

2021 Rachel Issaka; Jason Dominitz

N/A

Analysis of Speaker Introduction Formality by Gender at the American College of Gastroenterology 2020 Annual Scientific Meeting

Dig Dis Sci

2021 Rachel Issaka

BACKGROUND: Gender-based differences in the use of professional titles during speaker introductions have been described in other medical specialties. AIMS: Our primary aim was to assess gender-based differences in the formality of speaker introductions at the American College of Gastroenterology 2020 Virtual Annual Scientific Meeting. Our secondary aim was to assess gender-based differences in the formality of speaker self-introductions. METHODS: Reviewed presentations from the American College of Gastroenterology Annual Meeting for gender-based differences in professional title use during speaker introductions and self-introductions. RESULTS: Speakers included 29 women (37.2%) and 49 men (62.8%). We found no significant gender differences in the use of professional titles by introducers (t(67)=- 0.775, p=0.441) or in self-introductions (36.4% of women vs. 41.9% of men, t(63)=0.422, p=0.674). CONCLUSION: The lack of gender differences in professional title use may represent a novel advantage of virtual meeting formats or suggest increased attention to gender bias in introductions.

Advancing health equity: The Association of Black Gastroenterologists and Hepatologists

Nat Rev Gastroenterol Hepatol

2021 Rachel Issaka

N/A