Can MTDIRC help address inequity in cancer screening and early detection?
As a cancer prevention researcher with a focus on underserved populations, dissemination and implementation (D&I) science provides a special appeal. Why? Because the key elements in D&I lend themselves well to addressing cancer related disparities. The “top 3” for me include: use of existing evidence, community-academic partnership, and real world assessment.
At the heart of D&I research is the use of existing evidence. In the case of cancer screening and early detection there is sufficient evidence on what primary care providers should be doing. This includes practice guidelines, formal strategies, and even accreditation linked standards of care. What D&I science brings to the table is the “how.” In my case the “how” focuses on optimal cancer screening and early detection in federally qualified health centers. These centers treat most of our countries un- and underinsured and can benefit from detailed approaches for their settings.
For most academics, true community-academic partnerships (e.g., with clinic administrators, providers, and patients) tend to be a challenge. Few academic institutions have a history of or a structure for sustained community-academic partnership, especially among underserved communities. In order to be effective, D&I science requires such partnerships. This suggests that MTDIRC fellows may foster the creation, and/or expansion, of community-academic partnerships.
Real world assessment has been called for in public health research for decades, but not so much in cancer prevention and control. The application of D&I approaches in cancer prevention research, such as the ubiquitous Reach Effectiveness Adoption Implementation and Maintenance (REAIM) framework, offers great promise. Each of the REAIM steps asks investigators to look through a pragmatic lens, especially for the first (Reach) and last (maintenance) steps. Hopefully, the questions and assessments on “Reach” will move the spot light to those in greatest need while the questions and assessments on “Maintenance” will foster a dialogue beyond limited short-term research funds.
The training and collaborations provided by MTDIRC can help address inequity in cancer screening and early detection. The key elements in D&I science encourage academics to “apply” what is known and understand “how” this was done. Most importantly, the process is focused on impacting practice.