Documenting adaptations across the Accelerating Colorectal Cancer Screening and follow-up through Implementation Science Research Programs: Methods and adaptation examples

Borsika Adrienn Rabin^1,2*Erin S Kenzie^3,4Jill M Oliveri⁵Aaron J Kruse-Diehr⁶Sonja Hoover⁷Usha Menon⁸Mark P Doescher⁹Prajakta Adsul^10,11Shiraz I Mishra¹²Kevin English¹³Jesse Nodora¹⁴Helen Lam¹⁵Karen Kim¹⁵Jennifer Coury³Melinda Davis^16,3,4Teri Malo¹⁷Sarah Kobrin¹⁸Sujha Subramanian⁷Renée M Ferrari¹⁷

• ¹Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, United States
• ²UC San Diego ACTRI Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, La Jolla, California, United States
• ³Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, United States
• ⁴School of Public Health, Oregon Health and Science University, Portland, Oregon, United States
• ⁵Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States
• ⁶Department of Family and Community Medicine, University of Kentucky Medical Center, Lexington, Kentucky, United States
• ⁷Implenomics, Dover, DE, United States
• ⁸The University of South Florida and Tampa General Hospital Cancer Institute, Tampa, FL, United States
• ⁹Department of Family and Preventive Medicine and Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
• ¹⁰Comprehensive Cancer Center, University of New Mexico, Albuquerque, New Mexico, United States
• ¹¹Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico, United States
• ¹²University of New Mexico Comprehensive Cancer Center and Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
• ¹³Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque Area Indian Health Board, Inc., Albuquerque, NM, United States
• ¹⁴UC San Diego Health Moores Cancer Center, University of California San Diego, La Jolla, CA, United States
• ¹⁵Center for Asian Health Equity, University of Chicago, Chicago, IL, United States
• ¹⁶Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, United States
• ¹⁷Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
• ¹⁸Healthcare Delivery Research, National Cancer Institute, Bethesda, MD, United States

Introduction: Adaptations are common, expected, and often imperative for successful uptake and sustained implementation of clinical or public health programs in real-world practice settings. Understanding which adaptations have been made to evidence-based interventions and subsequent implementation strategies throughout the life cycle of a project can contextualize findings and support future scale-up of the program. Systematic documentation of adaptations is rarely conducted or reported, and little guidance exists on approaches to documenting adaptations. Methods: Accelerating Colorectal Cancer Screening and follow-up through Implementation Science (ACCSIS) is a National Cancer Institute-funded Beau Biden Cancer MoonshotSM Initiative developed to improve colorectal cancer screening, follow-up, and referral for care among underserved groups, including diverse racial and ethnic populations and people living in rural areas. Using an iterative data gathering approach—a survey, data abstraction, and data validation—we compiled information about adaptation documentation and analytic methods and intervention and implementation strategy adaptations from the eight funded ACCSIS research programs. An analytic team representing multiple ACCSIS programs reviewed, coded, and summarized the data using a rapid qualitative analytic approach. Results: ACCSIS programs varied substantially in how they defined and documented adaptations. Nine approaches were used to document adaptations; the most common were periodic reflections and review of meeting minutes and agendas. Nine analytic methods were reported to guide adaptation analysis; the most frequently mentioned were rapid qualitative methods, descriptive statistics, and mixed-methods analysis. A total of 96 adaptations were reported by the eight research programs, most of which occurred during the pre-implementation stage (68%) or were made to the program format (71%). Only 36% of the adaptations were due to the COVID-19 pandemic. Conclusions: Our multi-method, systematic approach allowed us to explore how sites document and analyze adaptations across eight ACCSIS Moonshot programs. Using a systematic approach allowed for comparisons of intervention and strategy adaptations within and across research programs and can inform the science of adaptations, while building a knowledge base of why such adaptations are needed and how they can inform implementation efforts across time. Methods described herein provide a template for similar assessment activities in other large, multi-site research initiatives.