Dr. Singal is an expert in hepatocellular carcinoma and colorectal cancer, particularly in early tumor detection and screening process failures. He serves as Medical Director of the Liver Tumor Program at UT Southwestern Medical Center and is currently leading several federal and state-funded projects to evaluate interventions to improve the effectiveness of early tumor detection efforts for both cancers in the United States. Dr. Singal has published over 100 scientific papers and has established collaborations with experts throughout the United States over the past several years. He has been active in many academic professional societies including American Association for Study of Liver Diseases (AASLD), International Liver Cancer Association (ILCA), American College of Gastroenterology (ACG), and American Gastroenterological Association (AGA). He has editorial experience including serving as an Associate Editor for Clinical Gastroenterology and Hepatology, Seminars in Liver Disease, and Clinical Translational Gastroenterology as well as an Academic Editor for PLOS Medicine.
Questions and Answers
What aspects of the program can be adapted without it losing its effectiveness? Are there specific audiences (beyond those included in the research study) that you feel this program could be adapted for? Any that it shouldn’t be adapted for?
It is important to include both screening invitation letters and at least two telephone call reminders to encourage screening. While these materials can be tailored to the target population as needed, it is important that they are kept at a low literacy to ensure understanding. We feel the intensity and effectiveness of this program could be increased by conducting additional telephone reminder calls and varying the timing of these calls (e.g., calling patients outside normal business hours). Other systems could try automated telephone reminders or text messaging; however, these methods have not been extensively validated.
What do you view as the facilitators to implementation? What might be some challenges?
We engaged stakeholders from the GI and Pathology departments in design and implementation of the colorectal screening outreach interventions. As a result, we were able to centralize FIT processing and streamline colonoscopy scheduling through the use of reserved endoscopy slots. Endoscopy capacity may be a challenge among health systems who serve larger at-risk populations. Additional challenges among our population included intermittent phone service and high rates of residential mobility; therefore, we would expect these strategies to be even more effective in other populations.
Do you have suggestions for questions that practitioners should include when they evaluate the adaptation/implementation of your program? Do you have specific evaluation tools that would be appropriate for practitioners when they evaluate this program?
We recorded all telephone call reminders for quality assurance purposes and addressed any deviations from the script with the research team. To ensure the each step of the protocol was implemented as intended, we monitored the timing of outreach activities closely through the use of several reports created within the study database.
What is your current research focus?
We are evaluating the long-term effectiveness of this program to increase completion of the screening process (including screening initiation and follow-up) within 3 years. Additionally, we are evaluating large-scale population health management efforts for other diseases such as liver cancer screening among patients with cirrhosis and hepatitis C screening and treatment among baby boomers.