Table 3 Measurement and evaluation challenges related to integrated implementation

Interventions and supporting activities

One-on-one education; patient reminders; provider reminders; electronic medical record system enhancements

Level of integration may vary across multicomponent interventions, with combined implementation at some levels and not others

Process measures

Proportion of patients receiving education; number of phone calls to remind patients or providers

Time spent during education sessions or phone calls on specific cancers may be difficult to accurately determine

Screening outcomes—short or medium term

Number of individuals screened; proportion completing recommended follow-up procedures

The denominator will differ for each type of screening based on individuals due for a screen during the time period of the intervention. Good tracking processes are required.

Comparing outcomes across clinics may be challenging as individuals not up to date with screening may vary in the mix of screenings required during the intervention period.

Diagnostic follow-up procedures are unique to each type of cancer screening and therefore the completion rates may also differ.

Screening outcomes—long term

Cancer mortality averted and life years saved due to screening

Long-term outcome estimates will require different microsimulation models for colorectal, breast, and cervical cancers. Joint impacts may be difficult to assign separately to each type of cancer screening

Implementation outcomes

Acceptability, appropriateness, feasibility, fidelity, sustainability

Joint implementation of interventions and supporting activities may mask implementation challenges related to each type of cancer screening

Cost measures and economic assessments

Activity-based cost of interventions; cost per successful screen

Stakeholders may not be able to separate out resource use and cost related to specific cancer screenings