In January 2008, we reviewed all CCC plans (n = 55) posted on the Cancer Control PLANET Web site (http://cancercontrolplanet.cancer.gov
). This Web site contains all published CCC plans and is regularly updated as new plans are disseminated. A list of search terms to identify evidence-based content was compiled on the basis of a content review of topics in CCC plans (16
). Other search terms likely to identify evidence-based content were included, as were names of organizations involved in reviewing or disseminating evidence-based information on cancer prevention. The feasibility of using key terms for the entire review was determined by using the terms to test a select number of plans. We excluded terms that were either too ambiguous or unlikely to yield evidence-based content related to CRC prevention and early detection.
We used the search feature in Adobe Acrobat Reader version 8 (Adobe Systems Inc, San Jose, California) to search each cancer plan for colorectal or colon cancer content. The paragraph related to the term was reviewed for specific key terms to potentially identify evidence-based content (). An abstraction tool to facilitate review was created in Microsoft Excel (Microsoft Corporation, Redmond, Washington). Content items were copied and then coded within this tool. Items were included if they referred to screening, interventions, or evidence-based sources or programs (including how to build or develop the evidence base). Only items specific to CRC prevention and early detection were abstracted. Names of organizations (eg, American Cancer Society) were only included if they were in the context of screening guidelines, evidence-based interventions, research projects, or the development of interventions. Therefore, items that only identified the organization were excluded (eg, name of person affiliated with the organization). In some instances, the key terms identified content that was clearly not evidence-based or was too ambiguous to classify. When this situation was encountered, the content was not abstracted after determining that it could not be classified as evidence-based.
Evidence-Based Content for Colorectal Cancer Identified in State, Tribal Governments and Organizations, Territories, and Pacific Island Jurisdictions' Comprehensive Cancer Control Plans (n = 54) by Search Term
Key terms included the following exact phrases or words: best practice(s), effective/effectiveness, established, evaluated intervention trial, evidence-base(d)/evidence base(d), evolving science, guideline(s), proven, research into practice, research-tested, science-based, scientific evidence, translation of research, and tested. The following organizations and sources of evidence-based recommendations and interventions (documents and Web sites) were included as key terms: American Cancer Society (ACS), Cochrane Reviews, the Task Force on Community Preventive Services' Guide to Community Preventive Services (Community Guide), the National Cancer Institute's Physician Data Query (NCI's PDQ), the Agency for Healthcare Research and Quality (AHRQ), Put Prevention into Practice (PPIP), NCI's and Substance Abuse and Mental Health Services Administration's (SAMHSA) Research Tested Intervention Programs (RTIPs), and United States Preventive Services Task Force (USPSTF) recommendations — Guide to Clinical Preventive Services. If multiple key terms identified the same content, each additional key term was also recorded.
The context of each key term was evaluated for whether it appeared in background information; a goal, objective, or strategy; an activity outside of a goal, objective, or strategy; a recommendation that will be promoted; or other. The section or chapter of the cancer plan where the term was located was categorized according to the following sections along the cancer control continuum: primary prevention, secondary prevention or early detection, treatment, palliation or end-of-life care, and survivorship. Other categories were based on where the content was found in the plan, including executive summary, introduction, conclusion, health disparities, and other. If recorded as "other," the specific title of the section or chapter was recorded. Because not all cancer plans were organized along the cancer control continuum, the "other" category often included chapters specifically addressing CRC. Direct mention of the following evidence-based cancer prevention recommendations and sources were noted and categorized as follows: Community Guide, Cochrane Reviews, NCI's PDQ, USPSTF, ACS, PPIP, and RTIPs. The year that the cancer plan was published (identified as a publication date or dated letter from a state official), Cochrane Reviews, NCI's PDQ, USPSTF, ACS, PPIP, and RTIPs. The year that the cancer plan was published (identified as a publication date or dated letter from a state official) was recorded. In the absence of a publication date, the first year of implementation of the cancer plan was used. The evidence-based content in the CCC plans was further evaluated and categorized according to whether it referred to 1) select evidence-based screening/early detection guidelines (ie, published by ACS or USPSTF or listed in NCI's PDQ) or 2) an evidence-based program or intervention in the community. The second category included interventions that were being proposed, planned, developed, adapted; were currently in use; or had been used. Some evidence-based content appeared as background or reference material only and was categorized as such. CCC plans could have content in all categories.
Two separate analyses were conducted. The first analysis examined the evidence-based content itself to describe the type of content that appeared in the CCC plans, and the second was a program-level analysis to identify the number of programs referring to specific types of evidence-based interventions or screening guidelines. The latter analysis was conducted to identify gaps in addressing evidence-based interventions in current CCC plans. All descriptive analyses were conducted using SAS version 9 (SAS Institute, Inc, Cary, North Carolina) after importing the abstracted and coded content from Excel.