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September 15, 2026BMC Family PracticeOpen Access

Exploring tradeoffs in approaches to providing and promoting colorectal cancer screening in low-income, medically underserved populations using causal loop diagramming

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Authors

MOMeghan C. O’LearyAHAnnika HoffMWM. Wilson

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Overview

Evidence synthesis reveals key resource tradeoffs in colorectal cancer screening for underserved populations, highlighting systems thinking to optimize long-term intervention sustainability.

Key Points

  • To evaluate tradeoffs between directly funding colorectal cancer screening tests and promoting screening through evidence-based interventions in low-income, medically underserved populations.
  • Identified and analyzed 38 peer-reviewed publications evaluating initiatives funded by the Colorectal Cancer Control Program (CRCCP).
  • Conducted inductive coding on 457 excerpts detailing the advantages and disadvantages of different implementation approaches.
  • Developed integrative narrative summaries and five causal loop diagrams (CLDs) using systems thinking principles.
  • Generated five causal loop diagrams covering system dynamics, intervention sustainability, cost drivers, stool-based versus colonoscopy modalities, and follow-up adherence.
  • Identified critical systemic trade-offs tied to short-term funding constraints, shifting population demographics, and upfront investments in clinical infrastructure and capacity building.
  • Demonstrated that causal loop diagrams effectively illustrate multi-level trade-offs to inform resource allocation and sustain screening programs over time.

Cite This Study

O’Leary et al. (2026) studied this question.

synapsesocial.com/papers/6aa913ba9013453be30a1dachttps://doi.org/10.1186/s12875-026-03510-3
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