Reducing Overscreening for Breast, Cervical, and Colorectal Cancers among Older Adults (R01 Clinical Trial Optional) | PA 18 005

Opportunity Information: Apply for PA 18 005

The National Institutes of Health (NIH) funding opportunity titled "Reducing Overscreening for Breast, Cervical, and Colorectal Cancers among Older Adults (R01 Clinical Trial Optional)" (Funding Opportunity Number PA 18-005) supports research aimed at curbing the unnecessary use of cancer screening tests in average-risk older adults. The FOA is grounded in the idea that, although cancer screening campaigns have improved early detection and outcomes in many populations, screening can become harmful when it continues past the point where benefits outweigh risks. In older adults especially, repeated screening for breast, cervical, or colorectal cancer may expose people to avoidable downsides such as false positives, anxiety, follow-up procedures, complications from invasive diagnostic tests, overdiagnosis, and treatments that do not improve longevity or quality of life. The overall goal is to generate evidence that helps healthcare systems reduce this kind of low-value care while protecting older adults health, independence, and day-to-day well-being.

This announcement is specifically focused on interventions that are based in healthcare settings and are designed to reduce overscreening. NIH is signaling that overscreening is not simply an individual choice problem; it is often driven by multiple, interacting influences that can occur at several levels at once. These levels include the individual patient (beliefs, preferences, fear of cancer, misunderstanding of benefits and harms, prior screening habits), the healthcare team (clinician knowledge of guidelines, communication style, incentives, workflow pressures, defensive medicine), the healthcare system (electronic health record reminders, quality metrics that reward more screening, institutional policies, referral pathways), and the surrounding community or community organizations (norms, messaging, local advocacy, access patterns). Because of that complexity, the FOA emphasizes research that both explains why overscreening happens and tests practical strategies to reduce it in real-world delivery systems.

A central requirement of the research approach is that proposed projects should intervene at two or more levels and measure outcomes at two or more levels, while also accounting for the interactions between those levels. In practice, this means NIH is looking for multi-level intervention designs rather than single-component solutions. For example, an application might combine patient-facing decision support with clinician communication training, or pair changes to EHR prompts and performance metrics with patient education and shared decision-making tools. Outcomes could similarly span multiple levels, such as changes in patient knowledge and decisional conflict, clinician ordering behavior, clinic-level screening rates among older adults, rates of follow-up diagnostic procedures, complications, patient-reported outcomes, or system-level measures of low-value care. The explicit expectation is that investigators will analyze how changes at one level affect other levels (for instance, how altering automated reminders influences clinician behavior and patient expectations, or how clinician messaging affects patient acceptance of stopping screening).

The mechanism is an R01 research project grant, with clinical trials listed as optional, meaning applicants may propose either clinical trial or non-trial research as appropriate for the intervention and evaluation plan. The opportunity falls under the discretionary grant category and is associated with CFDA numbers 93.394 and 93.866, reflecting NIH program areas relevant to cancer prevention, healthcare delivery, and aging-related outcomes. While the listing includes an original closing date of January 7, 2020, the scientific scope summarized here reflects what the FOA is seeking: rigorous healthcare-setting research that reduces overscreening and clarifies its consequences for older adults.

Eligibility is broad and includes many types of domestic applicants such as state, county, and local governments; special district governments; independent school districts; public and state-controlled institutions of higher education; private institutions of higher education; nonprofit organizations (with or without 501(c)(3) status); for-profit organizations (other than small businesses) as well as small businesses; public housing authorities/Indian housing authorities; and federally recognized Native American tribal governments. The FOA also highlights additional eligible applicants, including Alaska Native and Native Hawaiian Serving Institutions; Asian American Native American Pacific Islander Serving Institutions (AANAPISIs); Hispanic-serving Institutions; Historically Black Colleges and Universities (HBCUs); Tribally Controlled Colleges and Universities (TCCUs); faith-based or community-based organizations; eligible federal agencies; regional organizations; U.S. territories or possessions; tribal governments that are not federally recognized; and non-U.S. entities (foreign organizations). Overall, NIH is encouraging proposals from a wide range of institutions that can study overscreening in diverse healthcare environments and populations, especially where older adults may experience different risks, expectations, and system pressures that lead to continued screening even when it is unlikely to help.

• The National Institutes of Health in the education, health sector is offering a public funding opportunity titled "Reducing Overscreening for Breast, Cervical, and Colorectal Cancers among Older Adults (R01 Clinical Trial Optional)" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.394, 93.866.
• This funding opportunity was created on 2017-11-03.
• Applicants must submit their applications by 2020-01-07. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• Eligible applicants include: State governments, County governments, City or township governments, Special district governments, Independent school districts, Public and State controlled institutions of higher education, Native American tribal governments (Federally recognized), Public housing authorities/Indian housing authorities, Native American tribal organizations (other than Federally recognized tribal governments), Nonprofits having a 501 (c) (3) status with the IRS, other than institutions of higher education, Nonprofits that do not have a 501 (c) (3) status with the IRS, other than institutions of higher education, Private institutions of higher education, For-profit organizations other than small businesses, Small businesses, Others.

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