From the Guidelines
To improve bowel cancer screening participation, healthcare systems should implement a multi-faceted approach, prioritizing personalized invitation letters, educational campaigns, and offering multiple screening options, as recommended by the most recent guidelines 1. The approach should include:
- Personalized invitation letters with pre-scheduled appointments
- Educational campaigns addressing misconceptions about screening procedures
- Offering multiple screening options such as fecal immunochemical tests (FIT) and colonoscopy Primary care providers should directly recommend screening during routine visits, emphasizing that early detection significantly improves survival rates, as supported by the American Cancer Society's updated guideline for CRC screening in individuals at average risk 1. Practical barriers can be reduced by:
- Providing convenient appointment times
- Transportation assistance
- Ensuring screening is affordable through insurance coverage or subsidized programs Reminder systems using text messages, phone calls, or emails have proven effective, while cultural sensitivity in educational materials helps reach diverse populations 1. Community-based approaches involving trusted local organizations and mobile screening units can access underserved areas, and patient navigation programs that guide individuals through the screening process are particularly valuable for those with limited health literacy 1. These strategies work by addressing the common barriers to screening: lack of awareness, fear of procedures, practical obstacles, and cultural concerns, ultimately aiming to reduce bowel cancer mortality by up to 60% 1. It is essential to note that the American Cancer Society recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) exam, depending on patient preference and test availability 1. By following these guidelines and implementing a comprehensive approach, healthcare systems can improve bowel cancer screening participation and ultimately reduce morbidity, mortality, and improve quality of life for patients.
From the Research
Steps to Improve Bowel Cancer Screening Participation
To improve bowel cancer screening participation among patients, several steps can be taken:
- Implement targeted interventions for individuals with a family history of colorectal cancer, as they have low screening rates and report multiple mutable barriers to screening 2
- Develop multi-modal approaches that include patient-level components, such as mailed letters with education about screening options and pre-colonoscopy telephone counseling, as well as system-level modifications, like establishment of a patient navigator and expedited work-up for abnormal results 3
- Integrate population-wide, primary care, and targeted approaches to increase screening participation, including mass media campaigns, targeted awareness and education programs for underscreened populations, and programs involving general practice to improve the knowledge and confidence of general practitioners to discuss bowel screening with their patients 4
Addressing Barriers to Screening
Barriers to screening can be addressed by:
- Implementing interventions that include patient reminders or one-on-one interactions, eliminate structural barriers, or make system-level changes, such as simplifying access to fecal occult blood test cards 5
- Identifying culturally sensitive and cost-effective methods of promoting screening, particularly in medically underserved populations, such as U.S. Latinos 6
- Providing financial incentives for increasing screening rates, patient education programming, and involving promotores to support the work of clinical teams 6
Implementation of Multilevel, Multicomponent Interventions
Multilevel, multicomponent interventions can be implemented by:
- Partnering with academic institutions to deliver group-based, promotor-led CRC screening interventions for patients not up to date with screening 6
- Addressing concerns about available resources to implement new programs, lack of federal reimbursement for health education, competing priorities of other health concerns, and the need for more resources for confirmatory screening and treatment following a positive screen 6