Blue Review
A newsletter for physician, professional, facility, ancillary and Medicaid providers

May 2018

Overcoming Barriers to Colorectal Cancer Screening

Thank you for your continued support and interest in colorectal cancer (CRC) screenings. An article in the February 2018 Blue Review newsletter, Colorectal Cancer Screening: 80% by 2018, Will You Commit? discussed the efforts of Blue Cross and Blue Shield of Texas (BCBSTX), the American Cancer Society® and the National Colorectal Cancer Roundtable to have 80 percent of BCBSTX’s members, ages 50 to 75, screened for CRC by the end of 2018. A March Blue Review article, titled Colorectal Cancer Screening Options and Statistics – Get the Conversation Started Today, discussed the various CRC screening methods available.

Our CRC screening initiative series now continues with how to overcome barriers to CRC screening.

CRC screening can be a highly effective preventive measure that offers patients improved outcomes. The U.S. Preventive Services Task Force has found convincing evidence that screening for CRC through a variety of different methods can accurately detect early-stage CRC and adenomatous polyps.

The rates of new CRC cases and deaths among U.S. adults ages 50 years or older are decreasing due to an increase in screenings and changes in some risk factors (e.g., a decline in smoking). Still, overcoming barriers may be challenging.

Patient Concerns

A 2017 BCBSTX member survey asked members why they chose not to complete a CRC screening. The primary reasons included:

  • lack of symptoms or family history, and
  • procrastination.

After the at-home test concept was introduced to survey respondents, scores for likelihood to utilize an at-home CRC screening option went from 36 percent to 69 percent. Messages that focused on at-home privacy and insurance coverage resonated most with members.*

Let’s take a closer look at patient concerns and sample approaches you can take to overcome them.

Embarrassment or Awkwardness

  • Patients feel embarrassed about bowel functions and/or tests that involve stool collection.
  • Inform patients that there are several screening options available, including simple take-home tests that can be done in the privacy of their own homes.

Misconceptions about Cancer and Cancer Screening

  • Some patients feel that being asymptomatic equates to an absence of cancer.
  • Sensitivity to personal and cultural fears about cancer itself is important. Let patients know that many people diagnosed with colon cancer do not have any symptoms or a family history, which is why screening is so important.

Lack of Information

  • Information about available testing options and processes isn’t always readily available.
  • Discuss the variety of CRC screening test options, as well as individual considerations that may impact CRC screening test selection. Offer a questionnaire at the time of check-in to expedite the CRC screening selection and to allow the patient time to formulate questions about the CRC screening.
  • Once a CRC screening option is agreed upon, explain the expectations and process. Assure the patient that medications for discomfort will be provided for CRC screening procedures. Patient brochures and information are available through your local American Cancer Society office.

Concerns Regarding Costs and/or Interruption of Daily Life Responsibilities

  • Although CRC screening is a preventive measure, there may be out-of-pocket costs. Loss of work and/or lack of transportation may be a concern with a flexible sigmoidoscopy or colonoscopy. Inform patients that preventing CRC or finding it early does not have to be expensive. There are simple, affordable tests available.
  • Encourage patients to contact their BCBSTX customer service advocates, using the phone number on the back of their ID card, to discuss benefits and coverage.

Provider Concerns

Office Visit Time Constraints

  • Addressing acute or chronic conditions may take precedence over preventive care during a visit.
  • Train staff to identify patients with gaps in preventive care to allow focused and efficient use of provider time. Office systems that “flag” patients needing a CRC screening are helpful. Having printed materials available in waiting rooms may also encourage conversations.

Familiarity with Recommended CRC Screening Options

Office Process

  • Identify a CRC screening champion in your office to train staff in identifying patients who are due for screening.
  • Standing orders will allow key staff to assess, implement and follow-up with patients regarding their selected CRC screening option.
  • Stock Fecal Immunochemical Testing (FIT) kits in the office to dispense during visits. When patients agree to FIT testing, allow them to open the kit, handle the materials and complete the paperwork. The mystery will be removed if the patient can see the test and ask questions. They will be more likely to complete the CRC screening if they feel confident in the process.

Resources to Follow up on Positive CRC Screening

  • You may be concerned that patients with positive CRC screening results may not have access to gastroenterologists or cancer treatment specialists.
  • Review the availability of local resources to alleviate this concern or have patients call the number on the back of their member ID card to discuss resources.

LifeTimes®
Let your patients know they can find information about cancer on our LifeTimes health and wellness website. Several articles focus on the importance of colorectal cancer screening, such as: Growing Cancer Risk for Younger Adults: What You Should Know.