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

March 2017

Part 3: Overcoming Barriers to Colorectal Cancer Screenings

The third of a four-part series regarding colorectal cancer (CRC) screenings

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

The series now continues with article three, Overcoming Barriers to Colorectal Cancer Screening.

CRC screenings can be a highly effective preventive measure that offers your patients the best possible outcomes. The U.S. Preventive Services Task Force (USPSTF) has found convincing evidence that screening for colorectal cancer with several different methods can accurately detect early-stage colorectal cancer and adenomatous polyps.1

The rates of new colorectal cancer cases and deaths among adults aged 50 or older are decreasing in this country due to an increase in screenings and changes in some risk factors (e.g., a decline in smoking).2

Patient Concerns

A BCBSTX member survey, completed in January 2016, asked members why they chose NOT to complete CRC screenings. The top three reasons were:

  • “I did not know that the test was covered by my insurance.”
  • “I am afraid of the test/discomfort.”
  • “I do not have symptoms.”

Additional patient concerns included:

Embarrassment/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 completed in the privacy of their own home.

Misconceptions about Cancer and Cancer Screenings
Some patients feel that being asymptomatic equates to an absence of cancer.

  • Sensitivity to personal and cultural fears surrounding 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 even when they feel healthy.

Lack of Information
Information about available testing options and processes isn’t always readily available.

  • Discuss the variety of CRC screening options, as well as individual considerations that may impact CRC screening test selection. Offer a questionnaire at check-in to expedite CRC screening selection and to allow the patient time to formulate questions about CRC screenings.
  • Once a CRC screening option is agreed upon, explain the expectations and process. Assure that medications for discomfort will be provided for CRC screening procedures. Patient brochures and information are available through the local ACS.3

Concerns Regarding Costs and/or Interruption of Daily Life Responsibilities
Although CRC screenings are a preventive measure, there may be affiliated 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 colorectal cancer or finding it early does not have to be expensive. There are simple, affordable tests available.
  • Encourage patients to contact their BCBSTX customer service representatives to discuss benefits and coverage.

Provider Concerns

Visit Time Constraints
Addressing acute or chronic conditions may take precedence over preventive care during a visit.

  • Train your staff to identify patients with gaps in preventive care to allow for focused and efficient use of your time. Office systems that “flag” patients needing CRC screenings are advantageous. Having printed materials available in the waiting room may encourage conversations.

Familiarity with Recommended CRC Screening Options
Various factors determine which option is best for each patient.

Office Process

  • Identify a CRC screening champion in your office to train staff in identifying patients who are due for screenings.
  • Standing orders will allow key staff to assess, implement and follow-up with patients regarding their selected CRC screening option.
  • Stocking Fecal Immunochemical Testing (FIT) kits in the office, to dispense during visits, can be effective. 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 they can visualize the test and ask questions. They will also be more likely to complete the CRC screening if they feel confident in the process.

Resources to Follow Up on Positive CRC Screenings
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.

References:
1 Final Recommendation Statement: Colorectal Cancer: Screening (n.d.). US Preventive Services Task Force, Release Date June 2016.
2 Tests to Detect Colorectal Cancer and Polyps. Retrieved from NIH National Cancer Institute.
3 American Cancer Society, Find Local ACS