October 2017

Overcoming Barriers to Colorectal Cancer Screenings

Part 3 of a 4-part series discussing Colorectal Cancer Screening.
Colorectal Cancer (CRC) screenings can be a highly effective preventive measure that offers your patients the possibility of 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

The biggest influencer to motivate patients to get screened is you and your staff. One way to help your patients is to discuss overcoming barriers to CRC screening.

Patient Concerns
When some of our members were asked in a 2016 survey 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.

See below for examples of additional patient concerns, along with suggestions for what you and your staff can do to help.

Embarrassment/Awkwardness
Patients may 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 may 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 for the disease, 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 the patient that medications for discomfort will be provided for CRC screening procedures. Also consider directing the patient to the local American Cancer Society^® for informational brochures and other patient resources.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 Blue Cross and Blue Shield of Illinois (BCBSIL) members to call the Customer Service number on their ID card to discuss benefits and coverage.

Provider Concerns
Listed below are examples of concerns that may apply to you and your staff, along with suggestions to help you transform any challenges into opportunities to motivate your patients to get screened.

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 also encourage conversations.

Familiarity with Recommended CRC Screening Options
Various factors can help determine which option may be best for each patient.

• Review last month’s Blue Review article, Colorectal Cancer Screening Options and Statistics – Get the Conversation Started, which discusses available CRC screening methods, such as direct visualization tests, stool-based tests and serology.

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 help alleviate this concern or have patients call the number on their BCBSIL member ID card to discuss available resources.

BCBSIL, the American Cancer Society and the National Colorectal Cancer Roundtable have signed a pledge to have 80 percent of BCBSIL’s members, ages 50 to 75, screened for colorectal cancer by 2018. Click the links below to read parts 1 and 2 of this 4-part CRC screening article series:

• Colorectal Cancer Screening: 80% Participation by 2018 – Will You Commit?
• Colorectal Cancer Screening Options and Statistics – Get the Conversation Started

References:

¹Final Recommendation Statement: Colorectal Cancer: Screening (n.d.). USPSTF, Release Date June 2016.

²Tests to Detect Colorectal Cancer and Polyps. Retrieved from NIH National Cancer Institute.

³American Cancer Society, Find Local ACS

The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.

References to other third party sources or organizations are not a representation, warranty or endorsement of such organizations. Any questions regarding those organizations should be addressed to them directly.