When developing best practices for talking with patients about colorectal cancer screening, it is important to recognize that certain patient populations may have additional concerns or barriers to getting screened.
Socioeconomic and Psychosocial Barriers
Barriers to consider that may prevent some people from getting screened may include language, age, and social circumstances. One study reported 4 main barriers among a group of ethnically and linguistically diverse people who received care at community health centers in the Boston area.1
Low-income and low-education levels spanned the diverse group and may be responsible for these underlying barriers to screening.1
4 barriers to screening
Another study showed that unmarried people were less likely to adhere to colorectal cancer screening recommendations.2 And, in a survey of men and women aged 50 years and older, 18% cited BEING TOO BUSY as their primary reason for not getting screened.3
Additional factors associated with lower adherence to colorectal cancer screening recommendations
Lack of time
Although colorectal cancer affects men and women of all ages and races/ethnicities, the incidence and mortality rates of colorectal cancer are higher in African Americans compared with rates in other races.4 This may be in part because fewer African Americans get screened.4
Number of Colorectal Cancer Deaths by Race/Ethnicity & Sex5
Counseling Techniques to Try
Some things to keep in mind when having a conversation about colorectal cancer screening with your patients:
- Patients may not be comfortable initiating this conversation, so health care providers may need to start the discussion and encourage patients’ questions
- Even patients who agree that screening is important may delay making their appointments and may need additional reminders
- If referred to a gastroenterologist for these procedures, patients may not think to send information back to their primary care physician. Your staff may need to reach out to the specialist's office to ensure that appointments are made and results are received
- It may be helpful to acknowledge your patients' fears about certain screening tests, especially as the day of the procedure approaches
- Patients may not know that colorectal cancer may be prevented through regular screenings or that during a colonoscopy precancerous polyps may be identified and removed6
- Patients may not be aware of how frequently they should repeat the screening procedure
What Else Can I Do to Increase Screening Rates?
Although many physicians discuss cancer screening recommendations during annual checkups, this approach will not reach all the patients in the practice who need screening.
Instead, take a “global” or “opportunistic” approach and recommend screening during all types of visits. This may help to increase the number of patients who get a screening test. There are also opportunities throughout the year to remind patients to schedule a screening:
- Send a Happy Birthday and reminder card, text, or e-mail on a patient’s 45th birthday or every 10 years as needed7
- If your office utilizes electronic medical records, there may be an automatic communications feature
Create age-related preventive service checklists to keep in patients’ charts
- Give patients a copy of the checklist to increase their awareness
Send a message in March, which is Colorectal Cancer Awareness Month
- Consider a tie-in with the March Madness basketball tournament; make it fun and create a game to alleviate embarrassment
- Consider other reminders around holidays or events throughout the year, such as Christmas (give yourself a gift!) or Valentine’s Day (a perfect day to love your colon!)
- Leverage community organizations to send out additional reminders
- Lasser KE, Ayanian JZ, Fletcher RH, Good M-J. Barriers to colorectal cancer screening in community health centers: a qualitative study. BMC Fam Pract. 2008;9:15.
- Hudson SV, Ferrante JM, Ohman-Strickland P, et al. Physician recommendation and patient adherence for colorectal cancer screening. J Am Board Fam Med. 2012;25(6):782-791.
- Colon Cancer Alliance. Closing the gap in colon cancer screening: results of a national telephone survey. https://www.questdiagnostics.com/dms/Documents/Other/CCA_Quest_colon_cancer_study.pdf. June 2011.
- American Cancer Society. Cancer Facts & Figures for African Americans 2019-2021. Atlanta, GA: American Cancer Society Pub. No. 861419. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-african-americans/cancer-facts-and-figures-for-african-americans-2019-2021.pdf. Accessed March 23, 2020.
- National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer stat facts: colorectal cancer. https://seer.cancer.gov/statfacts/html/colorect.html. Accessed April 8, 2020.
- Centers for Disease Control and Prevention. Colorectal cancer screening. https://www.cdc.gov/cancer/colorectal/pdf/basic_fs_eng_color.pdf. Accessed March 25, 2020.
- Wolf AM, Fontham ET, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250-281.