What Multilevel Interventions Do We Need to Increase the Colorectal Cancer Screening Rate to 80%?

Abstract

Screening reduces colorectal cancer mortality; however, this remains the second leading cause of cancer deaths in the United States and adherence to colorectal cancer screening falls far short of the National Colorectal Cancer Roundtable goal of 80%. Numerous studies have examined the effectiveness of interventions to increase colorectal cancer screening uptake. Outreach is the active dissemination of screening outside of the primary care setting, such as mailing fecal blood tests to individuals' homes. Navigation uses trained personnel to assist individuals through the screening process. Patient education may take the form of brochures, videos, or websites. Provider education can include feedback about screening rates of patient panels. Reminders to healthcare providers can be provided by dashboards of patients due for screening. Financial incentives provide monetary compensation to individuals when they complete screening tests, either as fixed payments or via a lottery. Individual preference for specific screening strategies has also been examined in several trials, with a choice of screening strategies yielding higher adherence than recommendation of a single strategy.

Keywords: Colorectal Cancer; Healthcare Disparities; Implementation Science; Mass Screening.

Figure 1:

Conceptual Model of Multilevel Cancer Screening

Figure 2:

PROSPR Colorectal Cancer (CRC) Screening Process Model

Figure 3:

The Health Belief Model