Intervention during wait time: identification and referral of individuals non-adherent for colorectal cancer screening

Abstract

Background Despite unanimous recommendations from numerous specialty societies on regular colorectal cancer screening, a substantial proportion of eligible adults are non-adherent with screening. The current study investigated whether research associates (RAs) in the emergency department (ED) can adequately assess patients’ adherence with colorectal cancer screening recommendations, outlined by the US Preventive Services Task Force (USPSTF), and provide referrals to individuals who are found to be non-adherent. Methods RAs at seven heterogeneous hospitals in the USA queried non-emergent adult patients and visitors between the ages of 50 and 75. After obtaining verbal consent, the participant’s adherence with USPSTF guidelines for colorectal cancer screening was assessed. Participants found due for screening were provided with referrals to obtain these recommended screenings. Results A total of 8258 participants were surveyed on their colorectal cancer screening status, with RAs identifying 2063 participants who were not adherent with USPSTF guidelines for colorectal cancer screening and 67 for whom adherence could not be determined (total 27%). Conclusions Our study demonstrates that RAs can identify a large volume of eligible adults who would benefit from colorectal cancer screening across a variety of emergency department settings.

Characteristics and Barriers of Emergency Department Patients Overdue for Cancer Screening

“…Despite the fact that only 8.3% of participants reported that COVID-19 delayed their cancer screening, our findings found relatively high rates of patients overdue on screening compared to past studies conducted in the ED prior to the pandemic (overdue rates 12–33% for cervical, 9 – 11 12–46% for breast, 5 , 10 – 12 and 17–46% for CRC screening 5 , 12 , 13 ). Our higher rates of overdue screenings were probably due not to the pandemic but may have been related to the characteristics of our patient population.…”

“…Our higher rates of overdue screenings were probably due not to the pandemic but may have been related to the characteristics of our patient population. Our study had much higher percentages of Asian (7%) and Hispanic (30%) participants than other similar studies, which had 1–3% 5 , 9 , 10 , 13 and 7–18%, 5 , 10 – 13 , 25 respectively. Additionally, in our study Spanish-speaking patients represented 15% of all participants.…”

“…Past studies of cancer screening adherence for eligible ED patients have found that 12-33% of women were overdue or had uncertain adherence with cervical cancer screening [9][10][11] ; 12-46% of women were overdue for breast cancer screening 5,[10][11][12] ; and 17-46% were overdue for CRC screening. 5,12,13 The percentage of patients overdue for cancer screenings has been significantly higher for those who have no insurance 5,9,10,13 or a primary care physician, 9,13 and patients with less education, 5,9,13 with mixed findings on the role of race and ethnicity, 5,9,[11][12][13] However, these studies occurred prior to the coronavirus 2019 (COVID-19) pandemic. Results from large national surveys showed that approximately 55% of respondents reported that they or someone in their household delayed or skipped routine medical care during the pandemic, 14,15 suggesting that rates of being overdue for cancer screening may be higher post-pandemic and/or more disparate for some groups of patients.…”