Interventions to Increase Colorectal Cancer Screening Uptake in Primary Care: A Systematic Review

Abstract

Objective: We systematically reviewed and summarized previous studies that examined facilitators and barriers to implementing interventions to increase CRCS uptake in primary care practice.Methods: We searched PubMed, Medline (EBSCO), and CINAHL databases, from the inception of these databases to April 2020. The search strategy combined a set of terms related to facilitators/barriers, intervention implementation, CRCS, and uptake/participation. A priori set inclusion and exclusion criteria were used during both title/abstract screening and full-text screening phases to identify the eligible studies. Quality of the included studies was appraised using quality assessment tools, and data were extracted using a predetermined data extraction tool. We classified facilitators and barriers according to the Consolidated Framework for Implementation Research domains and constructs and identified the common facilitators and barriers looking at how common they were across studies.Results: A total of 12 studies were included in the review. Engagement of the clinic team, leadership team, and partners, clinics' motivation to improve CRCS rates, use of the EMR system, continuous monitoring and feedback system, and having a supportive environment for implementation were the most commonly reported implementation facilitators. Limited time for the clinic team to devote to a new project, challenges in getting accurate, timely data related to CRCS, limited capacity/support to use the EMR system, and disconnect between clinic team members were the most commonly reported implementation barriers.Conclusions: The synthesized findings improve our understanding of facilitators of and barriers to the implementation of interventions to increase CRCS participation in primary care practice, and inform the customized implementation strategies. Many of the included studies had limited use of rigorous implementation science frameworks to guide their implementation and evaluation, which precludes a comprehensive understanding of the implementation factors specific to CRCS interventions in primary care. Future studies assessing the CRCS intervention implementation factors would benefit from the use of implementation science frameworks.

Colorectal cancer screening barriers and facilitators among Jordanians: A cross-sectional study

“…Therefore, the healthcare authorities should emphasize the role of GPs in enhancing CRC screening rates. A recent systematic review investigated the facilitators and barriers to implementing interventions to enhance CRC screening uptake in primary care practice ( Adhikari et al, 2022 ). In that study, the authors found that engagement of the clinic team, leadership team, and partners were the most critical implementation facilitators.…”

Barriers and facilitators of implementing a multicomponent intervention to improve faecal immunochemical test (FIT) colorectal cancer screening in primary care clinics, Alberta

“… 17–19 A recent systematic review reports that many of the existing studies had limited use of implementation science frameworks to guide a comprehensive theory and/or evidence-based understanding of the implementation factors specific to CRC screening interventions in primary care. 20 …”

Primary care provider interventions for addressing cancer screening participation with marginalised patients: a scoping review protocol

“…For example, there have been general reviews published on interventions for screening uptake, 19 21 those focused on a specific cancer type only, 20 22–24 26 those focused on a specific type of intervention, 22 25 those focused on a specific population 24 or those in a primary care setting but without an equity focus. 26 Given that physician recommendation is one of the strongest and most consistent predictors of screening uptake, 27 28 a closer look at primary care provider (PCP) interventions for cancer screening is warranted. Moreover, much of the prior work published has focused on those who are eligible for screening broadly and not specifically on patients experiencing marginalisation.…”

“…While previous reviews on interventions aimed at increasing screening uptake have been published,19–26 none have focused specifically on our topic. For example, there have been general reviews published on interventions for screening uptake,19 21 those focused on a specific cancer type only,20 22–24 26 those focused on a specific type of intervention,22 25 those focused on a specific population24 or those in a primary care setting but without an equity focus 26. Given that physician recommendation is one of the strongest and most consistent predictors of screening uptake,27 28 a closer look at primary care provider (PCP) interventions for cancer screening is warranted.…”