Patient Education, Navigation Stand in the Way of Preventive Screening

August 22, 2023 - There are a lot of reasons why a young person might delay a preventive screening, with a new survey looking at colorectal cancer (CRC) screening showing that patient education and navigation are particularly burdensome.

The Harris Poll conducted on behalf of CRC screening provider Exact Sciences also showed that stigma, fear, and a lack of time in their personal lives keep 45-year-olds from completing a preventive screening.

Cancer screenings are extremely effective for early disease detection and improving prognosis. Citing 2023 data, the poll administrators said that achieving an 80 percent CRC screening rate among eligible adults—screening is advised for those age 45 and older—could save tens of thousands of lives.

"Colorectal cancer is one of the deadliest, but also one of the most preventable cancers, and routine screening starting at age 45 using one of several guideline-recommended methods is the most effective way to reduce risk of dying from this disease," Cynthia M. Yoshida, MD, a gastroenterologist at the University of Virginia Medical Center and medical lead of the UVA Comprehensive Cancer Center's Colorectal Cancer Screening Program, said in a statement.

Low colorectal cancer screening rates are particularly notable among young people ages 45 to 50. Researchers estimate that around 20,000 individuals under age 50 will be diagnosed with CRC this year, and 3,750 will die from this type of cancer.

"Despite this, we see many people in this critical age group not getting screened, and this research provides an important but troubling window into why, revealing not just one, but a multitude of barriers – a virtual obstacle course to lifesaving colorectal cancer screening,” Yoshida added.

Of the poll’s 1,000 respondents, all of whom were age 45, nearly three-quarters said there was at least one challenge that could keep them from getting a CRC screening. This indicates that even the 21 percent of people who said they did get a CRC screening had to navigate some of those challenges.

Preventive screening challenges fell into four distinct categories, with many patients reporting challenges in more than one.

For example, more than three-quarters of respondents (77 percent) said their parenthood responsibilities got in the way of getting a colorectal cancer screening. Nearly 80 percent said their full-time jobs got in the way. A similar proportion said they can’t prioritize making time for a CRC screening while 20 percent said they did not have time to get one.

Moreover, poor patient education and messaging around colorectal cancer screening kept some patients from engaging.

Less than half (38 percent) of respondents even knew they were of eligible age for a colorectal cancer screening, while 31 percent said they were unsure if they need to be screened or think they only need a screening if they have a family history of CRC. Two in five respondents didn’t know there was more than one way to get a CRC screening (colonoscopy and at-home testing).

The survey indicated that patients need more navigation and care coordination support from their providers. Around half (52 percent) of patients said that getting a recommendation from a provider would increase the odds that they get a CRC screening, but only 37 percent said they’ve gotten that kind of provider messaging.

Patients could also benefit from better healthcare navigation, with one in five saying they were worried about the cost of the preventive screening. Initial preventive screenings are free per the Affordable Care Act.

Fundamentally, patients need more comfort and support from their clinicians. A quarter of respondents said they’d rather get a root canal than a colonoscopy, likely due to fear of the discomfort of the screening. But it’s not just screening discomfort that’s discouraging. Another quarter of patients said they avoid getting a CRC screening because they are fearful of hearing bad news.

Providers can address these fears using shared decision-making techniques and educating patients about what they can expect during a CRC screening. It may be helpful to outline all of the options for CRC screening, as well.