Becker's Hospital Review

63 Executive Briefing Sponsored by: C olorectal cancer is the third leading cause of cancer related deaths in both men and women. More than 53,000 people were projected to die of colorectal cancer in 2020, with more than 3,500 of those deaths attributable to individuals under the age of 50, according to estimates from the American Cancer Society. While CRC rates have broadly decreased in recent decades, the trend is changing for younger patients. From 2012 to 2016, incidence rates increased by 2.2 percent annually in individuals younger than 50 years. 1 With thousands of lives on the line, the U.S. Preventive Services Task Force (USPSTF) revised their screening recommendations to target younger patients more aggressively. The USPSTF now recommends colorectal cancer screening beginning at age 45 for average risk patients. 2* Becker's Hospital Review recently spoke with experts from two leading health systems about these new recommendations and how their organizations will engage with younger patients to begin colorectal cancer screening as soon as they are eligible: • Lisa Ravindra, MD, internal medicine, Rush University Medical Center in Chicago • Nicole Trieste, RN, director, ambulatory care gaps and best practices, Danville, Pa.-based Geisinger Bringing down barriers to CRC screening Based on market research, individuals between the ages of 45 and 49 reported a below-average likelihood of getting screened for CRC in the next six months. 3 Patients in this demographic group are somewhat unusual since they are more likely than older populations to have younger children and hectic work schedules. Although they may recognize the importance of CRC screening, many face obstacles associated with scheduling the procedure. "We are all very busy and the thought of sitting on hold for several minutes to schedule a test that no one's really excited about is always a big deterrent," Dr. Ravindra said. "If we can improve those workflows and make them easier, that should be a priority." Health systems are looking at ways to improve the scheduling process such as direct lines to schedulers and access to quick appointments. Another alternative is patient self-scheduling using the online portal. That may be particularly beneficial for tech-savvy individuals in the 45-to-49-year-old age group. Discussing different screening options is also essential. "We are fortunate that for CRC screening, we have multiple modalities that are approved and effective," Dr. Ravindra said. "While the gold standard continues to be colonoscopy, some people are still hesitant due to the invasiveness of the procedure or having to take a day off work. Offering alternatives like the mt- sDNA home-based stool test is really important." Geisinger has configured its EHR with documentation and order sets for various CRC screening alternatives including colonoscopy, mt-sDNA and fecal immunochemical test (FIT). If patients elect to use mt-sDNA or a FIT kit, the care caps team conducts outreach to encourage test completion. *The USPSTF concludes with moderate certainty that screening for CRC in adults aged 45 to 49 years has moderate net benefit (Grade B Recommendation) "We contact patients who ordered mt-sDNA 60 to 90 days earlier, but haven't returned the kit, to answer questions and address concerns," Ms. Trieste said. "If patients have a positive mt-sDNA or FIT test result, our team also follows up if they don't schedule a colonoscopy." Leading health systems also recognize physician education as critical to success. Rush University Medical Center expects to publish newsletters and clinical reminders, hold lectures and make announcements at gastroenterology department meetings to ensure clinicians are aware of the CRC screening recommendation changes. Screen younger, screen smarter: How Rush and Geisinger are addressing rising rates of colorectal cancer among patients under 50 4 Action Steps for Smarter Cancer Screening 1. Include average-risk patients aged 45 years and older in all CRC screening outreach efforts. 2. Prioritize clinician education to ensure staff are aware of new cancer screening recommendations. 3. Update EHR algorithm to identify patients for appropriate health maintenance screenings and services. 4. Equip EHRs with real-time alerts to notify clinicians when a patient is eligible for screening at the point of care. *The USPSTF concludes with moderate certainty that screening for CRC in adults aged 45 to 49 years has moderate net benefit (Grade B Recommendation)

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