Becker's Hospital Review

51 EXECUTIVE BRIEFING SPONSORED BY T his year, colorectal cancer (CRC) is projected to kill more than 52,000 people in the United States. 1 Thousands of these deaths will occur among patients under 50. Many of these deaths will be preventable. 2 Clinicians and healthcare leaders are aware of both the current rates of CRC and the condition's preventability. Still, this awareness has not translated into elevated rates of screening. If everyone who needed a colorectal cancer screening received one, an estimated 53,000 deaths could be prevented in 2022. 3 It is possible that low rates of CRC screening are partially attributable to insufficient patient engagement efforts. One recent study identified "fear" or "worry" as the most common barrier to CRC screening as reported by patients. The study's authors concluded that new communication and intervention strategies may be needed help improve CRC screening. 4 Organizations like Pennsylvania-based Geisinger Community Medicine, Primary Care and Florida-based Sanitas Medical Center, which includes 37 clinics in FL and clinics in TX, NJ and TN, are two organizations putting patient communication and choice based shared-decision making at the center of their CRC screening efforts. To better understand how and why these organizations have made choice central to CRC screening, Becker's Hospital Review recently spoke with Cybele Pacheco, MD, Medical Director for Quality and Innovation in Primary Care at Geisinger, and Martha Duarte, MD, MHSA an epidemiologist with Sanitas Medical Center. Updated screening guidelines support shared decision-making 5,6 To bolster CRC screening rates, the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF) recommend CRC screening modalities including noninvasive tests, such as Exact Sciences' Cologuard® mt-sDNA test. † The current ACS guidelines were updated in 2018. This update — in addition to USPTF's long-standing recommendations — opens the door to actively involving patients in shared decision-making (SDM). Dr. Pacheco discussed how Geisinger staff engage patients in conversations about CRC screening. "Providers are triggered in the electronic health record (EHR) when a patient meets criteria for colorectal cancer screening," she said. "Based on this, we offer a variety of options from invasive testing to noninvasive sampling." In Dr. Pacheco's experience most patients prefer noninvasive screening. The hospital leverages an algorithm to identify when a patient meets the criteria for a noninvasive screening and then elevates this information for physicians in the EHR via a best practice alert. Then, physicians can directly make this option available to the patient. The hospital also embeds sustained prompting into the EHR, so physicians are empowered to have conversations about CRC during subsequent patient visits should a patient decline screening. "If a patient refuses, the best practice alert remains and no matter what type of visit they have after that — whether it's for a sinus infection or an eye appointment — if the patient is in the Geisinger system, the provider will be triggered to have that conversation again," she said. "We make every effort not to lose track of patients who decline to have a CRC screening." Federal guidance around CRC screening continues to make it easier for providers to empower patients with choice. New regulations enacted as part of the CARES Act to help patients get access to screenings amid the pandemic will require most health insurers to cover the costs of the full CRC screening continuum - including a noninvasive test - without a copay by 2023. 7 Organizations like Geisinger are making the most of these shifts in the CRC screening landscape and empowering patients to become more active participants in their care. "We're having really layered conversations with patients and provide them all the necessary information," Dr. Pacheo said. "Then we can really have a shared decision-making approach." The power of choice: How Geisinger & Sanitas are bolstering colorectal cancer screening by leveraging shared decision-making † Guidelines may refer to mt-sDNA by different names including FIT-Fecal DNA, sDNAand sDNA-FIT. 1 Key Statistics for Colorectal Cancer, American Cancer Society, www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html#:~:text=Deaths%20from%20colorectal%20 cancer,about%2052%2C580%20deaths%20during%202022. 2 Siegel, Rebecca L. "Colorectal cancer statistics, 2020." CA: A Cancer Journal for Clinicians, May 2020, acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/ caac.21601#:~:text=In%202020%2C%20approximately%20147%2C950%20individuals,aged%20younger%20than%2050%20years. 3 Siegel, RL, Miller, KD, Fuchs, HE, Jemal, A. Cancer statistics, 2022. CA Cancer J Clin. 2022. https://doi.org/10.3322/caac.21708 4 Muthukrishnan, Meera. "Patients' self-reported barriers to colon cancer screening in federally qualified health center settings." Prev Med Rep, 15 Sept. 2019, www.ncbi.nlm.nih. gov/pmc/articles/PMC6531912/. 5 Davidson KW, Barry MJ, Mangione CM, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965-1977. doi: 10.1001/jama.2021.6238 6 Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250-281. 7 Faqs About Affordable Care Act Implementation Part 51, Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act Implementation, www. dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-51.pdf.

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