Becker's Hospital Review

52 EXECUTIVE BRIEFING Noninvasive CRC screening supports cultural competency for vulnerable patients Dr. Duarte, whose medical center serves a community with large Hispanic and Caribbean diaspora populations, understands the importance of cultural competency when discussing screening options with patients. Speaking to the disparity gaps that could be exacerbated by not participating in SDM, she said that Sanitas — a multicultural and multinational company with a presence in seven countries — is continuously training, sensitizing and supporting its staff, most of whom are bilingual or multilingual, on how to present CRC screening options. The goal is to reduce the CRC screening gap, which according to the latest report by the American Association for Cancer Research, only 63.7 percent of white Americans are screened, 59.3 percent of African Americans and 47.4 percent of Hispanics. 8 "Many of our patients are immigrants and in some countries CRC screenings are not widely disseminated," Dr. Duarte said. "Beliefs, practices, diet, hereditary factors and [a lack of] widespread knowledge of CRC screenings can influence whether a CRC screening is performed or not. That's why cultural sensitivity is very important and education, understanding the needs of our patients and giving them options has been key to increasing CRC screening rates." Dr. Duarte noted that offering options to patients in a culturally appropriate way has led to more patients being screened and has decreased disparities. She credits Exact Sciences' mt- sDNA screening test — which is Sanitas' preferred non-invasive screening option recommended to patients who qualify — and the combination of other tests and practices such as Fast Track Colonoscopy, with raising CRC screening rates. 9 Sanitas began offering mt-sDNA in the first half of 2018; prior to then the organization's screening rates were well below its peers, according to Dr. Duarte. "It was disheartening to see that we were so behind and that many of our patients needed this screening and we couldn't find a way to deal with it. But by the end of 2018, we not only [caught up], but we exceeded expectations," she said, pointing out that the CRC screening rate at her facility jumped to over 55 percent by the end of that year. Making early gains permanent requires optimizing technology and patient follow-up To actively involve patients in shared decision-making for CRC screening over time, both Sanitas and Geisinger have optimized the technology that enables and supports layered and culturally competent conversations. For Sanitas, this has meant integrating its EHR platform with Exact Sciences' platform and creating a common interface, which allows Sanitas to send orders when a mt-sDNA test is prescribed and to receive the results from the providers who ordered those tests. The organization also leverages its EHR platform and internal patient portal to support campaigns that target specific populations for CRC screening and to send reminders to those patients who are prescribed for a CRC screening with mt-sDNA and who have the mt-sDNA kit at home but have yet to send in the sample for testing. Additionally, Sanitas and Exact Sciences are running a pilot project to identify patients whose primary language is not English, so that they can be engaged and involved in shared decision-making in their preferred language. To facilitate this process, Sanitas has a dedicated team of "colorectal trackers" — staff members with clinical experience who help patients follow the screening recommendation they have been given, whether for Cologuard, another noninvasive test or for a colonoscopy. "We expect this improvement will facilitate communication, understanding of the process and hopefully translate into more patients getting screened," Dr. Duarte said. For Geisinger, technology is seen as an indispensable aide to physicians. "My top priority as a quality director is to remind providers to have the conversation about CRC screening no matter what kind of appointment the patient is in for," Dr. Pacheco said. "What I love about our system is that the reminders pop up whether a patient is here for a Pap smear or something else. It's on everybody's task list and having that conversation is on everyone's to-do list, no matter why a patient comes in. We're set up for success — and technology is the basis." Choice and the power of shared decision-making The need for deeper engagement with patients is frequently invoked by health systems and health policymakers. Achieving this level of engagement, however, remains a strategic challenge. Geisinger and Sanitas exemplify two organizations making headway in the pursuit of more fruitful patient engagement. These organizations understand the appeal of choice and the power of shared decision-making, and this understanding is yielding tangible results in the form of better CRC screening rates. "It was necessary to rethink the way we were offering CRC screening to our patients," Dr. Duarte said. "The [government's] idea of integrating the different types of tests in a comprehensive way provides our patients and providers with choices to do the CRC screening and ways to support patients until a diagnosis is done and beyond." Dr. Pacheco agreed. "I think this will be huge," she said. "At the end of the day, what we want to do is get patients screened for a disease that's preventable or least treatable before it progresses too far." n The EHR and the Power of Choice: 3 CRC screening tips from Geisinger and Sanitas • Leverage best practices alerts in the EHR to prompt conversations about appropriate CRC screening options with patients. • Engage patients where they are by informing them about CRC screening options via email, text messages and phone calls. • Create a preventive health task force to follow up with patients and identify screening gaps. 8 CancerDisparitiesProgressReport.org [Internet]. Philadelphia: American Association for Cancer Research; ©2020 2022 March. Available from http://www.CancerDisparitiesProgressReport.org/. 9 Siegel, RL, Miller, KD, Fuchs, HE, Jemal, A. Cancer statistics, 2022. CA Cancer J Clin. 2022. https://doi.org/10.3322/caac.21708

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