Implementing Mailed Colorectal Cancer Fecal Screening Tests in Real-World Primary Care Settings: Promising...

Area of Science:

• Implementation Science
• Public Health
• Gastroenterology

Background:

• Colorectal cancer (CRC) screening rates in the USA are suboptimal, despite its proven benefits in reducing morbidity and mortality.
• The Colorectal Cancer Control Program (CRCCP) uses implementation science to promote health system changes and reduce CRC screening disparities.
• Mailed fecal testing is an evidence-based intervention that can mitigate barriers to in-person screening and reduce health disparities.

Purpose of the Study:

• To assess the implementation of mailed fecal testing in primary care clinics within the CRCCP.
• To identify characteristics of clinics that implement mailed fecal testing versus those that do not.
• To determine the implementation practices and identify opportunities for enhancing mailed fecal testing delivery.

Main Methods:

• Retrospective, cross-sectional analysis of mailed fecal testing implementation in 185 clinics across 62 US health systems.
• Comparison of clinic characteristics (type, location, patient demographics) between clinics offering and not offering mailed fecal testing.
• Assessment of implementation practices, including the use of evidence-based interventions (EBIs) and barriers to sustained implementation.

Main Results:

• Over half (58%) of clinics implemented mailed fecal testing, often alongside EBIs like patient/provider reminders and structural barrier reduction.
• Clinics implementing mailed fecal testing were more likely to have CRC screening policies and serve larger patient populations, but less likely to serve a high proportion of uninsured patients.
• Challenges to sustained implementation included insufficient leadership support (58%) and funding stability (29%).

Conclusions:

• Mailed fecal testing is widely adopted in CRCCP clinics, integrated with other EBIs to improve colorectal cancer screening.
• Opportunities exist to enhance mailed fecal testing implementation by increasing its availability in community health centers, providing prepaid return mail, monitoring distribution/return, ensuring follow-up colonoscopies, and strengthening sustainability planning.
• Addressing implementation gaps is crucial for maximizing the impact of mailed fecal testing in reducing colorectal cancer screening disparities.