A Critical Evaluation of Contextual Factors Affecting the Implementation of Pharmacist-Led Colorectal Cancer...

Colorectal cancer (CRC) is among the most preventable cancers and causes more than 50,000 deaths annually in the US. Screening disparities persist in rural versus urban populations and in populations with inadequate access to care. Community pharmacies, given their accessibility and trusted role in preventive care, represent a promising setting to expand CRC screening.

This scoping narrative hybrid review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and the Arksey and O'Malley framework, along with other refinements. Literature searches were conducted in PubMed, Embase (via Elsevier), ProQuest, Medline (via OVID), and ClinicalTrials.gov by using broad key words related to CRC screening and pharmacy. Eligible studies included US-based studies describing pharmacist involvement in community pharmacy CRC screening. Data were synthesized by using the Consolidated Framework for Implementation Research, with strategies mapped to the Implementation Research Logic Model.

Ten US studies met inclusion criteria: 1 randomized community-pharmacy intervention trial, 1 pilot implementation study, 3 stakeholder qualitative studies, and 5 national or statewide surveys. Key barriers included lack of reimbursement, workflow constraints, pharmacist knowledge gaps, and limited care coordination. Facilitators included high patient willingness, trust in pharmacies, compatibility with existing workflows, and professional support from pharmacists and providers. Evidence-based strategies included targeted pharmacist training, workflow reminders, formal referral agreements with primary care, and patient engagement initiatives. Policy reforms to establish reimbursement and strengthen information exchange were identified as essential for sustainability.

Community pharmacies are well positioned to expand CRC screening access. Addressing reimbursement, training, workflow, and coordination barriers through evidence-based strategies and supportive policy can enable pharmacist-delivered CRC screening to reduce disparities and improve population health outcomes.