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Engaging Stakeholders for CRC Screening: Lessons from Oregon

This research project explores the importance of engaging various stakeholders in implementing colorectal cancer (CRC) screening programs. The study highlights the impact of evidence-based policies on insurance coverage for colonoscopy and the use of FIT tests. It also addresses concerns, barriers, and opportunities for CRC screening among policymakers, community partners, clinic staff, and patients.

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Engaging Stakeholders for CRC Screening: Lessons from Oregon

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  1. Policy-makers Community Partners Clinic staff Patients Finding non-traditional allies for CRC screening Gloria D. Coronado, PhD Beverly B. Green, MD, MPH

  2. Policy-makers Community Partners Clinic staff Patients Key messages • Multi-stakeholder teams can be effective; • Know your audience --- evidence can help engage, inform action, and manage expectations.

  3. Policy-makers • 2014 Oregon passed legislation that requires insurance companies to treat to colonoscopy as a screening colonoscopy, even if polyps are removed. This means that patients who go in for a screening colonoscopy and have polyps removed will not be charged co-pays and deductibles. • 2015 Oregon passed legislation that prohibits insurance companies from imposing patient co-pays or deductibles for follow-up colonoscopies when a FIT test is positive. This means to there is no financial barrier to follow-up colonoscopy for insured patients.

  4. Community Partners

  5. Clinic staff

  6. Clinic staff Know your audience • Example 1: Concerns about obtaining colonoscopy for the uninsured. • “…I hear a lot of frustration from doctors that want to have their patient have the colonoscopy and it’s just not happening. It’s really an expensive exam…” (Nurse Practitioner) • “Even if you have insurance … it takes about nine months for a routine colonoscopy in this community. Usually, to get a colonoscopy with any speed, you need some reason.” (Medical director)

  7. Clinic staff Needed colonoscopies *based on OCHIN data from 1/1/2012 – 12/31/2012

  8. Clinic staff FIT reduces colon cancer mortalityNumber Needed to Scope to find an advanced adenoma*: Colonoscopy screening scenario: 47.4FIT-based screening scenario: 8.3 Colonoscopy screening FIT-based screening *For females aged 50 - 59

  9. Clinic staff Free FIT vs. Free colonoscopy program • Study included uninsured patients aged 54-64 at the John Peter Smith Health Network, a safety net health system. • Randomized patients into 3 groups: • Free FIT (n = 1593) • Free colonoscopy (n = 479) • Usual care (n = 3898) Gupta et al. JAMAIM 2013

  10. Patients Newly insured Financially challenged Insured procrastinator / rationalizer African American Hispanic 2015 Communications Guidebook, American Cancer Society

  11. Patient reasons for non-response Coronado et al. Translational Behavioral Medicine 2015

  12. Patients Pilot findings from Virginia Garcia

  13. Policy-makers Community Partners Clinic staff Patients Conclusion • Multiple stakeholders can/ should be involved in implementing a CRC screening program. Important to identify internal and external partners. • Understanding and addressing stakeholders’ concerns can build buy-in, expand impact, and help manage expectations.

  14. STOP CRC Research Team; • OCHIN; • Participating Clinics • STOP CRC Advisory Board Acknowledgments Funding source: NIH Common Fund [UH2AT007782 and 4UH3CA188640-02] and Kaiser Permanente Community Benefit

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