Five key lessons learned on increasing colorectal cancer screening in Canada

Colorectal cancer is one the most treatable cancers if caught early, but not enough people in Canada participate in regular screening. While screening programs for colorectal cancer are now in place in almost every jurisdiction, to date, no province or territory has achieved the 60 per cent screening target.

The low screening participation rate points to health inequities and barriers to access experienced by specific communities and also an overall lack of awareness in the general population when it comes to colorectal cancer.

However, with support from the Partnership, changes are underway across the country that will help programs expand their reach to populations with low colorectal cancer screening participation rates. With funding from the Partnership, five jurisdictions (Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, and the Northwest Territories) engaged communities to co-develop and implement evidence-based approaches for increasing colorectal cancer screening in their respective communities. So far, the results are encouraging, with some communities doubling their screening participation rates.

To share the learnings from the project more broadly, “lessons learned” videos from each of the partners were developed, featuring insights that highlight common themes as well as unique perspectives.

Here are five key takeaways:

Start off on the right note

Building mutual respect and trust is key in creating relationships that last. This is true in many circumstances, and especially relevant when trying to engage communities who have faced, and continue to face, barriers in health equity. This is emphasized in Manitoba’s video which points to the importance of fostering strong partnerships with communities at the start of any outreach initiative, and maintaining that throughout the entire project life cycle. Being accessible and engaging is also important – using humour, for example, in education and awareness materials for the public.

Follow the lead of the community

Recognizing the wisdom and capacity for leadership within under-screened communities is a core foundation on which to build these relationships and goals. This approach is highlighted in New Brunswick’s video, noting how outreach initiatives are much more effective when community members lead the effort. It is also equally important to understand the factors behind the lack of participation in colorectal screening in the communities and obtain the buy-in of primary care providers at the start of any engagement work.

Co-design with the community

In Newfoundland and Labrador, engaging the community in co-designing educational materials was a core aspect in building connections and strategies to reduce barriers in colorectal screening. Instead of using overly prescriptive messaging in community engagement, leveraging clinical and demographic data, including knowledge shared by community members, to focus and guide the work will result in more effective outcomes. Utilizing prior, established relationships in creating awareness and access for screening participation is also an essential component when it comes to increasing screening within the community.

Understand cultural appropriateness

While co-designing with community members, it is also important to be mindful of the local, cultural contexts within which the engagement work is being done. The Northwest Territories video underscores how cultural appropriateness is a vital component in any kind of healthcare- and equity-related work. “There is power in the community,” a lesson which is echoed by the other partners as well.

Good partnership requires work

One of the key lessons from Alberta is that connecting with communities that are under-screened requires diligent work and intentionality in order to be impactful. These partnerships are dynamic and fluid, and anyone invested in improving access to colorectal cancer screening and increasing screening rates in colorectal cancer screening programs has to adopt a nimble and responsive mindset. They must also make it easy for their partners and collaborators by equipping them with tools that they need in order to successfully build these relationships and achieve their goals, including the many virtual tools that have risen to prominence during the COVID-19 pandemic, such as virtual outreach sessions and workshops.

These insights apply not only to increasing access and screening participation rates in colorectal screening programs, but in any work that requires the support and co-leadership of equity-deserving communities.

To learn more about the lessons shared by our partners, click on the video playlist below.