Colorectal cancer screening in Canada 2021/2022

    Strategies to improve colorectal screening for all eligible people

    Ten provinces and two territories employ strategies in order to improve colorectal screening for all eligible people. Many use media campaigns, presentations, and program material to increase awareness and education on colorectal screening. The use of client reminders is also a prevalent strategy to increase screening participation.

    P/T Strategies used Description of activities to improve colorectal screening for all eligible people
    YT · Education
    · Client reminders
    · Media
    · Improving colonoscopy services and screening resilience
    Program website, direct communications with providers,
    Reminders to recall to screen, program follows-up all TNPs by mailing FIT kit and letter encouraging participant to repeat the test
    Small media newspapers etc. quarterly, mass media yearly, engaging more social media platforms
    Purchase of colonoscopy equipment and knowledge exchange software
    NT Mass media, small media, social media, client reminders, direct community engagement to co-design programs. Radio ads, newspaper ads, posters, social media posts as tailored to the individual communities. Meetings prior to launch with individual health region representatives and community stakeholders. Reminder letters mailed to clients who do complete tests.
    NU Opportunistic screening at this time. As part of the implantation plan for a organized screening program several of these strategies will be utilized  
    BC Media
    Provider reminders and recall systems
    Client reminders
    AB · Education (one on one and group)
    · Client invitation
    · Media (small and mass)
    · Provider assessment and feedback
    · Healthcare provider cultural competency training
    · Development of culturally safe materials and resources
    Direct community engagement to co-design programs
    Pilot nurse practitioner led integrated mobile screening services (mammogram, Pap, and FIT).
    FIT mail out
    SK Education; Client reminders; media; provider reminders and recalls; provider assessment and feedback; SK provides an annual quality report from the Screening Program for Colorectal Cancer (SPCRC) for colonoscopies done on FIT positive patients in Saskatchewan (age 50-74); presentations to new physicians in the province; social media posting, website;
    MB · Comprehensive letter campaigns
    · Informative web site
    · TV advertisement (run at select periods)
    · Satisfaction surveys
    · Invitation letters sent to all new 50-year old’s and new Manitobans
    · Reminder and recall letters sent at appropriate intervals
    · Screening Program web page on CCMB site that educates and provides for test requests
    · TV ad runs in March. Promotional pieces in development that support tv ad
    · Satisfaction survey sent to all clients testing positive who have gone on to have follow up investigation
    ON · Correspondence campaigns (invitation, recall and reminder letters)
    · Media
    · Public education and awareness campaigns
    · Public education
    · Provider reminder and recall systems (Screening Activity Report)
    · Education to primary care providers and endoscopists
    · Provider incentive strategies
    · ColonCancerCheck sends letters to eligible people inviting them to participant in screening by talking to their PCP and reminding participants when it is time for their next screening test (recall)
    The program also provides physician linked correspondence (letters that include the participant’s primary care provider name) which has been shown in research to increase participation.
    · In Ontario, the Ministry of Health is responsible for carrying out province wide public awareness campaigns. ColonCancerCheck’s Lead Scientist and the Ontario Minister of Health conducted a television appearance to support Colorectal Cancer Awareness Month (CCAM)  in March 2020.
    · ColonCancerCheck provides materials to Regional Cancer Programs to support colorectal cancer awareness initiatives such as CCAM (e.g., postcards, posters and social media posts)
    · ColonCancerCheck provides Regional Cancer Programs with a program fact sheet to support regional outreach efforts to improve screening participation in eligible people.
    · Ontario Health (Cancer Care Ontario) helps PCPs identify people eligible for screening or follow-up through the Screening Activity Report, an online tool that gives physicians who participant in a patient enrolment model practices the screening status of each of their enrolled age eligible patients (i.e., those who are overdue, never been screened or require follow up).
    · Ontario Health (Cancer Care Ontario) works with Regional Cancer Programs to educate primary care providers and endoscopists on the benefits and impacts of screening with FIT and screening recommendations (e.g., screening summary tools). Regional Cancer Programs offer accredited continuing professional development module presentations for both primary care provider and endoscopists.
    · Ontario Health (Cancer Care Ontario) provided guidance in the form of tip sheets to primary care providers and endoscopists to support the screening participation in eligible populations during COVID-19.
    · Ontario Health (Cancer Care Ontario) works with Regional Cancer Programs to educate primary care providers on colorectal cancer screening recommendations. Regional Colorectal Screening and Gastrointestinal Endoscopy Leads and Regional Primary Care Leads provide expertise and education to healthcare providers in each region to support screening participation.
    · To support family doctors in ensuring that their patients participate in relevant screening programs, the Ministry of Health has implemented Cumulative Preventive Care Bonuses. Through this program, eligible family doctors who practice as part of a Patient Enrolment Model, meaning, patients are formally rostered to a family doctor, may receive bonuses for maintaining specified levels of preventive care for their enrolled patients.
    QC Promotion towards PCPs Publication in their medical journal, dissemination of FIT rates by region
    NB · Education (groups)
    · Participant reminders
    · Media (social media, radio, transit ads)
    · Provider correspondence
    · Provider assessment and feedback
    · Reducing out of pocket costs
    · Direct mailing of screening test to participants
    · Patient navigation
    · Bilingual program materials
    · Community engagement for program feedback
    · Leverage learnings from the project ‘Developing Strategies for Underscreened Populations through Community Engagement’.
    · Offering virtual and in person education sessions on cancer screening programs in general, and specific to each screening site as requested by the public, health care providers, regional health authorities, community groups or special interest groups.
    · Program reminder letters and re-invitation letters mailed directly to participants.
    · Coordinated communication and awareness strategies are planned regularly throughout the year to promote and increase visibility of provincial cancer screening programs via various media such as radio ads, targeted digital ads, Facebook, Twitter, billboard and transit ads, website, animated and testimonial videos.
    · Program sends correspondence to primary care providers to alert them when their patients have been deemed ineligible or have declined screening.
    · Performance reports including program updates are sent yearly to program endoscopist as feedback.
    · As required, program will provide bowel preparation products to those who are unable to purchase.
    · The program directly mails all screening tests (FIT) to participants who have completed the program questionnaire and are deemed eligible as per CPGs.
    · The program’s screening access coordinators (nurses) will assess and arrange for program colonoscopy, including providing education for positive FIT participants.
    · ALL program correspondence, educational and promotional materials are offered in English and French. The program offers a toll-free phone line for public inquiries on cancer screening which is answered by bilingual staff.
    · Public surveys have been offered by phone, online and following education sessions. Feedback provided to the program is collected and evaluated regularly.
    · Plan to leverage the recommendations from the ongoing underscreened population project being conducted in NB.
    NS Education for primary care providers Extensive education and engagement sessions with primary care providers are planned as part of the FIT Plus Project; anticipated that closer collaboration with primary care will bolster participation rate of eligible Nova Scotians. Mechanism to screen all eligible people is already in place as FIT kits mailed automatically to all Nova Scotians between the ages of 50-74.
    PE · Client reminders
    · Media (small and mass)
    · Pick up and drop off locations for testing kits
    · Receptionist tool – Pick up location (provider education)
    · Initial letter and second letter, second call
    · Brochure for clients
    · Manage supply and delivery to pick up location, health centred including educational materials, screening path, decision aid for clinicians
    · Help with labeling, for kits that were rejected by lab
    · Send kits to participants to repeat FIT or when they are due for next FIT
    NL · Virtual education sessions provided to health care professionals, primary care practitioners and other community partners
    · Development of a data analytic tool to develop strategies to target recruitment efforts
    · Partner with community partners to promote screening via social media
    · Direct engagement with community health clinics and groups
    · Content developed for each Regional Health Authority (RHA) and delivered via MS Teams province wide. Population screening programs added to primary care practitioner orientation in some RHAs
    · Tableau reader that examined 5 years of de-identified screening data, broken down to the Regional Health authority and public health zone
    · Social media hits