Managing screening programs when dealing with constrained resources

The extent to which any of these strategies are required will be driven by the extent to which resource capacity is constrained within the jurisdiction, which in turn will be heavily influenced by the extent of COVID-19 in the population and local response (e.g., redeployment of staff, travel restrictions etc.), and may vary throughout the pandemic by region and by community.

Recommendation 1: Work with partners to develop pathways and prioritization frameworks and to support the sharing of information to ensure equitable screening during periods of constrained resources.

Key evidence and implementation considerations

• Alterations to pre-existing screening practice should not be arbitrary and should be based upon stated criteria which relate to the objectives of screening and operational constraints.
• Service resumption must fully consider the full screening pathway and not be based upon primary screening alone. Moreover, service resumption must fully consider the impact of screening volumes on resources shared with other aspects of the healthcare system.
• Development of evidence-based prioritization frameworks that take into consideration all indications for service use may help address competing needs in an equitable fashion.
  • Provide guidance to healthcare providers and facilities to support prioritization of services by urgency of the indication.
• Screening programs should direct providers and facilities to align practices with local COVID-19 guidelines rather than establishing separate screening program guidelines.
• Screening programs can support local/regional-level decision making in a number of ways:
  • Identifying opportunities to help ensure the most appropriate and effective use of constrained resources (for examples see Ontario tip sheets).
  • Identify opportunities for facilities/regions to consider implementing (or expanding access to existing) processes for evidence-based strategies that support effective and equitable use of constrained resources (e.g., processes for centralized intake of referrals, use of frameworks to make evidence-based decisions for triage and prioritization of screening participants, and use of centralized waitlists [i.e., system where screening participants are booked to open slots that are not assigned to a specific provider but rather a pool of providers]).
  • Identify opportunities to help ensure the most appropriate and effective use of constrained resources to ensure safety (including staff, PPE, etc.)
• Given local and regional variation in the spread of COVID-19, screening programs should develop guidance about how to deal with these variations such that response to future waves of the pandemic can be deployed at the local level.

Recommendation 2: Utilize screening program data to inform capacity planning during periods of constrained resources.

Key evidence and implementation considerations

• Establish a set of monitoring criteria to determine prevalence of COVID-19 in the community and related service capacity.
• Screening programs can support local/regional-level decision making by using data available to the program and developing tools to support planning.
  • Tools may include updates on service volumes at the provincial/regional/facility level, modelling regarding backlogs based on historical volumes, tools that allow for manipulation of the data to assess the impact of various strategies on backlog recovery. For examples, refer to Ontario models.

Recommendation 3: Consider rationing proactive recruitment and correspondence to manage screening services.

Key evidence and implementation considerations

• In June 2020, the WHO recommended modifying and considering the temporary delay of cancer screening programs and services that require contact with the health care providers (e.g. mammography and colonoscopy).
• Guidance from Ontario suggests that resumption of screening services and mailing of test kits should be gradual and prioritized based on risk.
• Make decisions regarding the appropriateness of mailed correspondence and when to stop / re-start letters that encourage screening taking into consideration operational factors (e.g. Canada Post delays, impacts of physical distancing / infection control policies on fulfillment house practices etc.) as well as the impact of recommending screening on the healthcare system capacity (e.g. primary care, diagnostic services etc.).

Learn more

For more information and references, download the guidance document Management of Cancer Screening Services During the COVID-19 Pandemic and Building Resilient, Safer & Equitable Screening Services.