Collaboration, community engagement key to shifting trends in CRC screening, outcomes

The rising incidence of colorectal cancer among young adult patients is disturbing but not surprising.

As health care providers, we have been following these trends for some time, both through the work of investigators like Rebecca Siegel, MPH, senior scientific director of surveillance research at the American Cancer Society, who oversees the organization’s annual CRC statistics report, and in real time in clinical practice and through patient and patient advocate stories.

While our advances in overall CRC prevention, screening and treatment — particularly among those aged 50 years and older — deserve to be celebrated, more remains to be done to reverse this unfavorable trend among young adults.

Patients and providers know more today about the influence of diet, physical activity, smoking and alcohol use, family history and screening on the risk for CRC than they did 10 and even 5 years ago, yet the upward trend in CRC incidence among young adults continues.

Embrace change, collaboration in the health ecosystem

Disrupting this pattern requires more intentional investment in innovation and collaboration across our health ecosystem.

We need scientists meaningfully engaging with people across our diverse communities to enhance our collective understanding of yet uncaptured environmental and molecular influences on CRC risk among young adults.

We need more health care providers to step outside the walls of their clinics and hospitals and into the neighborhoods of those who lack access to screening, those who are not utilizing the access available to them and those who are not engaging in research that is critical to positively impacting the CRC care continuum from prevention to survivorship.

We need health systems and payers to continually assess policies and practices for potential barriers to timely, evidence-based care. We need more frequent and actionable dialogue among stakeholders, including scientists, health care providers, patients and patient advocates.

Those concrete actions then create a foundation of discovery from which we can all identify and mitigate racism and implicit biases in the health ecosystem, including addressing health-related social needs that negatively impact access and utilization of care services. At all levels of the health ecosystem, we must be nimble to change and collaborate in ways that we have not in the past, because improving screening is not an individual sport.

The good news is that we see examples of this happening already: Organizations such as the Association of Black Gastroenterologists and Hepatologists are convening and partnering with academia, patient advocacy organizations and pharmaceutical companies to elevate and share the voices of communities who are under-screened and underserved. These efforts can help reverse the negative trends observed among those at risk for GI diseases and advance health equity.

CMS has pushed for social determinant of health (SDOH) screening, and payers such as Elevance Health are integrating incentives into health care provider contracts to conduct such screening, like the SDOH Performance Improvement Project.

Additionally, more people will be screened for CRC with fewer barriers, thanks to the lowered recommended screening age and closing the Medicare loophole with the KY modifier, whereby those with positive stool-based tests undergo a follow-up colonoscopy with no cost-sharing.

Encourage discussion to address inequities in care

As we hold ourselves to a professional standard of deep and frequent community engagement, we must approach those conversations with cultural humility, unhindered by our own baggage. It requires that we take the time to listen to those who are most proximal to inequities, learn from what we hear and then apply that knowledge to co-designing solutions.

This is not too dissimilar from how we should be approaching patient encounters in the clinical setting: We first invite the patient into the exam room, work to build rapport and trust, and cultivate a shared understanding of the goals of our time together. In that manner, we should intentionally welcome community perspective and experience in our rooms (labs, clinics and boardrooms) and work both to build relationships and overcome medical distrust.

Once we have the patient in the room, we typically take a history. Similarly, once community representation is in the room, we need to employ active listening: eliciting their story and asking questions that communicate we hear them, understand and want to learn more about the facilitators and barriers to an ideal health journey.

Now, it is time for the physical exam or, through a community engagement lens, time to take in what the community has told us and pinpoint the underlying issue. When we do that, we can co-create a solution — a treatment plan — based on shared decision-making.

Personal stories carry power, leverage positive change

How we communicate with the people we serve is incredibly important. It is imperative that we communicate in a way that meets people where they are — from both a health literacy and plain language perspective — and challenges norms of transactional-style communication. Some of this can start simply with storytelling.

One of the things I am most passionate about is how we are telling our stories as health care providers and how we amplify the stories of patients and community members we serve. Every provider, whether they recognize it or not, collects stories routinely from their patients, and those stories carry so much power that can be leveraged for positive change.

Stories are a form of connective tissue that unite us and that remind us of our shared humanity and of our opportunities to improve and save the lives of many, including those at risk for CRC.

As we center the stories and experiences of cancer survivors and their caregivers and the voices from minoritized and underserved communities — allowing them to inform our perspectives and strategies in research, care delivery and management, community engagement and partnerships across the health ecosystem — we will get closer to a colorectal cancer-free world.

For more information:

Darrell M. Gray II, MD, MPH, FACG, is chief health equity officer at Elevance Health. He also co-founded and serves on the board of directors of the Association for Black Gastroenterologists and Hepatologists. He can be reached at: darrell.grayii@elevancehealth.com.