Preventative screenings, which test for signs of disease before the onset of symptoms, allow for the early detection and treatment of several health conditions. The CDC currently recommends regular preventative screenings for 4 types of cancer: breast, cervical, colorectal, and lung. Detecting these cancers in their early stages is imperative, as it improves treatment outcomes and reduces the overall cost of care.
Despite the proven benefits, preventative cancer screenings are underutilized today. While some cancer screenings, like mammography, have become commonplace and routine because of high awareness among patients and providers, others, such as lung cancer, have low rates that stem from various barriers that keep eligible patients from seeking preventative care. This underutilization indicates a need for healthcare stakeholders and organizations to collaborate to help eliminate preventable barriers.
Primary care physicians (PCPs) are typically responsible for identifying when their patients are due for a preventative cancer screening. However, patient identification can be challenging for a variety of reasons:
- Changing Screening Guidelines – In the U.S., cancer screening guidelines are established by the United States Preventive Services Taskforce (USPSTF). The USPSTF revisits these guidelines approximately 3.5 years after publication and continues to evolve their recommendations over time as newly published studies indicate a need to change existing criteria. As a result, it can be difficult for PCPs to keep track of the most up-to-date guidelines for all preventative health measures.
- Prioritization – With the average PCP-patient interaction being only 18 minutes long, PCPs must prioritize what information to cover with their patient during a primary care appointment. Because preventative cancer screenings are not always the immediate need, they can be overlooked. However, continuously de-prioritizing preventative screenings can be dangerous and lead to a late-stage diagnosis.
- Missing or Inaccurate Data – Cancer screening guidelines are based on certain demographic and lifestyle factors such as age, sex, and smoking history. Some of these factors, particularly those that are associated with certain stigmas, are often misrepresented or completely missing from patient records. The lack of accurate data makes identification difficult, as many providers rely on automated alerts that are triggered by the information available in EHRs.
While the communication breakdown from providers to patients is a large contributor to low preventative cancer screening rates, there are several barriers aside from a lack of provider awareness that directly impact patients:
- Patient Hesitancy – Undergoing a preventative cancer screening can cause fear and anxiety among patients. These feelings typically stem from unfamiliarity with the cancer screening process or fear of the potential outcome. This hesitancy leads patients to opt-out of preventative screenings to avoid 1) pain or radiation exposure, 2) potential side effects, or 3) the possibility and associated costs of receiving a positive diagnosis or identifying incidental findings.
- Financial Coverage – Although the Affordable Care Act requires most health plans to fully cover preventative health services for eligible individuals, some plans (e.g., grandfathered plans) may not provide coverage, making patients less likely to get screened. Additionally, many insured patients may not realize that their preventative screenings are fully covered and therefore do not get screened in hopes of avoiding an additional out-of-pocket expense. Lastly, this issue affects uninsured individuals who may not be aware of or have access to free screenings provided though community health organizations.
- Access – Many individuals who fall within the eligibility criteria for preventative cancer screenings live in rural or underserved areas. Often, these individuals do not regularly see a PCP, live far from a screening site, or have limited access to educational resources outside of the clinic. All of these accessibility barriers greatly reduce the chances of eligible individuals getting screened.
Solutions for Providers and Patients
Innovation within the healthcare industry can empower greater collaboration to reduce the burden on PCPs and patients when it comes to determining screening eligibility and completing preventative screenings. Healthcare stakeholders are already implementing solutions to address both provider-facing and patient-facing barriers. Below is a list of some of the key trends we are seeing in the industry:
- Alternative Care Sites – Care sites outside of PCP offices, such as retail pharmacies and clinics, can offer avenues for patient education and identification. For example, Walmart Health has begun hosting Community Wellness Days to provide select immunizations and health screenings. Organizations like these can help determine cancer screening eligibility, reducing the need for PCPs to play a role in identification.
- Enhancing Automated Alerts – While EHR alerts are commonplace, the effectiveness of those alerts is dependent on the quality and organization of patient data. Researchers are working to build algorithms that can fill gaps in data (e.g., smoking status, pack-year information) by analyzing clinical notes.
- Self-Identification and Education Tools – Many stakeholders, such as health systems, non-profits, and retail pharmacies are hoping to fill patient knowledge gaps by providing easily accessible information about cancer screenings online. Tools like the Should I Screen questionnaire or the USPSTF Prevention TaskForce application can help individuals check if they are due for a cancer screening and locate a screening center.
- Reducing Invasiveness – In an effort to increase patient comfort and convenience with the screening process, alternative screening methods are being explored. For instance, The Galleri Test provides an option for patients to detect multiple cancer types through a single blood draw while companies like Nurx and Everlywell are working to make bring cancer screening to the home. While these tests are not currently meant to replace preventative cancer screenings, they may help reduce fear and anxiety by providing patients with insights before their screening.
- Increasing Access – To reduce access barriers, healthcare stakeholders are beginning to bring free or low-cost preventative screenings to underserved communities. For instance, Johnson & Johnson, WVU Medicine, and Canon Medical Systems collaborated to bring lung cancer screenings to rural areas through a mobile screening bus.
Collaborative Healthcare Innovation Increases Screening Rates
All stakeholders benefit from increased preventative cancer screening rates in unique ways. Patients avoid higher medical expenses and improve their health outcomes. Similarly, payers reduce cost, receive higher quality ratings and ensure that their members are healthy. Providers have better chances of treating and curing cancer while pharmaceutical companies achieve optimal drug usage by targeting the right patient population.
Here at 11TEN Innovation Partners, we are constantly looking for opportunities for stakeholders across the healthcare industry to develop mutually beneficial solutions that enhance patient care. Recently, we worked with a large pharmaceutical client to assess innovative ways to increase preventative cancer screening rates. Through leveraging our clinician network, facilitating collaborative workshops, conducting market scans, and connecting industry partners, we delivered an actionable, detailed approach for our client to implement an innovative, scalable cancer screening solution. For more information on innovation in oncology, or to develop your own healthcare innovation plan, contact the 11TEN Team.