Engaging Stakeholders for CRC Screening: Lessons from Oregon

1. Policy-makers Community Partners Clinic staff Patients Finding non-traditional allies for CRC screening Gloria D. Coronado, PhD Beverly B. Green, MD, MPH

2. Policy-makers Community Partners Clinic staff Patients Key messages • Multi-stakeholder teams can be effective; • Know your audience --- evidence can help engage, inform action, and manage expectations.

3. Policy-makers • 2014 Oregon passed legislation that requires insurance companies to treat to colonoscopy as a screening colonoscopy, even if polyps are removed. This means that patients who go in for a screening colonoscopy and have polyps removed will not be charged co-pays and deductibles. • 2015 Oregon passed legislation that prohibits insurance companies from imposing patient co-pays or deductibles for follow-up colonoscopies when a FIT test is positive. This means to there is no financial barrier to follow-up colonoscopy for insured patients.

4. Community Partners

5. Clinic staff

6. Clinic staff Know your audience • Example 1: Concerns about obtaining colonoscopy for the uninsured. • “…I hear a lot of frustration from doctors that want to have their patient have the colonoscopy and it’s just not happening. It’s really an expensive exam…” (Nurse Practitioner) • “Even if you have insurance … it takes about nine months for a routine colonoscopy in this community. Usually, to get a colonoscopy with any speed, you need some reason.” (Medical director)

7. Clinic staff Needed colonoscopies *based on OCHIN data from 1/1/2012 – 12/31/2012

8. Clinic staff FIT reduces colon cancer mortalityNumber Needed to Scope to find an advanced adenoma*: Colonoscopy screening scenario: 47.4FIT-based screening scenario: 8.3 Colonoscopy screening FIT-based screening *For females aged 50 - 59

9. Clinic staff Free FIT vs. Free colonoscopy program • Study included uninsured patients aged 54-64 at the John Peter Smith Health Network, a safety net health system. • Randomized patients into 3 groups: • Free FIT (n = 1593) • Free colonoscopy (n = 479) • Usual care (n = 3898) Gupta et al. JAMAIM 2013

10. Patients Newly insured Financially challenged Insured procrastinator / rationalizer African American Hispanic 2015 Communications Guidebook, American Cancer Society

11. Patient reasons for non-response Coronado et al. Translational Behavioral Medicine 2015

12. Patients Pilot findings from Virginia Garcia

13. Policy-makers Community Partners Clinic staff Patients Conclusion • Multiple stakeholders can/ should be involved in implementing a CRC screening program. Important to identify internal and external partners. • Understanding and addressing stakeholders’ concerns can build buy-in, expand impact, and help manage expectations.

14. STOP CRC Research Team; • OCHIN; • Participating Clinics • STOP CRC Advisory Board Acknowledgments Funding source: NIH Common Fund [UH2AT007782 and 4UH3CA188640-02] and Kaiser Permanente Community Benefit