Colorectal cancer screening in Canada: 2021/2022

Strategies to improve screening for underserved populations

Seven provinces and two territories have employed strategies to improve screening for various underserved populations. Most jurisdictions engage specific underserved populations in decision-making and informing strategies. Screening awareness campaigns, social media posts, and brochures are regularly used to engage underserved populations in screening. Culturally appropriate client reminders have also been implemented to better reach these populations.

Strategies to improve screening for underscreened populations

P/T Intended audiences  Strategies used Strategy co-developed with community?  Description of activities to improve screening for underserved populations 
YT  · Low-income
· Immigrants
· Racial/ethnic minorities
· Environmental scan to better understand effective intervention to address disparities in cancer screening for people with low income and rural/remote Yukon communities
· Overview of organizations in the territory supports low-income, immigrants,  racial/ethnic minorities
· Healthcare providers volunteer list for participants without a provider
· ColonCheck Yukon Disparity Report – areas of consideration: promotion and awareness, healthcare system (Canada and Yukon), hesitancy and non-participation, client surveys, and Putting People First Report
· Collaborating with other outreach programs to reach individuals who are unable to access the program
· If participant does not have a PCP, the program will refer to a physician who will follow the client throughout screening pathway
NT  · Non-English and non-French speakers · Development of culturally safe materials and resources · Translated promotional materials
· Pictograph based instructions with FITs
AB  · Low-income
· Immigrants and refugees
· Racial or ethnic minorities
· Specific cultural groups
· Non-English and non-French speakers
· Education (one on one and group)
· Client invitation and reminders
· 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
All: ✓ · Been engaged in creating a health equity project for several years with data identified lower screening subpopulations in northeast Calgary to co-design strategies with the intent to scale and spread effective methods across Alberta
MB  Immigrants and refugees
Non-English and non-French speakers
· Comprehensive letter campaigns that included an insert translated in 17 languages
· Interpreter services
· Translated resources
· Focus testing with primary care advisory groups and community groups
All: ✓ · Including information of available interpreter services and translated documents on most public facing communications
· Cancer screening education module created for new international healthcare providers.
· Curriculum designed for educators to use with adults with low literacy – curriculum found on screening website
ON  · Under and never screened
· Men
· Never and under screened populations or populations who are not attached to PCPs
· Sioux Lookout Zone First Nations communities
· People who missed their routine cancer screening test due to COVID-19
1. Reminder correspondence
2. Targeted correspondence
3. Mobile screening coaches
4. Planned pilot program to improve access to the FIT
5. Changes to correspondence eligibility
6. Screening awareness campaign
3. ✓
4. ✓
6. ^
· The program sends invitations to people who are overdue to screening (i.e., non or infrequent responders) every 2 years who are ages of 50-74.
· In 2019, Cancer Care Ontario implemented invitation letters with targeted messaging for men. The initiative was based on the findings from a randomized controlled trial showing that male-specific letters resulted in an increase in colorectal cancer screening participation in men.
· Mobile coaches in select regions (North West, Hamilton Niagara Haldimand Brant) provide screening services to people who do not have a PCP or face barriers accessing existing screening services (due to transportation or other barriers)
· A pilot is being planned to explore access to and support improvements in colorectal cancer screening by having FIT kit inventory available at nursing stations and health centres.
· The Ontario Ministry of Health issued a directive to pause non-essential services in the spring of 2020, including screening, as a result of the COVID-19 pandemic. This included a pause in invitation and recall letters, which gradually resumed beginning in December 2020. Recognizing that people who were 74 during the correspondence pause may have since turned 75 (and would no longer be eligible to receive letters within our typical correspondence campaign), the upper age limit for invitation and recall letter correspondence campaigns was extended to by one year to ensure those who did not screen due to the pandemic receive notifications to screen
· The Ontario’s Ministry of Health will be leading a public campaign to remind people about the importance of regular cancer screening in September 2021 and have provided Ontario Health (Cancer Care Ontario) with funding to develop additional strategies to support the resumption of screening.
NB  · People without a primary care provider
· Specific cultural groups
· Low-income
· Specific geographic areas
1. Program offers colon screening kits to eligible people without a provider referral.
2. Target education to multicultural community groups.
3. Eliminate costs of bowel preparation product.
4. Target strategies to improve participation
2. ✓
4. ✓
· Participants can request a screening kit regardless of having a primary care provider.
· The program offers group presentations upon request from multicultural community groups based on education needs for targeted audience.
· The program will provide bowel preparation products to those who are unable to purchase.
· Using GIS mapping, the program is able to identify areas of low participation in order to further assess community needs and services.
NS~  · Immigrants and refugees
· Racial or ethnic minorities
· Education sessions · Presentations on importance of screening
PE  · Immigrants and refugees
· People without a primary care provider
· Non-English and non-French speakers
· Cancer screening brochures sent to Newcomers Association
· Cancer screening brochures and letters available in English and French
· Brochures reviewed for plain language
· Recruitment regardless of physician status (affiliated, unaffiliated)
· Connect participants without a PCP to a nurse practitioner for follow up on a positive FIT.
NL  · New Canadians
· Immigrants and refugees
· Low income
· Collaboration and education to primary care providers and community groups that work with immigrant, refugee and low income populations
· Provision of programmatic educations and promotions materials
· Development of wordless instructions to be used throughout the screening program

*Quebec does not have an organized screening program available so there are no concerted strategies in place. Each health institution is responsible for implementing the appropriate strategies to reach out to the population it serves.
ON: ^Developed in consultation with primary care providers
NS: ~Program currently participating in a study to investigate whether racialized groups participate in the Colon Cancer Prevention Program disproportionately compared to others.