Advocating for patient choice in colorectal cancer (CRC) screening

Offering the Cologuard® test as a noninvasive CRC screening option for average-risk patients 45+ in informed decision-making may enhance patient experience and improve adherence.1,2
Physician introducing informed decision making and discussing colorectal cancer screening options with a patient who is sitting on an exam table.
Informed decision-making, also called informed choice or shared decision-making, is a collaborative process allowing patients and their providers to make decisions together, accounting for patient preferences in addition to scientific evidence.1

Consider the benefits of informed decision-making for CRC screening

Offering patients choices may increase adherence2
CRC screening completion is 3x higher in patients who discussed screening options with their clinician.2
Offering the Cologuard test for average-risk patients may improve screening rates3
Geisinger Health increased their CRC screening rate to 70% by prioritizing the Cologuard test as a first-line noninvasive option.3
Case study summary
Geisinger Health
Overview
Geisinger Health prioritized the Cologuard® test as its first-line noninvasive option for average-risk patients1
Results
Achieved 70% colorectal cancer (CRC) screening rates
How they did it
  • Drove engagement and alignment across internal stakeholders
  • Supported informed decision-making with actionable tools
  • Developed systematic quality improvement protocols via health information technology (HIT) utilization and electronic health record (EHR) optimization

References

  1. Data on file. Exact Sciences Corporation. Madison, WI.

Higher follow-up colonoscopy
completion rates

Patients with positive Cologuard test results have been shown to be more likely to follow through with a subsequent colonoscopy when compared to fecal immunochemical test (FIT).4,5

The Centers for Medicare & Medicaid Services has expanded their definition of CRC screening to include follow-up screening colonoscopies after a Medicare covered noninvasive test, such as the Cologuard test, returns a positive result.6
Laiyemo study design
Influence of provider discussion and specific recommendation on colorectal cancer screening uptake among U.S. adults1
Laiyemo AO, Adebogun AO, Doubeni CA, et al. Prev Med. 2014;67:1-5.
Study objective
To evaluate whether provider CRC screening modality recommendations influence patient screening completion.
Study design

Researchers used the 2007 Health Information National Trends Survey (HINTS) to identify 4283 respondents who were at least 50 years old and answered questions about their communication with their care providers and CRC screening uptake. CRC screening discussions occurred with 3320 (76.2%) respondents. Approximately 95% of these discussions were with physicians.

Researchers defined being compliant with CRC screening as having undergone fecal occult blood testing (FOBT) within the past year, sigmoidoscopy within the past 5 years, or colonoscopy within the past 10 years. Survey weights were used in all analyses.

Study limitations
Findings were limited, since they were based on self-report and the authors were unable to verify CRC screening uptake through chart reviews. The survey instrument had limitations in that it did not ascertain the detail of the discussions with the healthcare provider nor did it provide specific timing (in months and years) for when the discussions about CRC screening took place relative to when the screening tests were performed. Data not available on whether the discussion about screening was initiated by the patient or healthcare provider.

References and footnotes

  1. Laiyemo AO, Adebogun AO, Doubeni CA, et al. Influence of provider discussion and specific recommendation on colorectal cancer screening uptake among U.S. adults. Prev Med. 2014;67:1-5.
Physician having a discussion with a patient in a healthcare setting lobby.

Consider including informed decision-making as part of a CRC screening program to help achieve goals in patient-experience–based measures such as:

  • Consumer Assessment of Healthcare Providers and Systems (CAHPS) for Merit-Based Incentive Payment System (MIPS)7
  • Medicare Health Outcomes Survey (HOS)8
Learn how incorporating the Cologuard test may increase your system's screening rates
Health system experiences with the Cologuard test
Discover how your Electronic Health Record (EHR) can enable optimized workflows

References

  1. Volk RJ, Leal VB, Jacobs LE, et al. From guideline to practice: new shared decision-making tools for colorectal cancer screening from the American Cancer Society. CA Cancer J Clin. 2018;68(4):246-249.  
  2. Laiyemo AO, Adebogun AO, Doubeni CA, et al. Influence of provider discussion and specific recommendation on colorectal cancer screening uptake among U.S. adults. Prev Med. 2014;67:1-5. 
  3. Data on file. Exact Sciences Corporation. Madison, WI. 
  4. Finney Rutten LJ, Jacobson DJ, Jenkins GD, et al. Colorectal cancer screening completion: an examination of differences by screening modality. Prev Med Rep. 2020;20:101202.
  5. Austin G, Kowalkowski H, Guo Y, et al. Pattern of initial colorectal cancer screening after turning 50 years old and follow-up rates of colonoscopy after positive stool-based testing among the average-risk population. Curr Med Opin. 2023;39(1):47-61. 
  6. Pub 100-03 Medicare national coverage determinations. Centers for Medicare & Medicaid Services. October 12, 2023. Accessed April 19, 2024. https://www.cms.gov/files/document/r12299ncd.pdf
  7. CAHPS for Merit-Based Incentive Payment System (MIPS) survey. Agency for Heathcare Research and Quality. October 2018. Updated July 2022. Accessed June 6, 2024. https://www.ahrq.gov/cahps/surveys-guidance/cg/cahps-mips.html
  8. About the Medicare Health Outcomes Survey (HOS). Centers for Medicare & Medicaid Services. Updated February 15, 2024. Accessed June 6, 2024. https://hosonline.org/en/program-overview/

Indications and Important Risk Information

The Cologuard® test is intended for the qualitative detection of colorectal neoplasia associated DNA markers and for the presence of occult hemoglobin in human stool. A positive result may indicate the presence of colorectal cancer (CRC) or advanced adenoma (AA) and should be followed by colonoscopy. The Cologuard test is indicated to screen adults of either sex, 45 years or older, who are at typical average risk for CRC. The Cologuard test is not a replacement for diagnostic colonoscopy or surveillance colonoscopy in high-risk individuals.

The Cologuard test is not for high-risk individuals, including patients with a personal history of colorectal cancer and adenomas; have had a positive result from another colorectal cancer screening method within the last 6 months; have been diagnosed with a condition associated with high risk for colorectal cancer such as IBD, chronic ulcerative colitis, Crohn’s disease; or have a family history of colorectal cancer, or certain hereditary syndromes.

Positive Cologuard results should be referred to colonoscopy. A negative Cologuard test result does not guarantee absence of cancer or advanced adenoma. Following a negative result, patients should continue participating in a screening program at an interval and with a method appropriate for the individual patient.

False positives and false negatives do occur. In a clinical study, 13% of patients without colorectal cancer or advanced adenomas received a positive result (false positive) and 8% of patients with cancer received a negative result (false negative). The clinical validation study was conducted in patients 50 years of age and older. Cologuard test performance in patients ages 45 to 49 years was estimated by sub-group analysis of near-age groups.

Cologuard test performance when used for repeat testing has not been evaluated or established. Rx only