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Pharmacy-Based FIT Distribution Could Broaden CRC Screening, But Results Must be Delivered with Care, New Survey Reveals
If FIT results indicated colonoscopy, respondents preferred personal follow-up vs digital; significant barriers to undergoing fear of the test and positive cancer finding were the most significant barriers to follow-up.
Distribution of fecal immunochemical tests (FIT) through local pharmacies, an emerging approach to expanding colorectal cancer (CRC) screening, could help enhance early detection, provided a sensitive and tailored strategy is used to deliver results, particularly positive findings that would indicate a follow-up colonoscopy, concluded authors of a new study published in Cancer Causes & Control.
Parth D Shah, PharmD, PhD
Based on results of a national online survey of more than 1000 US adults, investigators reported that adults overwhelmingly prefer personal contact from a health care provider, such as a phone call, after receiving positive results from CRC screening, while digital updates are acceptable for negative results.
Led by Parth D Shah, PharmD, PhD, associate professor in the cancer prevention program, public health sciences division, at Fred Hutch Cancer Center Seattle, WA, researchers surveyed 1,045 US adults aged 45 to 75, who were presented with hypothetical scenarios involving a pharmacy-based CRC screening program, called PharmFIT, which would make FIT available through community pharmacies. Respondents were asked about their preferences for receiving screening results, how they’d want to be contacted for follow-up, and what barriers could potentially dissuade them from pursuing a recommended colonoscopy.
Personal Follow-Up Preferred
Results showed a clear preference for digital communication (email, text, or patient portals) for routine or negative test results, but 78% of respondents favored direct, interpersonal communication for positive FIT results. Psychosocial concerns emerged as the top barriers to follow-up: 41% cited fear of colonoscopy, and 35% expressed anxiety about a potential cancer diagnosis, both reservations outpacing structural issues such as cost (18%) and transportation (15%).
“Our results reveal key preferences for how patients wish to receive FIT reminders, results, and follow-up referrals for colonoscopy, highlighting the importance of tailored, multimodal communication strategies to enhance patient adherence to screening practices and acceptability of a pharmacy-based screening program,” Shah et al wrote.
As pharmacy-based CRC screening becomes a more viable strategy to reach underserved populations, the study’s findings offer critical guidance for program design. Pharmacies, the authors argue, could serve as accessible entry points for preventive care, but only if follow-up processes are built with patient trust and communication needs in mind.
The study also found that preferences varied by demographics. Older adults, individuals with a regular provider, and those with higher incomes were less likely to report barriers to pursuing a follow-up colonoscopy. Meanwhile, non-White respondents and Medicaid beneficiaries were less inclined to prefer automated notifications, indicating the need for equity-focused design in outreach efforts.
Local FIT Access Could Support Early Uptake
Shah et al suggest that expanding access to CRC screening through pharmacy-based FIT could help broaden the well-recognized benefit of initiating screening at earlier ages. The authors cite a community-based cohort study that found starting FIT screening between ages 40 and 49 can reduce CRC mortality by 39% and lower incidence by 21%, compared to starting at age 50.
Among the study's limitations the authors acknowledged the cross-sectional and online-only nature, which may exclude individuals without internet access or digital literacy—it provides timely data as health systems consider ways to expand CRC screening access.
“Pharmacies, as accessible health care locations, can play a pivotal role in CRC screening initiatives, but effective implementation of such programs requires careful consideration of communication strategies that align with patient preferences and address identified barriers,” the researchers wrote. “Tailored communication strategies, integrating both digital and interpersonal methods, and addressing psychosocial and structural barriers, can enhance patient engagement and follow-up adherence in pharmacy-based CRC screening programs.”
