A Rural Community Overcomes Barriers to Colorectal Cancer Screening

Posted on by DCPC

By Van S. Breeding, MD
Director of Clinical Affairs and Family Practice Physician
Whitesburg, Kentucky

Photo of Van S. Breeding, MD
Van S. Breeding, MD
Director of Clinical Affairs and Family Practice Physician
Whitesburg, Kentucky

I’m the Director of Clinical Affairs for a community health center in rural southeast Kentucky. Our service area includes multiple counties that have some of the highest rates of cancer and death from cancer in the United States. Colonoscopy screens for colorectal cancer and can prevent it by finding precancerous polyps. However, in our community health center, we had a dismal record of getting patients in for proper screening. Only about 16% of eligible patients were getting the screening they needed. I wondered what was preventing people from getting these life-saving screenings. The barriers seemed to be financial, cultural, and personal—such as fear of having a colonoscopy.

I can identify with this. At the same time this was going on, I reached my 50th birthday, and it was time for my own screening colonoscopy. While looking into having mine done, I realized that there were barriers to having this preventive procedure, even for myself. Getting the colonoscopy required three separate appointments and three days off from work. In an area of high unemployment, it is difficult to get off even half a day of work.

Not only did this open my eyes to the barrier of time off from work to get the screening done and the cost, it also opened my eyes to the risk that not getting screened poses to our families.

We set up a task force to get information to our patients who needed to be screened. The Affordable Care Act helped us overcome financial barriers because it requires most insurance companies to cover the full cost of a colonoscopy, with no copay for patients. We also had a program through the state health department that provided free colonoscopies for those who did not have adequate insurance coverage.

We overcame the time barrier by partnering with a local hospital system. Though it was unfortunately three hours from our service area, we were able to set up a local outreach center. Working with our local hospital, we arranged for screening colonoscopies to be done on Mondays and Fridays.

The task force worked with our scheduling staff, check-in nurses, quality team, and medical providers to identify every person who was at risk and needed an early screening colonoscopy at age 40 because of family history, or who was in the age group of 50 to 75 years for routine screening.

We worked with nurses, the hospital, and providers to make the system easy to set up and easy for the patient to participate in. Some patients preferred to be screened with the FIT (fecal immunochemical test), another type of recommended test, which is repeated yearly.

As a personal champion for screening colonoscopies, I used my own story, along with stories of people under the age of 50 in our community who had gone through colonoscopies, in order to encourage our patients to get screened. After personally reassuring them of the ease of the procedure, helping with the fear of the prep, and then showing them that they will be comfortable during the procedure, we were able to gain ground on patient trust and get them scheduled for their colonoscopies.

While we have improved our rates, our goal is to get 100% of patients in the recommended age group screened, either with colonoscopies or with yearly FIT tests, so that the high level of colon cancer in our area can be adequately screened for and corrected with minimal treatment. I share my personal story with everyone, hoping that both professionals and patients will realize that we all have barriers—and we can all overcome them together as a community.

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6 comments on “A Rural Community Overcomes Barriers to Colorectal Cancer Screening”

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    A great post and a great effort to help our people! Thank you, Dr. Breeding, for taking the time and having the interest to share your personal story and to go beyond that by helping to eliminate barriers for the patients. If every doctor did that for a particular problem, we might see a great decrease in the many other serious diseases and illnesses that are so prevalent in our community.

    Thank you so much for this giant step, more like a leap, into health care for those who may not otherwise receive it….Thank you so much, Dr. Breeding, for sharing your own experience to encourage participation….God bless you….

    Thanks to Dr Breedings kind heart and concern for his patients many people are living a healthy life. Our communities need more healthcare providers that care about their patients personally. Thanks again Dr Breeding for all you have done for our family.

    My problem is drinking all of that liquid stuff they give you. With stomach problems and GERD I cannot do it.
    Also, when my husband had this test done, he woke up during the procedure and heard the doctor say, “He is not cleaned out enough.!” He was embarrassed and he had done all that he was supposed to. It makes people very uncomfortable.

    Does anyone know where to find the public record and actual verbiage for the satute revisions listed below?

    In February 2013, the Obama administration stated that for people in group and individual health plans, polyp removal during a screening colonoscopy was an integral part of the screening test and should be covered without patient cost sharing

    In February 2013, the federal government clarified that high-risk patients could qualify for more frequent screening without cost sharing.

    They were found on this website:

    It seems that our Federal Government is trying very hide to hide and limit access to the legislation they pass
    on our behalf. Conspiracy??? No Federal Law database? We pay for Congress and yet they spin their little webs in secret. It’s about time we get some transparency.

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Page last reviewed: Wednesday, June 24, 2020
Page last updated: Wednesday, June 24, 2020