Consensus Recommendations - National Consortium for Cancer Screening and Care

Responding to the COVID-19 Pandemic: Improving Cancer Screening and Care in the United States

In March 2021, the American Cancer Society (ACS) created the ACS National Consortium to establish a collective national response to the detrimental impact of the COVID-19 pandemic on cancer screening and care. The consortium members included 28 government agencies, health organizations, national roundtables and cancer advocacy organizations, professional societies and associations, research institutions, and other relevant industry partners. The consortium members met to identify, discuss, and agree on consensus recommendations for improving cancer screening and care in the United States.

See the nine recommendations below or click on the button to download the full recommendations report.

See the Consensus Recommendations Report

See the Recommendations Executive Summary

See Additional Resources

Accelerate Recommendations

National Partnerships

Accelerate the collective action of partnerships, coalitions, and roundtables to influence the adoption of evidence-based cancer screening interventions and policies.

Implementation Strategies

Connect organizations and catalog resources. Review the list of national partners to ensure diverse representation and perspectives. Continue prioritization of health equity and further the identification and sharing of evidence-based and promising practices, policies, and strategies in a coordinated way. Engage patient advocacy organizations to ensure the perspectives and experiences of those facing cancer helps in informing and guiding the work.

Facilitate implementation of best practices tailored to community needs. Make implementation guidance available and accessible to all. Facilitate the uptake of evidence-based practices and new research findings in clinical and community contexts.

Ensure sustainability of and collaboration across national roundtables. Improve buy-in from members, stakeholders, and decision-makers to increase and diversify membership and funding.

Evaluate Impact. Use top-down and bottom-up feedback for evaluation and course correction. Strengthen the literature around short-term and long-term impacts of roundtable/coalition work on adoption of best practices in cancer prevention, screening, and care. Validate the ability of roundtables to drive implementation and discover innovative intervention approaches.

Coordinated Messaging

Accelerate a coordinated, innovative campaign to promote cancer screening as a public health priority.

Implementation Strategies

Create a coordinated campaign. Deliver precision messaging on contemporary platforms that most effectively inform populations highly affected by cancer. Invite customization from participating organizations to meet the needs of those they serve. Learn and build from practices that resonated during the COVID-19 pandemic.

Meet communities where they are. Recognize that communities receive health information and media through a variety of channels and utilize established and trusted message delivery options, including trusted messengers. Improve characterization of social contexts and develop language that better addresses social determinants of health-affecting cancer outcomes.

Strive for well-informed decisions. Encourage organizations to address health literacy and develop cancer messaging that is not just understandable but meaningful and usable.

Proven Programs

Accelerate screening efforts by supporting and expanding proven programs that effectively reach communities that are historically excluded and underserved.

Implementation Strategies

Sustain and grow patient navigation and community health worker programming. Advocate for financial reimbursement of patient navigation programs within health systems and community health worker programs within communities. Further, sustain the services via workforce training and advocacy for appropriate payment options.

Increase implementation of effective patient navigation and community health worker models across communities most in need. Improve support for community health workers and patient navigators to work with people who are underserved and/or most likely to have poor outcomes for all cancer types.

Build linkages between health systems care coordination and community outreach. Promote more partnerships among health systems/providers and community agencies to increase access to clinical services. Utilize community health workers as well as patient navigators to support these linkages and enhance the collective impact on patient outcomes across the care continuum.

Utilize cancer screening risk assessment strategies. Promote universal access to combined screening strategies for individuals based on risk, and incorporate processes for collection, documentation, tracking, and monitoring of individual risk-based information.

Quality Measures

Accelerate the adoption of improved quality measures, accountability measures, and institutional goal-setting that prioritize equitable outcomes.

Implementation Strategies

National measures. Propose and advocate for quality measures that better monitor on-time screening and follow-up care equally across populations.

National accreditation. Encourage national standards for accreditation of screening that hold institutions accountable.

Health systems reporting. Require health systems to report outcomes by key demographic and disparity factors (insurance status, race/ethnicity, sexual orientation, gender identification, etc.).

Electronic health records. Encourage/develop the capacity to look at screening longitudinally over time (e.g., enhanced EHR tools). (Current measures do not show who is cycling in/out of being up-to-date.) Seek to configure clinical care systems to address social determinants of health.

Pandemic-Related Innovations

Accelerate innovations and interventions that better expand equitable access to cancer screening and care.

Implementation Strategies

Tailor the screening conversation to reduce fears and misinformation. Identify both new and persisting fears that lead to reluctance (procrastination of screening) in patient populations, and then tailor the communications approach to combat misinformation and decrease fears. Increased patient knowledge of the benefits of cancer screening can help overcome misconceptions.

Increase access points for preventive care and promote remote screening options. Expand cancer screening services to include addressing structural barriers to screening access (e.g., expanded clinic hours) and offer cancer screening services in non-traditional settings (e.g., retail, mobile van, at-home tests). Provide seamless navigation to the most appropriate resource in terms of patient-centricity and cost. Assess and improve the remote-to-in-person workflow to understand the reimbursement and policy implications so that providers are incentivized to use the most seamless route.

Modify community tracing technology and staffing. Take best practices from contact tracing and technology, including utilization of lay community navigators for cancer screening purposes.

Improve integration and adoption of technological innovations in cancer screening and care. Identify methods to improve screening and care that will benefit and support populations with disproportionate cancer burden. Ensure that innovations and technology improve outcomes and do not exacerbate disparities.

Strengthen Recommendations

Public Trust

Strengthen trust in public health and health care systems by using a forward-looking, whole-person approach.

Implementation Strategies

Health care providers should adopt whole-person approaches. Providers can use this approach to introduce timely and relevant cancer prevention and screening education when treating chronic conditions and co-morbidities.

o Payment reform must support the whole-person approach in the clinical setting.

The integration of whole-person approaches should include multiple healthcare disciplines. For example, behavioral health experts, community health workers, and navigators should be included in cancer prevention, screening, and care interventions.

Improve the understanding of medical mistrust. Conduct community-based participatory research to understand the issue. Use the findings to change organizational policies and practices, inform health care providers and professionals, and adjust messaging to reach apprehensive communities.

Empower communities to guide health messaging. Ensure receiving communities are prepared to guide the content and delivery of messaging about cancer screening in culturally-appropriate ways. Develop public awareness campaigns that build trust prior to interactions with health care providers.

Comprehensive Preparedness Plans

Strengthen health system and community preparedness plans for health disruptions by including cancer and other chronic disease care in the plans.

Implementation Strategies

All health care organizations should delegate a champion to create a preparedness plan. Champions for organizations such as hospitals, community health centers, and state health departments should create preparedness plans that address cancer and other chronic diseases. Preparedness plans must include cancer needs (i.e., continuity of screening, diagnosis, treatment, and survivorship follow-up) with a goal to minimize disruptions to care with careful consideration of underlying risks and health equity.

Foster community partnerships, representation, and accountability. Health systems should be responsive to the communities they serve and create accountable partnerships. Patient advocacy groups and other community organizations should have representation via direct participation and influence in the development of health system preparedness plans.

Create community messaging plans and structure. Ensure preparedness plans encompass all voices of the community and set up two-way communication paths between health systems and the community. This will help ensure that during the next emergency, including a pandemic, trust will be maintained and strengthened, and response messages will be effectively disseminated.

Assess federal, state, and local policy options. Consider options that would provide resources to states and counties to help establish health preparedness emergency committees. The preparedness committees would help to clarify the roles at the federal, state, and local levels, and each committee would include a cancer expert.

Document and Understand Cancer Disparities

Strengthen the understanding of outcomes in cancer screening and care by collecting and utilizing demographic and social determinants of health data.

Implementation Strategies

Identify key players. Conduct an environmental scan for entities that have the capacity to both collect and utilize needed data. Include national and state agencies, electronic health record companies, and other pertinent data-collection organizations in the inventory produced by the environmental scan.

Recommend standards for data collection, reporting requirements, and corrective action plans. Establish recommendations for best practices in data collection and utilization.

Enforce national quality standards. Ensure that quality processes for the collection and reporting of data are followed. Provide organizational and professional training for the people who will collect the data.

Aggregate multiple sources of data. Create a repository of de-identified and publicly available data, including data from the Health Resources & Services Administration (HRSA), the Centers for Medicare & Medicaid (CMS), private payers, and electronic health record vendors. Provide guidance on how to leverage the data at the state and local levels.

Utilize data for planning and evaluation. Data should inform the development and evaluation of interventions that address disparities in the entire cancer care continuum, including survivorship.

Transdisciplinary Teamwork

Strengthen transdisciplinary teamwork in support of health care delivery.

Implementation Strategies

Coordinate more connections between interdisciplinary health care teams. Create opportunities for connections between health care teams that do not normally work together. These connections occurred out of necessity throughout the pandemic in response to patient needs and/or safety and as a response to organizational needs and capacities.

Establish a national culture of partnership. National agencies and organizations, like the Centers for Disease Control and Prevention (CDC) and the American Cancer Society, can broker longitudinal relationships and generate trust among
public health, community, government, industry, health care organizations, and professional
societies.

Normalize conversations around science- and evidence-based approaches. Build respectful spaces for conversations and reconnection between health care and public health professionals, community leaders, and community/patient populations. National, state, and local partners should work together to disseminate tools that emphasize approaches informed by implementation science.

Create transdisciplinary professional education opportunities. Work with traditional and non-traditional partners to create educational opportunities to build a complete foundation of health care and science literacy.