Patient perspectives on a proposed pharmacy-based colorectal cancer screening program

Transl Behav Med. 2023 Dec 15;13(12):909-918. doi: 10.1093/tbm/ibad057.


Colorectal cancer (CRC) is a common and preventable cancer. CRC screening is underutilized, particularly within medically underserved communities. Most interventions aimed at increasing CRC screening are delivered through primary care clinics. Pharmacies are more accessible than traditional primary care settings and may be ideally suited for delivering CRC screening and increasing access. Fecal immunochemical test is an at-home, stool-based CRC screening test that could be distributed through pharmacies. The purpose of our study was to assess patient perspectives on receiving fecal immunochemical test-based CRC screening through pharmacies. We conducted semi-structured interviews with participants residing in North Carolina and Washington. Interviews explored acceptability and intervention design preferences for a pharmacy-based CRC screening program. The interview guide was informed by Andersen's Healthcare Utilization Model and the Theoretical Domains Framework. Interviews were conducted at the University of North Carolina at Chapel Hill and Fred Hutchinson Cancer Research Center, audio-recorded, and transcribed. Patients perceived a pharmacy-based CRC screening program to be highly acceptable, citing factors such as ease of pharmacy access and avoiding co-pays for an office visit. Some concerns about privacy and coordination with patients' primary care provider tempered acceptability. Trust and positive relationships with providers and pharmacists as well as seamless care across the CRC screening continuum also were viewed as important. Patients viewed pharmacy-based CRC screening as an acceptable option for CRC screening. To improve programmatic success, it will be important to ensure privacy, determine how communication between the pharmacy and the patient's provider will take place, and establish closed-loop care, particularly for patients with abnormal results.

Keywords: FIT; colorectal cancer; pharmacy; screening; uninsured.

Plain language summary

Colon cancer is a common and preventable cancer in the USA and testing for colon cancer can be done at home with a simple test. Yet, many people remain unscreened. This is particularly true for people who may not have ready access to health care, such as those who have limited incomes or resources or who live in rural areas. Most people live close to a pharmacy and visit a pharmacy more frequently than a primary care office. Pharmacies commonly offer services beyond medication dispensing (e.g. flu shot, diabetes management), making them a potential avenue for increasing colon cancer screening. This study aimed to learn what patients think about receiving colon cancer screening through pharmacies. We interviewed 32 people who fit the age-range recommended for colon cancer screening. They were open to, even embracing of, getting screened for colon cancer through a pharmacy, primarily because of its convenience, accessibility, and because it would not require a co-pay. At the same time, they emphasized the need for privacy and coordination with their primary care provider. We concluded that colon cancer screening in pharmacies is potentially a good option for people, provided they have privacy and that their primary care providers are informed.

MeSH terms

  • Attitude of Health Personnel
  • Colorectal Neoplasms* / diagnosis
  • Colorectal Neoplasms* / prevention & control
  • Early Detection of Cancer / methods
  • Humans
  • Pharmacies*
  • Pharmacy*