Associate Professor Department of Psychiatry and Behavioral Medicine University of California, Davis Sacramento, California
Cerrone Cohen, MD
Medical Instructor Department of Community and Family Medicine Department of Psychiatry Duke University School of Medicine Durham, North Carolina
Disclosures
The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
avoids the yearly adherence to a screening program that is needed with stool cards alone
does not rely on patients collecting and returning stool kits for processing.
A potential challenge for patients with limited social support is the requirement to have someone accompany the patient on the day of colonoscopy.
Take steps to improve the screening rate. In addition to specific recommendations based on symptom severity, there are systems-level interventions that should be considered to improve the screening rate. These include:
addressing transportation issues that are a barrier to screening
considering the use of health navigators or peer advocates to help guide patients through the sometimes complex systems of care.
A more comprehensive systems-level intervention for mental health clinics that work primarily with persistent and severe mentally ill populations might include employing a care coordinator to organize referrals to primary care or even exploring reverse integration. In reverse integration, primary care providers co-locate within the mental health clinic, (1) allowing for “one-stop shopping” of mental health and primary care needs and (2) facilitating collaboration and shared treatment planning between primary care and mental health for complex patients.
Bottom Line
Screening tests for colorectal cancer (except colonoscopy) are useful for the asymptomatic stage only. Stool-based studies, flexible sigmoidoscopy, and colonoscopy are the best studied screening options, and vary in recommended screening intervals. The specific screening modality to recommend should (1) be individualized and (2) take into account patient preference, likelihood of adherence to the schedule, and how well psychiatric symptoms are controlled.
Related Resources
American Cancer Society. www.cancer.org.
National Cancer Institute. Colorectal cancer–patient version. www.cancer.gov/types/colorectal.
