Equitable colorectal cancer screening implementation framework via a modified Delphi Consensus for Romanian healthcare
Abstract
Abstract Colorectal cancer (CRC) continues to be a predominant cause of cancer-related mortality on a global scale. Screening for early detection plays a crucial role in significantly reducing both incidence and mortality rates. However, screening uptake varies widely across regions due to disparities in healthcare resources and implementation of screening programs. The aim of this study was to evaluate various potential strategies for implementing an effective colorectal cancer screening program that enhances adherence. This program should be feasible and appropriate, considering the demographic characteristics, geographical distribution, and logistical factors, including human and material resources, of medical facilities at the national level in Romania. A multidisciplinary panel was convened using a modified Delphi process (two survey rounds and a consensus meeting in early 2022) to develop a harmonized CRC screening framework tailored to diverse healthcare settings. Clinicians and allied professionals from 19 countries (Europe, Asia, and Africa) contributed to the consensus recommendations for average-risk individuals. The panel advised that primary care physicians should play a central role in CRC risk assessment and patient engagement and endorsed initiating screening at age 45 and continuing to 75, with selective extension up to 85 for healthy, willing individuals. To improve participation, we recommended region-specific screening strategies that accommodate local resources and demographics and emphasized a patient-centered approach offering multiple modalities (colonoscopy, fecal immunochemical testing, CT colonography), emphasizing that the most effective test is one that patients are willing to complete. Finally, the study group deemed implementing a centralized system for screening invitations, result tracking, and patient recall essential. This consensus guideline provides a scalable model to enhance screening adherence and reduce CRC mortality through early detection and prevention. This framework is developed for the Romanian healthcare context, informed by international professional input but tailored to local healthcare infrastructure and estimated population needs.
Article Details
Authors (68)
Ionut Negoi
Alexandra Boromiz
Suman Baral
Eduard-Alexandru Bonci
Mihai Botezatu
Teodor Cabel
George Ovidiu Cirstea
Gabriel Constantinescu
Ionut Bogdan Diaconescu
Corneliu Dimitriu
Gabriel Dimofte
Constantin Dina
Florin Dinu
Horia Doran
Sergey Efetov
Biniam Ewnte
Ildar Fakhradiyev
Matteo Frasson
Roxana Ganescu
Dragos Garofil
Zoe Garoufalia
Octav Ginghina
Florin Grama
Claudiu Herteliu
Ioan Tănase
Victor Stefan Ionescu
Hizbullah Jan
Kenneth YY Kok
Sorinel Lunca
Robert Gabriel Lupu
Yasuko Maeda
Iuliana Marin
Radu Mihail Mirica
Alin Moldoveanu
Anca Morar
Francesk Mulita
Ana-Maria Musina
Velenciuc Natalia
Ruxandra Negoi
Omar Rabah Obaid
Akmalbek Otabekov
Francesco Pata
Tapan Patel
Gianluca Pellino
Sorin Stefan Popescu
Xenia Pucheanu
Lupu Robert Gabriel
Luis Rodrigo
Laura Elena Roșu Munteanu
Vasile Sandru
Massimo Sartelli
Haddadi Saïd
Toni Seppälä
Charalampos Seretis
Mostafa Shalaby
Makkai Silviu
Bogdan Stoica
Kire Stojkovski
Marcel Tantau
Ciprian Toma
Elena Adelina Toma
Alexandru-Vicentiu Tudor
Stefana Ilinca Tudorascu
Alexia Ungureanu
Andreea-Catalina Ungureanu
Gabrielle van Ramshorst
Georgios Ioannis Verras
Albina Zubayraeva