Equitable colorectal cancer screening implementation framework via a modified Delphi Consensus for Romanian healthcare

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.

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Publication Details

Journal
Scientific Reports
Published
2025-11-28
DOI
https://doi.org/10.1038/s41598-025-26713-7
Primary Topic
Colorectal Cancer Screening and Detection
Type
article
Field-Weighted Citation Impact
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article

Equitable colorectal cancer screening implementation framework via a modified Delphi Consensus for Romanian healthcare

Albina Zubayraeva, Sergey K. Efetov, Georgios Ioannis Verras, Yasuko Maeda et al.
Scientific Reports
Colorectal Cancer Screening and Detection
article

Equitable colorectal cancer screening implementation framework via a modified Delphi Consensus for Romanian healthcare

Albina Zubayraeva, Sergey K. Efetov, Georgios Ioannis Verras, Yasuko Maeda, Ruxandra Irina Negoi, Luı́s Rodrigo, Mihai Alexandru Botezatu, Robert Gabriel Lupu, Ana-Maria Mușină, Gabriëlle H. van Ramshorst, Francesk Mulita, Anca Morar, Toni T. Seppälä, Gianluca Pellino, Roxana Gănescu, Octav Ginghina, Bogdan Stoica, Claudiu Herţeliu, L Munteanu, Kenneth Yuh Yen Kok, Elena Toma, Eduard-Alexandru Bonci, Constantin Dina, Akmalbek Otabekov, Alin Moldoveanu, Gabriel Constantinescu, Biniam Ewnte, Ildar Ravisovich Fakhradiyev, Francesco Pata, Teodor Cabel, Hizbullah Jan, Kire Stojkovski, X Pucheanu, Suman Baral, Ionuţ Negoi, Vasile Şandru, Florin Grama, Corina Toma, Dragos Nicolae Garofil, Marcel Tanțău, Tapan Patel, Andrei Ungureanu, S S Popescu, Matteo Frasson, Mostafa Shalaby, Radu Mirică, Iuliana Marin, Zoe Garoufalia, Sorinel Luncă, Adrian Tudor, V. Ionescu, Charalampos Seretis, Ionut Bogdan Diaconescu, Gabriel Dimofte, Haddadi Saïd, I Tănase, Horia Doran, Linda Gabriel, C Dimitriu, Massimo Sartelli, Velenciuc Natalia, Makkai Silviu, Alexandra Boromiz, Stefana Ilinca Tudorascu, Florin Dinu, George Ovidiu Cirstea, Omar Rabah Obaid
article en

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.

Scientific ReportsVol. 15(1)
Cleveland Clinic (US), Khyber Medical College (PK), Tampere University of Applied Sciences (FI), Pokhara University (NP), Ovidius University (RO), Mansoura University (EG), Carol Davila University of Medicine and Pharmacy (RO), Macedonian Academy of Sciences and Arts (MK), Sechenov University (RU), Universiti Brunei Darussalam (BN), Kazakh National Medical University (KZ), University of Campania "Luigi Vanvitelli" (IT), Iuliu Hațieganu University of Medicine and Pharmacy (RO), Sir Sayajirao General Hospital Medical College (IN), Clinical Emergency Hospital Bucharest (RO), Ghent University Hospital (BE), General University Hospital of Patras (GR), Hospital Universitari i Politècnic La Fe (ES), Grigore T. Popa University of Medicine and Pharmacy (RO), Transylvania University of Brașov (RO), Institutul Regional de Oncologie (RO), Center of Technology and Engineering for Nuclear Projects (RO), Gheorghe Asachi Technical University of Iași (RO), Cleveland Clinic Florida (US), Debre Tabor University (ET), Sanatorium Kilchberg (CH), Tampere University (FI), Hospital Universitario Central de Asturias (ES), Japan Organization of Occupational Health and Safety (JP), Inova Alexandria Hospital (US), Queen Elizabeth University Hospital (GB), 108 Military Central Hospital (VN), Fundaţia pentru Formare Profesională şi Învăţământ Preuniversitar - Viitor (RO), Ospedale di Macerata, University of Macerata (IT), University of Zadar (HR), Universitatea Națională de Știință și Tehnologie Politehnica București (RO), Bucharest University of Economic Studies (RO)
Openalex Percentile: Top 48%
Colorectal Cancer Screening and Detection
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