Impact of COVID-19 on colorectal cancer screening in a federally qualified health center: Provider and staff perspectives

The COVID-19 pandemic and associated policies discouraging routine-care visits dramatically affected cancer screening in the United States. Yet little is known about the perspectives of providers and staff at federally qualified health centers (FQHCs) on colorectal cancer (CRC) screening during this period. We administered hour-long telephone interviews with clinic leadership and frontline staff at a Los Angeles-based FQHC. Questions explored barriers and facilitators to CRC screening, and adaptations implemented to address challenges posed during three phases of the COVID-19 pandemic: early (March-July 2020), middle (August - December 2020), and later (January - December 2021). All interviews were recorded, transcribed, and content-analyzed by trained and experienced qualitative methodologists. Participants' (n = 20) ages ranged from 26-56; most were female (85%), and in leadership positions (65%). Early in the pandemic CRC screening efforts were severely hampered as the health center was inundated with upper respiratory infections, lacked infrastructure to rapidly scale telehealth, and had minimal guidance from prior disaster plans geared for short-term challenges (e.g., flu). Limited availability of stool test kits and reduced gastroenterology capacity also thwarted CRC screening delivery. Throughout the pandemic, the FQHC faced challenges hiring and retaining staff for cancer screening outreach. In the later phase of the pandemic, the FQHC responded by expanding CRC screening options, deploying health record tools enabling automated outreach, and retraining staff on CRC screening workflows. Interviewees identified strategies to strengthen pandemic preparedness and sustain CRC screening, including improved monitoring of infectious disease through incoming patient call data to guide staffing decisions, diversifying vendor relationships and specialty care partnerships to ensure access, particularly in gastroenterology, and increasing home-based testing options. Our findings, while limited to the experience of one large FQHC, may help inform efforts to develop guidance that community health centers can apply in responding to future pandemics or other natural disasters to minimize impacts on CRC screening.