Colorectal cancer screening in Canada: 2021/2022

Strategies to improve screening for First Nations, Inuit and Métis

Screening programs in eight provinces and three territories report work with First Nations, Inuit and/or Métis to increase participation and improve the screening experience. This work includes engaging First Nations, Inuit and Métis in decision-making and informing approaches to culturally appropriate screening and program resources, such as social media campaigns and engaging with and educating healthcare providers working directly with First Nations, Inuit, and Métis communities.

Strategies to improve screening for First Nations, Inuit, and Métis

P/T  Intended audiences Strategies used   Strategy co-developed with community?   Description of activities to improve screening for First Nations, Inuit, and Métis 
YT  · First Nations
· Inuit
· Métis
· Environmental scan to better understand effective intervention to address disparities in cancer screening for people with low income and rural/remote Yukon communities
· Providing services closer to home
· Overview of organizations in the territory supports First Nations, Inuit, Métis
All: ✓ · ColonCheck Yukon Disparity Report – areas of consideration: promotion and awareness, health care system (Canada and Yukon), hesitancy and non-participation, client surveys, and Putting People First Report
· Collaborating with other outreach programs to reach individuals who are unable to access the program
· Considering mobile screening unit to increase access to screen in rural/remote Yukon communities
NT  · First Nations
· Inuit
· Métis
· Development of culturally safe materials and resources
· Healthcare provider cultural competency training
All: ✓ · Translated promotional materials
· Pictograph based instructions with FITs,
NU  · First Nations
· Inuit
· Métis
· Opportunistic screening at this time. As part of the implementation plan for a organized screening program several of these strategies will be utilized ✓^
AB  · First Nations
· Inuit
· Métis
· Education (one on one and group)
· Client invitation and reminders
· Media (small and mass)
· Provider assessment and feedback
· Healthcare provider cultural competency training
· Development of culturally safe materials and resources
· Direct community engagement to co-design programs
All: ✓ · Partner with Indigenous representatives to conduct screening disparities evaluations and use findings to inform strategies to improve screening in Indigenous populations.
· Share evidence and learnings with service providers to provide culturally safe care.
· Work with Indigenous partners to develop and provide culturally appropriate information.
SK  · First Nations
· Métis
· Working directly with northern communities to assess, implement and evaluate responsive and tailored participation strategies All: ✓ · Trialing different methods of invitation to assess effectiveness
MB  · First Nations
· Métis
· Comprehensive letter campaigns
· Enhanced test instructions; illustrated, and video
· Cross program promotion
· Interpreter services
· Invitations, recalls, and reminders are actively sent to eligible persons
· ColonCheck partners with Community Engagement Liaisons in each regional health authority in the province to provide resources for one to one education
· Grant funded project to mail 15,000 FOBT kits to underserved populations, where a great proportion is being send to First Nations and Metis populations
· Two mobile breast screening clinics offer education on colon cancer screening and provide information on accessing test kits
· Creating new illustrated instructions to support those challenged by written instruction
ON  · First Nations
· Inuit
· Métis
· Group education and mass media
· Client reminders
· Development of culturally safe materials and resources
· Provider reminders and recall systems
· Mobile screening
· Partnerships
· Direct community engagement to co-design programs
All: ✓ · Through Indigenous Cancer Care Unit (ICCU), Regional Indigenous Cancer Leads and regional teams, communities are engaged to inform programs/initiatives to improve education and awareness of cancer screening.
· The ICCU is currently engaged in a study to investigate current correspondence and identify methods to enhance patient reminders. Reminders are sent to all eligible Ontarians through Ontario Health (Cancer Care Ontario)’s cancer screening correspondence letters for both invitations and recalls.
· Continued ICCU support for the Cancer Screening Fact Sheets, Toolkit, and awareness postcards/posters which were designed and tailored with and for each First Nation, Inuit and Métis population.
· Cancer 101 Video: Ontario Health (Cancer Care Ontario) made this video for First Nations people. The video gives basic cancer information and answers many common questions about cancer. Other groups that helped make the video are CAREX Canada, the Occupational Cancer Research Centre and the Canadian Cancer Society.
· The Screening Activity Report (SAR) is an online report, which provides screening data to help family doctors improve their cancer screening rates and appropriate follow-up. The report allows family doctors to quickly find specific cancer screening information for each patient, including those who are overdue or have never been screened. In June 2018, the SAR was expanded to the Sioux Lookout Zone, which consists of several First Nations communities, providing non-patient enrollment model physicians and nurses access to their community data. This SAR was developed specifically for the Sioux Lookout municipality and the 27 First Nation communities that reside in the Sioux Lookout Zone.
· The ICCU and Northwestern Regional Cancer Program in partnership with communities jointly plan community events to provide access to screening through a mobile screening coach in the North West region.
· Through the relationships developed and fostered by the ICCU, regional teams have been able to continue working with communities as guided through the Indigenous Cancer Strategy.
· The ICCU and Cancer Screening are partnering with the Sioux Lookout Regional Health Authority and primary care providers to pilot strategies to improve access to colorectal cancer screening with FIT in Sioux Lookout and Zone communities, to support improvements in colorectal cancer screening participation in SLZ communities and to inform the implementation of these strategies in other populations.
· A grant received by Dr. Jill Tinmouth and Dr. Amanda Shephard (“Catching Cancer Early how well do Ontario screening programs perform for First Nations and Métis persons?”) will provide Ontario Health (Cancer Care Ontario) with strategies to improve participation for First Nations and Métis people and may inform cancer screening recommendations in these populations.
NB  · First Nations
· Métis
· Group education
· Leverage learnings from the project ‘Developing Strategies for Underscreened Populations through Community Engagement’.
All: ✓ · The program offers group presentations upon request from First Nations Communities based on education needs for targeted audience.
· Leverage learnings from the project ‘Developing Strategies for Underscreened Populations through Community Engagement’.
NS  · First Nations · Education · Health fairs
PE  · First Nations · Attending community events in person ✓~ · Attended annual community health care events with joined cancer screening booth in person – stopped during pandemic, March 2020
NL  · First Nations
· Inuit
· Métis
· Participation and engagement with CPAC funded Project for First Nations, Inuit, and Metis within Care Care Program
· Targeted presentations to health care professionals who provide direct health services to Indigenous populations
· Development of translated materials for within the home screening FIT kit
· Development of wordless instructions to be used throughout the screening program
· Presentations and updates at provincial gatherings

*Quebec does not have an organized screening program available so there are no concerted strategies in place. Each health institution is responsible for implementing the appropriate strategies to reach out to the population it serves.
NU: ^This will be part of the consultation process.
PE: ~Invited/asked to come by community health centres.