A Critical Evaluation of Contextual Factors Affecting the Implementation of Pharmacist-Led Colorectal Cancer Screening: A Scoping Narrative Hybrid Review

PEER REVIEWED

Figure 1. The figure presents a Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) 2020 flow diagram summarizing the identification, screening, eligibility assessment, and inclusion of studies. A total of 494 records were identified from 4 sources: PubMed (n = 27), MEDLINE via OVID (n = 24), ProQuest (n = 442), and ClinicalTrials.gov (n = 1). Prior to screening, 456 records were removed: 25 duplicate records, 420 records marked as ineligible by automation tools, and 11 records removed for other reasons. After removal, 38 records remained and were screened by title and abstract. Nineteen records were excluded at this stage. Nineteen full-text reports were sought for retrieval and assessed for eligibility; no reports were unavailable. Of the 19 full-text reports assessed, 9 were excluded: 8 studies conducted outside the United States and 1 incomplete clinical trial. Ten studies met eligibility criteria and were included in the final review. The diagram follows the standard PRISMA 2020 structure with 4 stages: Identification, Screening, Eligibility, and Included.

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Figure 2. This figure presents a conceptual framework illustrating multilevel barriers and facilitators that influence CRC screening delivery in community pharmacy settings and corresponding implementation strategies designed to address identified barriers. The framework is organized into 4 domains: innovation, inner setting, outer setting, and individuals, with arrows linking contextual barriers and facilitators to implementation strategies, mechanisms, and outcomes.

Innovation characteristics include low complexity, high acceptability, and compatibility with the pharmacy environment. Inner setting factors are workflow and staffing burden in busy dispensing environments and lack of closed-loop follow-up systems. Outer setting factors are lack of reimbursement and patient unwillingness to pay, care coordination challenges, and concerns about privacy. Individual-level factors are pharmacist knowledge gaps regarding CRC screening guidelines and patient-level behavioral barriers, such as forgetting or misplacing FIT kits.

The figure outlines corresponding implementation strategies, including workflow redesign; task shifting to technicians or interns; use of pharmacy management system prompts; educational outreach and guideline-focused training; quick-reference job aids embedded in workflows; development of reimbursement pathways and policy advocacy for pharmacist recognition; enhancement of privacy measures; formalization of collaborative practice agreements; establishment of standard operating procedures for positive FIT follow-up; and investment in bidirectional health information exchange. These strategies operate through defined implementation mechanisms, including reducing workload burden, improving feasibility in daily practice, enabling financial sustainability, improving trust and continuity of care, increasing fidelity of screening delivery, and supporting patient adherence and completion rates. The anticipated implementation outcomes include increased uptake and adoption, improved feasibility and fidelity, and increased acceptability and sustainability. The figure also highlights clinical outcomes, including earlier detection of colorectal cancer, increased access to CRC screening, and reduced loss to follow-up.

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