The comprehensive analysis of the causal loop diagram reveals several key insights and recommendations for clinics aiming to enhance colorectal cancer (CRC) screening. By understanding the interconnected factors that influence per-person screening costs, clinics can carefully consider which screening modality is prioritized and take strategic actions to improve screening adherence while minimizing costs.

Here are some high-level recommendations:

• Consider Short-Term and Long-Term Health and Financial Impacts in Decision-Making: Select CRC screening modalities and EBIs to support those modalities with both annual and long-term (e.g., 10 years) screening completion and costs per person screened in mind.
• Understand Patient Needs when Recommending CRC Screening: Engage patients in conversations about their individual circumstances and barriers to care. Prioritize the use of stool-based testing vs. routine colonoscopy depending on factors including patients’ health-related social needs and ability to complete different types of screening.
• Align Screening Modalities with EBI Implementation: For largely stool-based CRC screening programs, select interventions that can support year-to-year screening completion and adherence to follow-up colonoscopy for those with positive results. For largely colonoscopy-based programs, prioritize interventions that can support adequacy of bowel preparation, minimize out-of-pocket expenses, and reduce no-shows. Ensure that provider recommendations align with clinic EBI activities.

By integrating these recommendations, clinics can enhance their capacity to address CRC screening gaps and reduce screening costs.