Table 4 Informants’ quotes of themes related to COVID-19 and its impact on CRC screening activities

COVID-19

 Pandemic

QI director: “That (pandemic) was I think the largest factor. I can’t really think of a factor that would have really prevented us from moving forward. That changed everything.”

Screening champion: “Yeah, so we did great before the pandemic in increasing our colorectal cancer screening. And then after the pandemic, our numbers decreased precipitously.”

 Shelter in place order

SFCCC leader: “Well, initially in the pandemic, in the shelter in place order in San Francisco was on, I think March the 15th or somewhere around there so starting in late March and April, initially many of the clinics greatly reduced in-person visits.”

QI manager: “I guess probably the biggest challenge, and maybe it was just when the pandemic started last year, all our screening was put on hold for a little bit because people were more worried about, obviously like shelter-in-place and the pandemic and protecting themselves.”

 Competing demands during crisis

QI manager: “All of the QI staff were now… They were in the COVID tents, they were doing testing. So not only were the patients not coming in for the test, but our staff were just not on QI, it basically almost completely halted. We stopped having QI meetings for a window of time.”

Screening champion: “COVID has been a huge challenge. I think screenings, not just colorectal cancer screenings have been a challenge to remember, because you have to do extra screenings around COVID and then there’s only so many minutes you have with every patient and our patients are very complex. So I think remembering those routine screenings has definitely been a challenge.”

 Shift to virtual visits

SFCCC leader: “The numbers dropped dramatically, both because of the drop in in-person visits and the newness of trying to get screening done when you were doing most of your visits virtually.”

Screening champion: “Well, the main issue is that we have to somehow get a physical test kit to a patient. Usually that was done in per person in clinic. And now that we’re not having as many people come in and switching most of our services over to telehealth. That has just complicated things.”

 Uncertainty with CRC screening strategies

SFCCC leader: “It’s just that both they (clinics) and us are still struggling to find the optimal way to do routine things like colorectal cancer screening in the middle of this pandemic.”

Medical director: “So we’re impacted because we recognize that we are not doing as well on screening. And the primary challenge I think that we had, is that we rooted our screening on the anticipation of the personal interaction and education that came from patients who are coming to our clinic.”

 CRC Screening Program support—maintaining the focus on CRC screening

SFCCC leader: “SF CAN has maintained the focus on colorectal cancer screening. What happens with the pandemic is that you lose that focus for all the reasons. The focus shifts to COVID and so most clinics are, for that matter, most large health systems and most providers have seen drops their regular QI measures during the pandemic. We have also made a pitch to our clinics to do something similar with breast cancer.”

 CRC Screening Program support—availability

QI director: “I was, basically, taking on the program when we were entering the pandemic. But based on my experience overall in working with SF CAN, it’s been very positive. They’ve been very responsive with our needs and anything basically that we seek of their support.”

Screening champion: “I think they have been really available and proactive in reaching out to us. They’ve been understanding of our challenges and really trying to keep up with how our clinic is handling the pandemic. I don’t think it has changed very much other than not having in-person meetings, but they’ve been just as available to us.”