The rate of screening for colorectal cancer (CRC) in the U.S. remains low (under 65%), meaning that thousands of people die of colorectal cancer unnecessarily. Colorectal cancer screening tests range from more invasive and very sensitive for polyps and cancer (colonoscopy) to less invasive and less sensitive (e.g., fecal immunochemical testing (FIT)). Screening rates go up when patients consider all these tests, not just colonoscopy. Informing patients about their options for CRC screening could produce higher quality decisions, improve the match between patient preferences and tests performed, and increase uptake of CRC screening. Decision aids (DAs) are a promising tool for accomplishing this goal. Also, precision CRC prevention - providing information about an individual's specific risk for CRC - has great promise to increase uptake and improve decision making.

Unfortunately, the COVID-19 pandemic is causing severe challenges to providing CRC screening and other prevention services. Health systems are trying to adapt, but these efforts have only begun and are poorly understood. Moreover, patient perceptions of disease risk and risk from COVID-19 are unknown.

The study team will engage with the leadership, staff, and providers in the study team's partner healthcare systems, to identify facilitators and barriers to implementing patient decision aids and provider notifications as well as cancer risk assessment tools, for colorectal cancer screening, and for other evidence-based cancer screening during the COVID pandemic and, potentially, after the conclusion of the pandemic.

At the conclusion of the study, the investigators will have extensive information regarding how best to provide decision aids through an electronic health record (EHR) portal, with or without personalized information, and to deliver provider notifications, which can guide broader implementation.

The study will involve interviews with staff and providers at the study team's partner healthcare systems to identify facilitators and barriers to implementing decision aids and provider notifications for colorectal cancer screening.

Also, the investigators will interview patients to identify perceptions of prevention during the COVID-19 pandemic including risk perception and barriers to screening, perceptions of risk from both the pandemic and disease, and patient cancer screening and risk prevention behaviors engaged in or postponed during the pandemic and patient rationales for their decisions. This part of the study will suggest potentially promising approaches for providing prevention and disease management during the COVID-19 pandemic.

Inclusion Criteria:

Health system participants will be eligible if:

• they are employed by one of the study team's partner healthcare systems.

Patient participants will be eligible if:

• they have had a primary care visit during the past 24 months
• they have completed cancer screening during the past 5 years prior to 2020 for breast, cervical or lung cancer as noted in the electronic health record (EHR)
• age 50 years or older
• speaks English
• accessible by phone.

Exclusion Criteria:

Patients will be excluded if:

• they did not complete any cancer screening for breast, colon, cervical, or lung cancer during the past 5 years prior to 2020
• did not complete a primary care visit at a partner healthcare system during the past 2 years.

The participants will be health system primary care patients, and health system leadership, providers, or staff involved in primary care.

Adverse events were monitored during the interviews. The time frame for patient participants was a one-time phone interview that lasted about 30 minutes. The interviews for health system participants lasted about 30-60 minutes.

We involved just two healthcare systems in one Midwestern city. Our sample of interviewed leaders, providers, and staff may not have been representative of the entire organizations. Our method for identifying patients to interview did not include all patients at these health systems who were due for screening early in the pandemic, so we may have failed to include important perspectives or experiences.