Mapping global evidence on pharmacy-based colorectal cancer screening initiatives in community settings: A scoping review

BACKGROUND: Community pharmacists are an accessible yet underutilized workforce for colorectal cancer (CRC) screening, but global evidence on their impact and the optimal implementation models remains fragmented. OBJECTIVE: To synthesize global evidence on the effectiveness, implementation contexts, and key motivators and barriers of pharmacy-based CRC screening initiatives to inform scalable healthcare integration. METHODS: This scoping review was conducted searching PubMed, Scopus, Embase, and CINAHL for studies published from inception to October 2025, guided by the Population-Concept-Context (PCC) framework. Eligible studies included pharmacist-led or pharmacy-based CRC screening interventions (e.g., kit distribution, education, referral) as well as observational studies assessing implementation determinants, including pharmacist knowledge, patient attitudes, and system-level motivators and barriers. Data were extracted, then synthesised thematically and presented narratively. RESULTS: A total of 27 articles representing 24 unique studies from 13 countries were included. Interventions featuring direct provision of faecal immunochemical tests (FIT) consistently demonstrated superior uptake (e.g., 93.5% kit return rate in Spain; 59.3% completion in US bundled vaccination models). In contrast, models relying solely on education or physician referral demonstrated lower uptake (e.g., 17%). Regarding implementation determinants, motivators included high patient trust, service accessibility, and pharmacist willingness to expand their professional role. However, critical barriers undermined scalability, specifically the lack of reimbursement mechanisms, knowledge gaps regarding screening guidelines, and fragmented communication pathways with primary care providers for positive-result follow-up. CONCLUSIONS: Pharmacy-based CRC screening initiatives were effective and achieved high adherence when delivered through direct-provision models integrated into national or regional health frameworks. However, the current reliance on ad-hoc, non-reimbursed pilot programs limits sustainability. Policy efforts must focus on formalizing reimbursement mechanisms and establishing closed-loop communication with primary care to transform this opportunistic service into a scalable public health strategy.