Fostering Appropriate Ordering of Colorectal Cancer Screenings Among Primary Care Providers
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Authors
Sovde, Abby
Issue Date
2025-03-12
Volume
Issue
Type
Manuscript
Language
Keywords
Colorectal Cancer , Screening Guidelines , Rural , Quality Improvement , Minnesota , Education , Toolkit
Alternative Title
Abstract
Background/significance: Colorectal cancer is among the highest rates of cancer- related morbidity and mortality in the United States (ACS, 2024d). the USPSTF (2021) recommends starting CRC screening at age 45. The five-year CRC survival is 90-91% when treated early as opposed to 13-17% when treated in advanced stages (ACS, 2024d). The national, state, and local screening rates remain lower than the goal of 80% that the National Colorectal Roundtable has set for each community (American Cancer Society National Colorectal Roundtable, 2024). Guidelines related to CRC screening exist but are not strictly followed due to lack of recommendation from healthcare providers, knowledge of screening intervals, and patient awareness of importance of screening (Knight, et. al., 2015; Zhu, et. al., 2021).
Purpose: The purpose of this quality improvement project was to improve the number of CRC screening tests that are ordered by providers closer to the recommended 80% benchmark over a 12-week period for patients aged 45-75 at all visit types to identify and educate patients who are due to encourage acceptance of the ordering of a CRC screening test.
Design/methods: A toolkit containing current CRC screening guidelines, a CRC screening assessment form to identify those due for screening and to assist providers with ordering screening, an educational patient handout, and a patient reminder with contact numbers for questions related to scheduling, finances, and insurance was implemented. Data was collected from the CRC screening assessment forms weekly to identify adherence and rate of tests ordered. A post intervention survey was conducted to the staff involved to determine sustainability.
Results: A total of 822 patients aged 45-75 were seen in the 12-week intervention. Overall, 68% (n=559) had their CRC screening status reviewed. Of the 559 patients that were reviewed, 24% (n=135) were due for a CRC screening. Of the 135 patients that were due for a CRC screening test, 36% (n= 49) had screening tests ordered, 57% (n=78) received the educational handout, 54% (n=74) received a reminder slip, and 61% (n=83) had their health maintenance updated accordingly. Of the 49 CRC screening tests that were ordered, 30 colonoscopies (61.22%, 95%CI = 46.24% - 74.46%), and 17 Cologuard tests (34.69%, 95%CI = 22.06% - 49.71%) were ordered. The most common reason a test was not ordered was patient refusal (36/86, 41.86%). Sustainability survey showed disagreement with continued use of the CRC screening assessment form but an increase in comfort with ordering CRC screenings.
Conclusion: This QI project aimed to support primary care providers with ordering CRC screening tests in eligible adults. While CRC screenings were not ordered to the targeted goal, participants of the QI project found the educational handouts and the reminder slips to be beneficial. Future suggestions include tracking through the EHR, mandatory update of health maintenance before signing the chart, and to continue to use assistive staff, provider and patient education, and reminder slips for cost effective and timely ways to promote CRC screening.
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Publisher
Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University