IMPROVING COLORECTAL

CANCER SCREENING RATES

Monica L. Scholz, RN
 U.S. PREVENTIVE SERVICES
TASKFORCE(USPSTF)

“The USPSTF recommends screening for

colorectal cancer starting at age 50
years and continuing until age 75 years”
(2016). This is a GRADE A rating.
 AMERICAN CANCER
SOCIETY(ACS) GUIDELINES
• The ACS recommends that people at average risk of colorectal cancer
start regular screening at age 45
• People have a life expectancy of more than 10 years get screen through
the age of 75.
• High Risk patients might need to start colorectal cancer screening before
age 45(ACS, 2019)
 PICOT QUESION

FOR PATIENT AGES 50-75 YEARS OF AGE IN A RURAL NORTHEAST

KANSAS PRIMARY CARE CLINIC, WHAT IS THE EFFECT OF AN
APPICATION FOR CRC EDUCATION and DECISION AID WITH THE
ABILITY TO SELF-ORDER CRC SCREENING, COMPARED TO USUAL
CARE, ON THE NUMBER OF THOSE WHO OBTAIN CRC SCREENING IN
THE NEXT 6 MONTHS.
 EVIDENCE
• According to Miller et al. (2018) who
completed a randomized control trial on the
use of an application for CRC, education and
a decision aid with the ability to self-order
CRC screenings in the primary care setting
doubles the number of patients that agree
to have CRC screenings when compared to
usual care.
 MOBILIZE
• Vision: To improve the percentages of patients in a rural primary care practice who get
regular screening for CRC.
• The community will be Rural Northeast Kansas.
• Participates will be invited by email, mailings, and an advertisement for the application on the
primary care practices Facebook page.
• An application with CRC education will be created by the nurse practitioner and nurses in the
practice with the help of a technical support professional.
• The application will walk the patient through a decision aid, risk, benefit, incidence of CRC,
general education, safety information, and other general statistical information about the
efficacy of CRC screening.
• The application will allow the patient to order CRC screening at the end of the education
which will be set up by their provider.
• The application will send out reminders to the patient in the form of text messaging or email.
 ASSESS
• In Missouri, only about 64% and in Kansas 66% of eligible adults have
received their needed Colorectal Cancer Screening (American Cancer
Society, 2017).
• An estimated 27,150 men and 23,110 women will die from (Colorectal
Cancer (CRC) each year (American Cancer Society, 2017).
• In a year, an estimated 95,520 new cases of colon cancer and 39,910 cases
of rectal cancer diagnosed in the United States (American Cancer Society,
2017).
• According to American Cancer Society (2017), “As of January 1, 2016, there
were 724,690 men and 727,350 women alive in the US with a history of
CRCs (p.4).
• Baseline data for the target area will be obtained through medical records
with consent.
 POTENTIAL BARRIERS TO COLORECTAL
CANCER SCREENING AND SOCIAL
DETERMINANTS OF HEALTH
1. Knowledge and Education related to risk factors and benefits.
2. Lack of provider recommendation
3. Fear of the procedure itself
4. Scheduling
5. Fear, and lack of knowledge
6. Financial resources
7. No usual source of care

THIS INTERVENTION WILL ADDRESS BARRIERS 1, 2, 3, 4 and 5:

(American Cancer Society, 2017)

 PLAN
• GOAL: To have an increase of 20% in adults age 50 and older screened
for colorectal cancer in a rural northeast Kansas family practice
• Measure: In a 6 month time frame
• Data collection: prior to implementation, midway, and after.
• Comparison: Usual care
• Baseline measure from the clinic will be obtained with consent from the
patient’s medical record.
• Baseline measure from American Cancer Society: 64% in MO/ 66% KS
 IMPLEMENT
• Team members: Doctors, nurse practitioners, nursing staff, technical support
• Nurse Practitioner will be the manager of the project.
• Nursing staff will assist with ensuring all patient eligible receive application intervention.
• Technical support will assist with application
• Training: All STAFF will be trained on the use of application, patient education, and marketing
• Location: Pilot study at one Rural northeast Kansas Primary care practice
• Time: 6 months
• Participants: All willing patients in the clinic that are eligible for CRC screening
• Recruitment: postal mailings,, text messages, or advertisement on the Clinics Facebook
page.
• Communication plan: The patient will receive text message of email reminders if the order CRC
screening with the application. The patient’s provider will receive notification prior to seeing the patient
indicating that they have “self-ordered” their CRC screening. See Recruitment.
 EVALUATE
• Evaluation plans
• Rate of CRC screening will be measured prior to implementation, midway, and after.
• Pros: Medical records will be factual information
• Cons: Patient follow through may decrease rate of completion.
• Cons: Patient could obtain screening outside of practice knowledge.
• Pre & Post- intervention knowledge about CRC and CRC screening will be assessed via a quiz and the
data will be compared.
• Pro: give team an understanding of the quality of the information provide for quality improvement purposes.
• Cons: patient may not complete or click through skewing the data.
• Team will have monthly meetings to update, assess and discuss plan compliance and need for
improvement.
• Patient will be given a survey to rate the application intervention.

• The clinic community will be updated on the progress of the intervention via the Facebook page.
 REFERENCES
• American Cancer Society. (2017). Colorectal cancer facts & figures 2017-2019. Retrieved from
https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-canc
er-facts-and-figures/colorectal-cancer-facts-and-figures-2017-2019.pdf
• American Cancer Society. (2019). American cancer society guideline for colorectal cancer
screening. Retrieved from https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-
staging/acs-recommendations.html
• Center of Excellence in Rural Health, University of Kentucky. (2016). About kentucky homeplace.
Retrieved from http://ruralhealth.med.uky.edu/about-kentucky-homeplace
• Miller, D. P., Denizard-Thompson, N., Weaver, K. E., Case, L. D., Troyer, J. L., Spangler, J. G., . . .
Pignone, M. P. (2018). Effect of a digital health intervention on receipt of colorectal cancer
screening in vulnerable patients. Annals of Internal Medicine, 168(8), 550. doi:10.7326/m17-2315
• Office of Disease Prevention and Health Promotion. (2019). Stories from the field. Retrieved from
https://www.healthypeople.gov/2020/healthy-people-in-action/Stories-from-the-Field
• U.S. Preventive Services taskforce. (2016). Colorectal cancer: Screening. Retrieved from
https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal
-cancer-screening2?ds=1&s=Colorectal%20Cancer%20Screening