Increasing Patient Participation with Colorectal Cancer Screening in Primary Care: An Evidence-Based Improvement Initiative

Amoako-Attah, Irene
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Background: Colorectal cancer (CRC), although lethal, is preventable. Most CRC begins as adenomas that slowly grow over 10–20 years; therefore, the mainstay for CRC is early detection and removal of precancerous polyps. CRC incidence is increasing in younger age groups, leading to a change in the recommended screening age from 50 to 45 years old. Purpose: The purpose of this paper is to establish risk categorization using the National Comprehensive Cancer Network’s CRC screening guidelines and evidence-based interventions to improve compliance, screening, detection, and referrals, as well as to save lives from colon cancer. Methods: Lewin’s change theory provided the theoretical framework, and the Stetler model of evidence-based practice guided implementation of the project. Data analysis consisted of descriptive statistics, a run chart depicting weekly screening rate progress, and a pre- and post-guideline implementation chi-square. Results: Analysis of data related to the implementation showed patients increased the rate at which they returned CRC screening tests as well as an increase in the number of patients referred to the gastroenterologist for colonoscopy. The project was statistically (p = .001) and clinically significant (12 times more positive cases were detected). Conclusion and Implications for Practice: Use of a systematic screening methodology for risk based on the evidence increased detection of patients with positive fecal immunochemical and Cologuard test results. Patient navigators were instrumental in the increased number of tests returned and should be considered best practice in primary care sites.

Colorectal cancer screening, Colon cancer, Colorectal neoplasms reminder systems, Practice guidelines colonoscopy/standards, Early detection of cancer, Screening modalities