Colorectal cancer: Improving screening in a rural clinic.

Abstract

e13054 Background: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Between 2012-2016, the age adjusted mortality rate was 18-25 per 100,000 persons in Robeson County, North Carolina. During this timeframe, it is estimated that if all people aged 50 and older in NC were routinely screened, 40 out of 100 deaths from late stage CRC can be prevented. A chart review in a rural primary care clinic identified patients not being appropriately screened for targeted intervention. Methods: Our retrospective chart review at Lumberton Medical Clinic, a rural outpatient Internal Medicine Clinic, reviewed 1622 records from adults 50-75 years old during the timeframe September 2017 through August 2018. Patients with history of CRC or status-post colectomy for other reasons were excluded from this study. Patient records were assessed for compliance with USPTF CRC screening guidelines. USPTF recommends adults aged 50 to 75 years receive screening as follows: 1) Fecal occult blood testing (FOBT) annually 2) Flexible sigmoidoscopy every 5 years 3) Colonoscopy every 10 years OR 4) Combined FOBT (every 3 years) plus flexible sigmoidoscopy (every 5 years). Results: The review showed that during the timeframe studied, 56% of patients received appropriate screening, 44% were found with no documentation of screening, and 17% were never offered screening or informed about current guidelines. Following data analysis, intervention to increase screening rates has been initiated. This involves provider education, posters in clinic, and individualized letters mailed to patients found deficient during the study. The success of this direct patient outreach effort will be measured over six months. Conclusions: The mortality rate from CRC cancer is higher in Robeson County compared to the NC state rate. Additionally, 40% of deaths from late-stage CRC may be prevented by doing a routine screening. It is the responsibility of providers to emphasize the importance of proper screening. This retrospective review found that a large percentage (44%) of adults are not being adequately screened in our rural clinic. Direct outreach is underway to increase compliance rates in this high-risk population served by our rural clinic.