Colorectal Cancer Screening In Primary Care Research Articles

GetFIT for CRC: Nurse Practitioner–Led Program to Improve Colorectal Cancer Screening

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. This program evaluation was conducted to assess the outcomes of a nurse practitioner–led quality improvement program to increase CRC screening in primary care using the logic model framework. The GetFIT for CRC program consisted of applying a multifaceted intervention to reduce barriers to CRC screening via fecal immunochemical testing (FIT), thereby increasing FIT compliance. FIT completion rates rose to 65.4% 6 months postimplementation, showing special cause variation based on Institute for Healthcare Improvement rules. The increase in completion rates continues to be sustained at 58.5% 12 months after implementation.

General practice perspectives on a bowel cancer screening quality improvement intervention using the Consolidated Framework for Implementation Research.

An understanding of contextual factors that influence whether general practitioners advise their patients to be screened for colorectal cancer (CRC) might guide interventions to increase screening participation from its persistently low rate. We report on the use of a theory-based tool to explore contextual factors that might influence implementation of a novel quality improvement (QI) intervention to increase CRC screening in general practice (CRC-QI). The objective was to identify and incorporate strategies into the intervention that will enable flexible implementation across different practice settings. A qualitative study to explore contextual facilitators of, and barriers to, the implementation of a novel CRC-QI intervention. Eighteen staff, from three self-nominated general practices, participated in focus group discussions. The Consolidated Framework for Implementation Research (CFIR), which included constructs relevant to CRC screening in primary care, guided the formative evaluation. Findings were aligned to the CFIR model using a deductive thematic analysis. Contextual facilitators of, and barriers to, the implementation of the CRC-QI intervention were identified in each CFIR domain and CRC-relevant construct. Five consistent themes were identified that potentially influence elements of the CRC-QI intervention: priority setting and incentives, information technology, patient-level barriers, clinical practice, and the National Bowel Cancer Screening Program (NBCSP). Participants proposed that incentive payments and NBCSP policy changes (outer-setting strategies) would facilitate organisational change (inner-setting strategies) and the effective implementation of the CRC-QI intervention. There may be an opportunity to better engage general practice in CRC screening via outer-setting constructs that support existing clinical practice. For example, improvements to the National Cancer Screening Register and Quality Improvement Incentive - Practice Incentives Program (PIP) could be made without altering the NBCSP design.

Have we increased our efforts to identify strategies which encourage colorectal cancer screening in primary care patients? A review of research outputs over time.

Globally, colorectal cancer (CRC) screening rates remain suboptimal. Primary care practitioners are supported by clinical practice guidelines which recommend they provide routine CRC screening advice. Published research can provide evidence to improve CRC screening in primary care, however this is dependent on the type and quality of evidence being produced. This review aimed to provide a snapshot of trends in the type and design quality of research reporting CRC screening among primary care patients across three time points: 1993–1995, 2003–2005 and 2013–2015.Four databases were searched using MeSH headings and keywords. Publications in peer-reviewed journals which reported primary data on CRC screening uptake among primary care patients were eligible for inclusion. Studies meeting eligibility criteria were coded as observational or intervention. Intervention studies were further coded to indicate whether or not they met Effective Practice and Organisation of Care (EPOC) study design criteria.A total of 102 publications were included. Of these, 65 reported intervention studies and 37 reported observational studies. The proportion of each study type did not change significantly over time. The majority of intervention studies met EPOC design criteria at each time point.The majority of research in this field has focused on testing strategies to increase CRC screening in primary care patients, as compared to research describing rates of CRC screening in this population. Further research is needed to determine which effective interventions are most likely to be adopted into primary care.

The CRISP colorectal cancer risk prediction tool: an exploratory study using simulated consultations in Australian primary care

BackgroundIn Australia, screening for colorectal cancer (CRC) with colonoscopy is meant to be reserved for people at increased risk, however, currently there is a mismatch between individuals’ risk of CRC and the type of CRC screening they receive.This paper describes the development and optimisation of a Colorectal cancer RISk Prediction tool (‘CRISP’) for use in primary care. The aim of the CRISP tool is to increase risk-appropriate CRC screening.MethodsCRISP development was informed by previous experience with developing risk tools for use in primary care and a systematic review of the evidence. A CRISP prototype was used in simulated consultations by general practitioners (GPs) with actors as patients. GPs were interviewed to explore their experience of using CRISP, and practice nurses (PNs) and practice managers (PMs) were interviewed after a demonstration of CRISP. Transcribed interviews and video footage of the ‘consultations’ were qualitatively analyzed. Themes arising from the data were mapped onto Normalization Process Theory (NPT).ResultsFourteen GPs, nine PNs and six PMs were recruited from 12 clinics. Results were described using the four constructs of NPT: 1) Coherence: Clinicians understood the rationale behind CRISP, particularly since they were familiar with using risk tools for other conditions; 2) Cognitive participation: GPs welcomed the opportunity CRISP provided to discuss healthy and unhealthy behaviors with their patients, but many GPs challenged the screening recommendation generated by CRISP; 3) Collective Action: CRISP disrupted clinician-patient flow if the GP was less comfortable with computers. GP consultation time was a major implementation barrier and overall consensus was that PNs have more capacity and time to use CRISP effectively; 4) Reflexive monitoring: Limited systematic monitoring of new interventions is a potential barrier to the sustainable embedding of CRISP.ConclusionsCRISP has the potential to improve risk-appropriate CRC screening in primary care but was considered more likely to be successfully implemented as a nurse-led intervention.

Colorectal Cancer Screening Among Primary Care Patients: Does Risk Affect Screening Behavior?

Lifestyle factors including smoking, obesity, and diabetes can increase colorectal cancer (CRC) risk. Controversy exists regarding screening rates in individuals at increased CRC risk. To examine the effect of risk on CRC screening in primary care, cross-sectional data collected during January 2006-July 2007 from 720 participants in 24 New Jersey primary care practices were analyzed. Participants were stratified by risk: high (personal/family history of CRC, history of polyps, inflammatory bowel disease), increased (obesity, Type II diabetes, current/former smokers), and average. Outcomes were up-to-date with CRC screening, receiving a physician recommendation for screening, and recommendation adherence. Chi-square and generalized linear modeling were used to determine the effect of independent variables on risk group and risk group on outcomes. Thirty-seven percent of participants were high-risk, 46% increased-risk, and 17% average-risk. Age, race, insurance, education, and health status were related to risk. High-risk participants had increased odds of being up-to-date with screening (OR 3.14 95% CI 1.85-5.32) and adhering to physician recommendation (OR 7.18 95% CI 3.58-14.4) compared to average-risk. Increased-risk participants had 32% decreased odds of screening (OR 0.68, 95% CI 0.42-1.08). Low screening rates among increased-risk individuals highlight the need for screening interventions targeting these patients.

High Performance in Screening for Colorectal Cancer: A Practice Partner Research Network (PPRNet) Case Study

Colorectal cancer (CRC) screening is recommended for average-risk adults age 50 and older, yet half of eligible US adults are not current. This case study of highest performing practices within the Colorectal Screening in Primary Care study (C-TRIP) explains practice strategies used and provides a model for improving CRC screening in primary care. A case study design was used to analyze practice performance data and qualitative data obtained from site visits, network meetings, and correspondence. The Practice Partner Research Network (PPRNet) Translating Research into Practice (TRIP) Quality Improvement (QI) model provided an analytic framework to evaluate the 5 highest-performing practices in the C-TRIP intervention. Practice strategies were grouped within the concepts: prioritize performance (PP), redesign delivery system (RDS), electronic medical record tools (EMR), and activate the patient (AP). Thirteen specific practice strategies were exemplified within these four concepts (PP, RDS, EMR, AP). Most or all of these strategies were used by practices that achieved the highest proportion (up to 78%) of adults screened for CRC. Primary care practices achieving a high proportion of CRC screening use systematic processes in the organization of their care. This case study provides a framework to organize systems that increase early detection and prevention of colorectal cancer.

Improving Colorectal Cancer Screening: A Partnership Between Primary Care Practices and the American Cancer Society

The American Cancer Society (ACS) is interested in facilitating colorectal cancer screening (CRCS) in primary care. Similar clinics were assigned randomly to 1 of 3 CRCS arms: (1) usual care, (2) exam-room posters designed by the ACS; and (3) posters plus patient reminder calls from an ACS volunteer. Compared to patients due for screening in Arm 1, the odds ratio for getting CRCS in Arm 2 was 1.04 (95% confidence interval [CI], 0.81-1.34), P value not significant; in Arm 3, it was 1.49 (95% CI, 1.16-1.90), P value < .001. Exam-room posters plus patient reminder calls from the ACS can increase CRCS in primary care.

Determinants of Colorectal Cancer Screening in Primary Care

Colorectal cancer (CRC) is serious, yet a minority of US adults receive within-guideline screening exams. A random selection of patients attending clinics in 3 different settings completed a survey on CRC-related barriers, knowledge, and beliefs. Participants with fewer barriers, better knowledge, and more positive beliefs toward screening were significantly more likely to be within screening guidelines. A physician's screening recommendation was significantly related to screening in patients < 65 years, but was not significant for older patients. Large-scale studies are needed. Results can be used to develop multifaceted, tailored education programs to improve CRC screening in primary care.