Provider Intervention to Improve Colorectal Cancer Screening

This intervention uses physician education and strategic planning at publicly-funded health centers to improve the delivery and utilization of colorectal cancer screening among underserved populations. Providers are educated in small groups using a question and answer format that covers the following topics: colorectal cancer epidemiology and risk assessment, screening methods and guidelines, behavioral approaches to improving patient screening, barriers to screening, risk communication, and informed and shared decision-making. The educational intervention is followed by a facilitated strategic planning session with the entire health center staff using SWOT (Strength, Weaknesses, Opportunities, and Threats) analysis. The strategic planning session encourages health center staff working as a team to reach group consensus on a goal statement for colorectal cancer screening.

The goal of this provider intervention is to increase provider recommendation and patient adherence to colorectal cancer screening in publicly-funded health centers.

The intervention was evaluated using a randomized controlled trial that compared the intervention group to a control group. Pre-post intervention patient surveys revealed a 16% increase from baseline in colorectal cancer screening referral, dispensing, and completion among intervention centers, compared to only a 4% increase among controls (p < 0.001). The number of health center patients self-reporting a lack of physician recommendation as a reason for not having colorectal cancer screening significantly declined from 41% at baseline to 21% at follow-up (p = 0.04); there was no decrease among control patients. Patients reporting that they needed more advice and information to make good decisions about colorectal cancer screening significantly decreased from 50% at baseline to 24% at follow-up (p = 0.006); there was no decrease among control group patients.