Increasing colorectal cancer screening in a rural primary care setting: a quality improvement project

Abstract

Background: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Early detection significantly improves survival, yet screening rates remain low particularly among individuals younger than 50, though the exact reason remains unclear. Barriers to CRC screening are influenced by numerous factors. The most commonly cited barriers included limited patient knowledge of CRC and screening options, as well as limited knowledge of CRC screening guidelines and options among providers. Local Problem: In Montana, CRC is the third most common type of cancer diagnosis, as well as cancer-related deaths. Despite the vast information supporting the benefits of CRC screening, the rates of screening continue to be low at the state and national level leaving many individuals at higher risk for CRC. In 2022, 62.6% of Montana residents aged 45 to 75 were up to date with CRC screening recommendations, which is below the national screening goal of 68.3%. The purpose of this project is to increase CRC screening and decrease CRC incidence and mortality. Methods: This quality improvement project used the Plan Do Study Act tool to test a standardized workflow for CRC screening education and referrals. Interventions: Implementation of developed education on CRC and screening guidelines for patients and providers, a referral guide for recommended CRC screenings as well as nearby locations available for testing, and a standardized workflow for CRC screening at wellness visits. This process was tested weekly over eight weeks to evaluate the fit with clinic workflows. Results: CRC screening education was delivered to 100% project team, (n=6). Twenty-four patients out of 26 accepted CRC screening education averaging 84% meeting project goal of 70%. CRC screening documentation in EHR met goal of 100% all but one week. Of the 24 patients who accepted CRC screening, seven orders were placed (four colonoscopies and three Cologuards). Of those seven orders one colonoscopy and one Cologuard were completed. Conclusions: The results of this project demonstrated that improved patient and provider education on CRC and CRC screening guidelines led to higher CRC screening rates.