Intervention Type: Provider reminder or recall

Reminder that a patient is due or overdue for screening (Community Guide recommended*)

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Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Primary Care Practices

Colorectal cancer screening saves lives, yet more than 1 in 3 adults ages 45 and older is not getting screened as recommended.

Through a step-by-step format, this newly updated manual provides evidence-based, expert-endorsed strategies to improve colorectal cancer screening rates in primary care practices. The 2022 edition includes:

  • An expanded scope to include all primary care settings
  • Current screening guidelines and new screening modalities
  • Expert-endorsed strategies
  • Samples, templates, and tools
  • Updated literature references
  • NEW! Added exemplary case studies

Learn More

Background and Goals

The first edition, published in 2014, was one of the NCCRT’s most popular resources and has been instrumental in helping primary care practices throughout the United States achieve improvements in their colorectal cancer screening rates.  

The goal of this manual is to offer evidence-based, expert-endorsed recommendations for planning and implementing strategies in primary care practices to improve colorectal cancer screening rates. This manual provides a succinct step-by-step guide for primary care teams to improve colorectal cancer screening and outcomes in practice. These simple steps will assist teams to effectively:

  • Agree on and implement an office screening strategy
  • Provide education on appropriate and high-quality screening
  • Help patients to complete timely, recommended screening
  • Track follow-up of screening and results
  • Build networks among primary care, specialty care, and health systems
  • Provide examples of workflows from successful programs

View the NCCRT’s July 25, 2022 Steps Guide update webinar recording and slide set for an introduction to the new edition and testimonials from two primary care clinician champions on how the manual can be used to transform colorectal cancer screening delivery.  

Acknowledgement

The NCCRT would like to thank the numerous people who generously offered their time and expertise to the development of this updated second edition.

NCCRT is especially grateful to the advisory committee, who generously offered their time and expertise to develop this guidebook’s research and content, to HealthEfficient for serving as the lead author on this second edition, and to the Centers for Disease Control and Prevention for their support.

See the Acknowledgements section on page two of the Steps Guide for a comprehensive list of the many contributors.

This publication was supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $825,000 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.


Spread The Word

Sample Facebook & LinkedIn Posts

Colorectal cancer screening is one of the best ways to reduce the risk of colorectal cancer. Utilize the strategies in our Steps Guide to help increase screening rates in patients, and reference the newly added Case Studies to see their impact. https://nccrt.org/StepsGuide #80inEveryCommunity

Primary care clinicians’ use of our Steps Guide can help increase colorectal cancer screening rates in patients. We’re excited to include newly added case studies give insight into the effectiveness of strategies, all to meet the goal of #80inEveryCommunity. Read more: https://nccrt.org/StepsGuide  

Timely colorectal cancer screening is more important than ever now that major guidelines recommend screening start at age 45. The National Colorectal Cancer Roundtable’s newly updated Steps Guide provides a succinct step-by-step guide for primary care teams to improve colorectal cancer screening and outcomes in practice. https://nccrt.org/StepsGuide

Colorectal cancer screening saves lives. Learn how you can increase screening rates in primary care with the National Colorectal Cancer Roundtable’s newly updated Steps Guide: https://nccrt.org/StepsGuide

The lifetime risk of developing colorectal cancer is about 1 in 24 for men and 1 in 25 for women, yet nearly 1 in 3 adults ages 50 and older is not getting screened as recommended. The National Colorectal Cancer Roundtable’s newly updated Steps Guide is your one-stop-shop for strategies to increase colorectal cancer screening in your practice. Get started now at https://nccrt.org/StepsGuide

Only 72% of adults aged 50 and older are up to date with potentially life-saving colorectal cancer screening. Download the National Colorectal Cancer Roundtable’s newly updated Steps Guide to find evidence-based, expert-endorsed strategies to improve colorectal cancer screening rates. https://nccrt.org/StepsGuide

Sample Tweets

Colorectal cancer screening is one of the best ways to reduce the risk of colorectal cancer. Utilize the strategies in our Steps Guide to help increase screening rates in patients, and reference the newly added Case Studies to see their impact. https://nccrt.org/StepsGuide #80inEveryCommunity

Primary care clinicians’ use of our Steps Guide can help increase colorectal cancer screening rates in patients. We’re excited to include newly added case studies give insight into the effectiveness of strategies, all to meet the goal of #80inEveryCommunity. Read more: https://nccrt.org/StepsGuide  

The lifetime risk of developing colorectal cancer is about 1 in 24 for men and 1 in 25 for women. The new @NCCRTnews Steps Guide is your one-stop-shop for strategies to increase #CRC screening. https://nccrt.org/StepsGuide #80inEveryCommunity #GetScreened

Colorectal cancer screening saves lives. Learn how you can increase screening rates in your practice with the new @NCCRTnews Steps Guide: https://nccrt.org/StepsGuide #80inEveryCommunity #GetScreened

Major guidelines recommend people at average risk start colorectal cancer screening at age 45. Download the new @NCCRTnews Steps Guide for a succinct step-by-step guide to increase #CRC screening in primary care. https://nccrt.org/StepsGuide #80inEveryCommunity #GetScreened

Only 72% of adults aged 50+ are up to date with potentially life-saving colorectal cancer screening. Download the @NCCRTnews Steps Guide for evidence-based, expert-endorsed recommendations to improve #CRC screening rates. https://nccrt.org/StepsGuide #80inEveryCommunity #GetScreened

Template Newsletter Blurbs

Brief version:

The National Colorectal Cancer Roundtable’s newly released Steps Guide (www.nccrt.org/StepsGuide) provides evidence-based, expert-endorsed strategies to increase colorectal cancer screening rates in primary care. This 2023 edition offers a much-anticipated update to the signature NCCRT resource that has been instrumental in helping primary care practices throughout the United States achieve improvements in delivering potentially life-saving colorectal cancer screening in the communities they serve.

Extended version:

A primary care clinician recommendation is the most powerful influence on a patient’s decision to get screened for cancer. Download the National Colorectal Cancer Roundtable’s 2023 edition of the Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Primary Care Practices (www.nccrt.org/StepsGuide) to find evidence-based, expert-endorsed strategies to improve colorectal cancer screening rates in primary care. 

This 2023 version provides a much-anticipated update to the signature NCCRT resource that has been instrumental in helping primary care practices throughout the United States achieve improvements in delivering potentially life-saving colorectal cancer screening in the communities they serve as well as ten exemplary case studies. Timely colorectal cancer screening is more important than ever now that major guidelines recommend screening for people at average risk start at age 45. 

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Blue Star Conversations – May 17, 2023

On May 17th, 2023, the NCCRT’s NCCRT Professional Education & Practice Implementation (PEPI) Strategic Priority Team hosted the latest Blue Star Conversation, an interactive program for NCCRT members and CDC grantees. The latest session highlighted a short presentation by Elizabeth Ciemins, PhD, MPH, MA, Vice President of Research and Analytics at AMGA (American Medical Group Association), on rates of follow-up colonoscopy after a positive stool-based screening test from the recent Jama New Open publication, Rates of Follow-up Colonoscopy After a Positive Stool-Based Screening Test Result for Colorectal Cancer Among Health Care Organizations in the US, 2017-2020. Afterwards, participants discussed potential opportunities and challenges to overcome barriers affecting follow-up colonoscopy. 

Visit NCCRT’s Events & Webinars page to find information about upcoming programs and events.

Key links:

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Meeting Summary – Primary Care Strategy Meeting: Catalyzing Primary Care to Increase Colorectal Cancer Screening 

The NCCRT and the American Cancer Society ACS, supported by the Centers for Disease Control and Prevention CDC and Stand Up to Cancer, held the Primary Care Strategy Meeting: Catalyzing Primary Care to Increase Colorectal Cancer Screening on August 12, 2022. Leading experts and partners met to propose strategies for increasing the uptake of colorectal cancer (CRC) screening in primary care settings. 

This post-meeting summary includes an overview of the current state of CRC screening in the primary care setting, successes in advancing CRC screening in primary care despite ongoing challenges, an overview of NCCRT tools and research available to support primary care clinicians, strategic planning for overcoming prioritized barriers, and the successful partnership between NCCRT and the American Association of Medical Assistance (AAMA). 

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Webinar – 2022 NCCRT Steps Guide Update – July 25, 2022

This webinar provided an introduction to the 2022 Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Primary Care Practices, an updated second edition to the first edition that was originally published in 2014. The 2022 edition includes the following updates:

  • An expanded scope to include all primary care settings
  • Current screening guidelines and new screening modalities
  • 10 case studies of exemplary practice sites
  • Updated literature references

The first edition was one of the NCCRT’s most popular resources and has been instrumental in helping primary care practices throughout the United States achieve improvements in their colorectal cancer screening rates.  The 2022 edition will be released in August 2022. 

Speakers:

  • Laura Makaroff, DO, Senior Vice President, Prevention and Early Detection, American Cancer Society
  • Keith Winfrey, MD, MPH, FACP, Chief Medical Officer, New Orleans East Louisiana Community Health Center
  • Michelle Tropper, MPH, Director of Clinical Programs, HealthEfficient
  • Frank Colangelo, MD, MS-HQS, FACP, Chief Quality Officer, Premier Medical Associates
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How Can Women’s Health Providers Save More Lives from Colorectal Cancer?

This newly updated brief shares how women’s health providers can help advance the shared goal to reach colorectal cancer screening rates of 80% and higher in adults ages 45 and older.

NCCRT would like to thank the American College of Obstetricians and Gynecologists for supporting the development of this resource, and for their longtime commitment to advancing colorectal cancer screening as an NCCRT member. 

 

 

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Download Age 45 with 2023 Caveat Resource

The Dos and Don’ts of Colorectal Cancer Screening

This newly updated one-page flyer may be used to remind clinicians about some of the dos and don’ts when it comes to colorectal cancer screening. Partners have the option to cobrand the flyer with their organization’s logo. Contact your local American Cancer Society to learn more.

The flyer was updated in March 2022 to reflect the colorectal cancer screening starting age of 45 for average risk patients. Partners have the option to use one of two versions in 2022:

  • Age 45: This version references the starting age of 45 with no caveats (for health systems and health plans that are already covering screening at age 45 for all patients). 
  • Age 45 with 2023 caveat: This version references the starting age of 45 and includes an asterisk that explains that some health plans will not be required to follow the May 2021 USPSTF recommendation that lowered the age from 50 to 45 until 2023 (for health systems and health plans serving patients that may not yet have coverage for screening at age 45). 
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View Additional Course Information

Continuing Education Courses for Healthcare Providers on Colorectal Cancer Screening

To provide up-to-date information on recommended best practices for colorectal cancer screening, the Centers for Disease Control and Prevention (CDC) partnered with Medscape Education to create two continuing education courses for healthcare providers.

In one of these courses, Screening for Colorectal Cancer: Recommended Best Practices (0.5 CME/CNE credits), David Lieberman, MD, of Oregon Health and Science University, leads a video lecture that explains why colorectal cancer screening is important, how to determine the timing and frequency of colorectal cancer screening, recommended stool-based and direct visualization screening strategies, and how to improve screening quality with a programmatic approach and quality metrics.

The second course, CRC Screening and Surveillance: Optimizing Quality (1.0 CME/CNE credits), is a three-part clinical anthology that includes more detail on these topics and explains the role of primary care providers in stool testing and colonoscopy programs.

These free courses are available for continuing education credit. You can create a free Medscape account and view the courses at: https://www.medscape.org/viewarticle/946291  and https://www.medscape.org/viewarticle/945988.

Evaluation: The courses were developed by nationally recognized experts in colorectal cancer screening, including primary care clinicians, gastroenterologists, and epidemiologists.

Permissions: Made publicly available online through Medscape Education.

Publication date: March 15 and 24, 2021.

Post date: March 31, 2021.

Contact: Submit comments, questions, and suggestions via the links on the Medscape Education website. 

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Download Toolkit
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Interactive Table of Contents
Sample Screening Algorithms

Risk Assessment And Screening Toolkit To Detect Familial, Hereditary And Early Onset Colorectal Cancer

Limited or inaccurate family history collection and risk assessment is a major barrier to successful cancer screening. Individuals who have a first-degree relative with colorectal cancer (CRC) are at least two times more likely to develop CRC, with the risk increasing with earlier ages of diagnosis and the number of relatives diagnosed with CRC. Therefore, screening and prevention efforts must focus on those with familial or hereditary risk, which requires collecting the necessary family history information for risk assessment. Primary care clinicians play a pivotal role in identifying people at increased CRC risk and facilitating recommended screening.

This new NCCRT toolkit aims to improve the ability of primary care clinicians to systematically collect, document, and act on a family history of CRC and adenomas polyps, while also educating clinicians on the need for more timely diagnostic testing for young adults who present with alarm signs or symptoms of CRC and ensuring that those patients receive a proper diagnostic work up. This toolkit serves as a comprehensive, step-by-step guide to improve operations within practices and suggests many useful resources and tools to aid these changes. 

Companion Quick Start Guide

Accompanying the full toolkit is a short, quick start guide with recommendations on how to ease into the transition process, while still making the critical improvements necessary for successful system-wide implementation. 

Thank you to the outstanding work and guidance provided from the NCCRT Family History and Early Age Onset Colorectal Cancer Task Group and the smaller project advisory group. Also, thank you to the excellent work from our project developers at The Jackson Laboratory. 

 

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How To Assure Follow Up Colonoscopy For Positive FIT From The Process Side – January 30, 2018

This webinar was a repeat of one of our most highly rated workshops from the NCCRT meeting last month. The purpose of the webinar was to review evidence and processes to help ensure that patients obtain a follow-up colonoscopy after a positive test result.

Speakers:

  • Kevin Selby, MD, Kaiser Permanente Division of Research
  • Amanda Petrik, Kaiser Permanente Center for Health Research
  • Frank Colangelo, MD, FACP, Premier Medical Associates
  • Jason A. Dominitz, MD, MHS, FASGE, AGAF Department of Veterans Affairs

Note:  This webinar will not address access issues. For advice on securing access to colonoscopy, check out our webinars on Links of Care from 2017 and 2015. For more general guidance on implementing FIT screening programs, view this webinar or check out our new resource on stool based testing.

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Additional Q&A

Colorectal Cancer Screening In American Indian & Alaska Native Communities – November 28, 2017

This webinar explored the opportunities and barriers related to delivering quality colorectal cancer screening and follow-up care in health care settings serving American Indian and Alaska Native (AI/AN) communities. The webinar provided a review of basic basic data on colorectal cancer incidence, mortality, and screening rates in AI/AN populations, an overview of the American Cancer Society and the NCCRT’s work to address this issue, and presentations from two AI/AN-serving healthcare systems about their innovative approaches to increasing colorectal cancer screening.

Learn more about the American Cancer Society and the NCCRT’s work to address this issue in the post-meeting report from the April 2016 one-day summit to explore the challenges and potential solutions to improving access to quality colorectal cancer screening in this population.

Speakers:

  • Kris Rhodes, MPH, Chief Executive Officer, American Indian Cancer Foundation (Moderator)
  • Laura Makaroff, DO, Senior Director, Cancer Control Intervention, American Cancer Society, Inc.
  • Jessica Deaton, RN, BSN, Care Manager, Oklahoma City Indian Clinic
  • Richard Mousseau, MS, Director, Community Health Prevention Programs, Great Plains Tribal Chairmen’s Health Board