Tailoring Colorectal Cancer Screening Messaging: A Practical Coalition Guide

This resource is targeted at coalition members and leaders who are looking to make highly effective campaigns to increase colorectal cancer (CRC) screening rates in their communities, especially for those hardest to reach. Research shows that tailoring health messaging to a specific community produces greater changes in health behavior, such as CRC screenings. By using this step-by-step guide, coalitions can find practical tips and strategies as well as successful case studies illustrating the process.  

This guide was developed by the ACS NCCRT with funding from the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) cooperative agreement #NU58DP006460. 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.

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:

NCCRT Learning Center

The NCCRT Learning Center is a digital learning platform which features courses, tools, and other resources on colorectal cancer screening delivery and research. Current educational offerings include:

  • The Colonoscopy Needs Calculator—This tool estimates the number of colonoscopies your practice can realistically anticipate with a high-quality stool-based colorectal cancer screening program based on various screening rate goals and other data inputs. It also provides an estimation of what the total colonoscopy need would cost a system as well as a comparison between the costs of treating cancer and costs of providing colonoscopies.
  • The Communications Education Portal—This course houses our suite of market research findings on the unscreened for colorectal cancer and messaging recommendations to more effectively develop communication campaigns and resources for unscreened populations. Learners can peruse the market research findings from start to finish or jump in to find just what you need to educate, empower, and mobilize those who are not getting screened for colorectal cancer.

We plan to populate the NCCRT Learning Center with additional tools and learning modules over time. Users can create an account to track your progress, learn when new content is released, and access more courses as they become available.

 

The Colonoscopy Needs Calculator

This tool estimates the number of colonoscopies your practice can realistically anticipate with a high-quality stool-based colorectal cancer screening program based on various screening rate goals and other data inputs. It also provides an estimation of what the total colonoscopy need would cost a system as well as a comparison between the costs of treating cancer and costs of providing colonoscopies.

Users have the option to create an account to track your progress and update data over time.

Reigniting Colorectal Cancer Screening as Communities Face and Respond to the COVID-19 Pandemic: A Playbook

This resource provides an action-oriented playbook to be adopted throughout the COVID-19 pandemic and aims to align NCCRT members, 80% pledged partners, and colorectal cancer screening advocates across the nation to work together to reignite our screening efforts appropriately, safely, and equally for all communities.

The COVID-19 pandemic has challenged efforts to address inadequate screening and inequities in colorectal cancer outcomes, hindering the progress toward our 80% in Every Community goals. In the early stages of the COVID-19 pandemic, leading agencies, such as the Centers for Medicare & Medicaid Services (CMS) and the American Cancer Society, made recommendations to delay all non-urgent procedures. Colonoscopies to detect colorectal cancer have been delayed or cancelled and patient fears about contracting COVID-19 have led to further reductions in screening. This drop has raised concern that COVID-19 related screening delays will lead to missed and advanced stage colorectal cancer diagnoses and to excess deaths from colorectal cancer. Moreover, this burden will likely not be evenly distributed as screening disparities may be exacerbated in communities and populations that are disadvantaged by both old and new challenges in the COVID-19 era.

The colorectal cancer fighting community stands prepared and well-positioned to respond to and overcome the difficult task ahead, and this document offers the latest (as of June 2020) data, research, and clinical guidelines available related to colorectal cancer screening and COVID-19. 

Aligning Statements include: 

  1. Despite the challenges we face during the pandemic, colorectal cancer remains a public health priority, and we must provide the public with safe opportunities to prevent and detect colorectal polyps and cancer.
  2. Colonoscopy remains safe, is a good option for screening, and is quickly reopening around the country, but identifying patients who should receive higher priority for colonoscopic screening is a critical step.
  3. During a time when availability of elective screening colonoscopy may be limited by the COVID-19 pandemic, colorectal cancer screening can be safely offered through at-home stool-based tests.
  4. Gaining momentum and reigniting screening activities and public messaging will be highly dependent upon local regulatory requirements, public health priorities, and policy change.

Throughout the pandemic, individuals have options to screen for colorectal cancer. There are many safe, effective, and evidence-based screening tests available, including colonoscopy and non-colonoscopy options (e.g., stool-based tests, stool-DNA tests, and CT colonography). In addition to the information included in the Playbook specific to stool-based testing and colonoscopy, CT colonography also serves as an important option for patients. Learn more in an editorial published in Abdominal Radiology (July 2020), “CT Colonography’s role in the COVID-19 pandemic: a safe(r), socially distanced total colon examination.” 

We gratefully acknowledge the contributions of the following individuals and organizations. Thank you to our authors Durado Brooks, Rachel Issaka, Steven Itzkowitz, Michael Sapienza, Ma Somsouk, Richard Wender, Caleb Levell, and Emily Bell. We also extend a special note of gratitude to our committed partners, NCCRT Steering Committee members, and subject matter experts that have contributed to both reviewing and advising on this document, but also for their participation in ongoing discussions aimed at uniting and guiding the colorectal cancer community throughout the COVID-19 pandemic. And finally, we recognize the efforts of the Colorectal Cancer Alliance to provide support, in-kind staff, and continued commitment in coordinating a national response to improving colorectal cancer screening rates during the COVID-19 era. 

Advanced Colorectal Polyp Brief

The National Colorectal Cancer Roundtable created the Advanced Colorectal Polyp GI Brief to help endoscopists and primary care clinicians identify patients with advanced colorectal polyps, understand the epidemiology and associated risk factors, and most importantly know the risks of colorectal neoplasia for patients with advanced colorectal polyps and their first-degree relatives (parents, siblings, children).

This brief aims to:

  1. Remind endoscopists that patients with an advanced colorectal polyp and their close relatives are at increased risk for advanced colorectal polyps and colorectal cancer;
  2. Keep endoscopists up to date with current guidelines; and,
  3. Provide template letters to communicate colonoscopy and pathology results, risk status, and follow-up recommendations for patients and close relatives.

Supplemental template letters: 

Learn more on how gastroenterologists and endoscopists can play a role in the national efforts to improve colorectal cancer screening rates:

Colorectal Cancer Screening Best Practices: A Handbook for Hospitals and Health Systems

The purpose of the Colorectal Cancer Screening Best Practices: A Handbook for Hospitals and Health Systems is to provide advice on the design and delivery of a variety of effective CRC screening interventions to help all hospitals and health systems strengthen their colorectal cancer screening efforts.  With their expertise in both improving health and in serving as leaders in their communities, hospitals and health systems are uniquely positioned to play a pivotal role in increasing colorectal cancer screening for those they serve.  The handbook is divided into four sections:  Critical Steps, Case Studies, Implementation, and Tools & Resources. It is intended to provide you with needed information drawn from real life examples about how to ultimately improve CRC screening rates within the hospital and health system setting.

A corresponding webinar was held in July 2018 announcing the release of the handbook and included presentations from two health systems featured in the guide. View the Colorectal Cancer Screening Best Practices for Hospitals and Health Systems webinar.

Many thanks to the hospitals and health systems featured in the guide for sharing their time and their tremendous expertise, as well as to handbook’s expert advisory group, which was chaired by Drs. Michael Potter and Dorothy Lane, Co-Chairs of the NCCRT Professional Education and Practice Implementation Task Group.

This handbook is dedicated to the memory of Marie LaFargue.

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.

Colorectal Cancer Screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer

The US Multi-Society Task Force on Colorectal Cancer Screening, comprised of representatives from the American Society for Gastrointestinal Endoscopy, American College of Gastroenterology and American Gastroenterological Association, develops recommendations for the prevention and early detection of colorectal cancer. Recommendations are based on scientific evidence, practical considerations, and cost.
The latest set of recommendations, summarized in this press release, recommends screening begin at age 50 for average risk individuals, with screening starting at age 45 for African-Americans. The recommendations rank screening tests into three “tiers” according to the strength of the recommendation. The recommendations also provide guidance for screening individuals with a family history of the disease.

The press release links to joint publications of these recommendations in GastroenterologyThe American Journal of Gastroenterology and GIE: Gastrointestinal Endoscopy.

Evaluation: The US Multi-Society Task Force is made up of representatives from the American Society for Gastrointestinal Endoscopy, the American College of Gastroenterology, and the American Gastroenterological Association. Recommendations for screening are re-evaluated periodically as new evidence emerges and as shifts occur in health care delivery and access.

Permissions: Made publicly available online by the American Society for Gastrointestinal Endoscopy.

Publication date: June 2017

Post date: September 15, 2017

Contact: Follow instructions in the press release to reach out to media contacts at each of the three societies.

New Hampshire Colorectal Cancer Screening Program Patient Navigation Model Replication Manual

The New Hampshire Colorectal Cancer Screening Program (NHCRCSP) patient navigation model has been highly effective in increasing the completion and quality of colonoscopy screening and surveillance among statewide underserved groups. Patients in this program, all of whom were navigated, were 11 times more likely to complete colonoscopy than non-navigated patients in a comparison group. Given this success, the Centers for Disease Control and Prevention (CDC) and the NHCRCSP worked together to develop a manual to help others replicate the model. The manual includes step-by-step instructions for implementing a screening navigation program, including a detailed navigation protocol, guidance on data collection, navigator training, and sample templates and tools.

Intended Audiences: Any organization that conducts colorectal cancer screening or administers a colonoscopy program may benefit from implementing this intervention. Organizations could include health systems, endoscopy centers, primary care practices (including Federally Qualified Health Centers), universities, state or local health departments, and grantee programs. This manual also may be useful for health care providers, pharmacy staff, and other community partners to clarify their roles in the intervention and how it benefits their patients.

Congratulations to former NCCRT Steering Committee member Dr. Lynn Butterly and to all the others who helped create this resource.

Evaluation: A rigorous evaluation was conducted, including a comparison of NHCRCSP-navigated patients to a similar group of non-navigated patients. Learn more on page 8 and in Appendix D. Evaluation results were also published in the journal Cancer.

Permissions: Made publicly available online through the Centers for Disease Control and Prevention.

Publication date: October 2016

Post date: September 18, 2017

Contact: Send comments, questions, and suggestions to NHPNManual@cdc.gov or NHCRCSP@hitchcock.org.