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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.

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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.


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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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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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80% in Every Community Employer Challenge Guide

Employers have the ability to help save lives from colorectal cancer by encouraging their employees to get screened for colorectal cancer and reduce their risk of getting the disease.

This comprehensive guide provides the tools, resources and messaging for them to effectively increase timely, quality colorectal cancer screening in their workforce and be a part of the 80% in Every Community campaign.

Whether you work at a corporation, cancer center, health plan, non-profit, etc., you can find resources to help you ensure colorectal cancer screening is a priority in your workplace. It’s never too earlier to start planning your activities for March, National Colorectal Cancer Awareness Month!

Just getting started? View the short brief, How Can Employers Save More Lives from Colorectal Cancer?, for an introduction to increasing screening in the workplace. 

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Link to Guide
Link to Online Course

Mailed FIT Implementation Guide

The Mailed FIT Implementation Guide and the Mailed FIT Online Course have been developed to help improve colorectal cancer screening rates in diverse healthcare settings.

The Mailed FIT Implementation Guide provides a roadmap for how health systems and other health entities can design and carry out mailed fecal immunochemical test (FIT) outreach programs. The Guide was created by the National Association of Chronic Disease Directors (NACDD) in partnership with the Kaiser Permanente Center for Health Research (KPCHR) and with the support of the Centers for Disease Prevention and Control (CDC).

The goal of the Mailed FIT Implementation Guide is to provide administrators and staff with the information needed to make informed decisions and successfully implement an outreach program. The Guide details the process for planning and implementing a mailed FIT outreach program by addressing the following process steps: Prerequisites (Key Partnerships, Capacity, Technical Resources), Getting Ready, Selecting a FIT Kit, Executing a Mailed FIT Outreach Program, Following Up on Abnormal Test Results, and Sustaining the Program. Two chapters containing Resources and References are also included.

The Mailed FIT Online Course is the newest resource and was developed based on the components of the Mailed FIT Implementation Guide. The course is a free, self-paced online program for busy health professionals that provides easy-to-access information in video format. Ten videos narrated by subject matter experts from around the nation cover all components of a mailed FIT outreach program. Three testimonial videos from experienced clinics describe their tips and strategies for implementing a successful mailed FIT outreach program. Finally, a helpful companion notebook for the course gives step-by-step activities and checklists for gathering and organizing the information needed to establish an outreach program. The Mailed FIT Online Course was created by NACDD in partnership with KPCHR and with the support of the CDC.

Evaluation: The evidence provided in the Mailed FIT Implementation Guide and subsequently created Mailed FIT Online Course was based on two primary sources. The first source was the five-year STOP CRC trial of mailed FIT outreach programs in 26 federally qualified health centers in Oregon and California (2013-2018). The trial investigated whether the use of mailed FIT outreach programs with follow-up colonoscopy for abnormal FIT results could increase CRC screening rates above the rates obtained with usual care opportunistic screening. The findings showed a significant improvement in CRC screening rates and an overall FIT return rate of 21%. The second source of evidence was the 2019 Mailed FIT Summit, which was sponsored by the CDC and hosted by the NACDD. The Summit participants included subject matter experts and stakeholders from across the nation. An accompanying journal article published in CA: A Cancer Journal for Clinicians described the Summit’s goals, process, and findings in detail.

Permissions: Made publicly available online by the National Association of Chronic Disease Directors.

Publication date: Guide published October 2021, last revised June 14, 2022; Online Course published March 2023. 

Post date: August 22, 2022, updated August 2023. 

Contact: Please send comments or questions to Lorrie Graaf (lgraaf_ic@chronicdisease.org) or Dawn Wiatrek (dwiatrek_ic@chronicdisease.org).

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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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2022 Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening 

Black and African American people experience disproportionately high incidence and mortality rates from colorectal cancer (CRC), with CRC death rates almost 40% higher than those of white people. While screening is only one element of the work that needs to be done to address these CRC disparities, it is important to promote screening in the best way possible.

The 2022 Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening is intended to provide you with information and tools to help you work towards closing disparity gaps by using effective, tailored cancer screening messaging to help motivate people to get screened.

 

Learn More

Background and Goals

The guidebook is a supplement to the 2019 Colorectal Cancer Screening Messaging Guidebook: Recommended Messages to Reach the Unscreened. Based on the 2019 market research findings, the NCCRT and the American Cancer Society set out to gain a deeper understanding of the barriers to screening that Black and African American people face through our market research. The overall goal of the research was to: 

  • Gain a deeper understanding of the barriers to being screened 
  • Understanding healthcare behaviors and perceptions 
  • Understand how systemic racism and social injustice impact the Black community’s experiences within the healthcare system 
  • Uncover different motivators to encourage screening
  • Identify preferred and trusted information sources 
  • Gather reactions to potential messaging and messaging aspects to identify what elements of messaging will be most effective

This guidebook shares the findings and recommendations gathered from that research and is further designed to help educate, empower, and mobilize those not getting screened for colorectal cancer. Our vision is that our partners and advocates in the field use this guidebook to strengthen their communication campaigns and create resources that resonate with Black and African American communities.

View the June 21, 2022 webinar introducing the messaging guidebook.

Additional NCCRT market research and messaging guidance:

Acknowledgement

The NCCRT would like to thank the Public Awareness & Social Media Strategic Priority Team members and Advisory Committee, who generously offered their time and expertise to develop this guidebook’s research and content. We want to extend a special thank you to Quest Diagnostics, the Association of Black Gastroenterologists and Hepatologists, and Elevance Health Foundation for their support and guidance in conducting the market research and developing this guidebook.

Spread the Word

Sample Facebook/LinkedIn Posts

Black and African American adults experience disproportionally higher incidence and mortality rates from colorectal cancer. The National Colorectal Cancer Roundtable’s newly released messaging guidebook provides market-research findings and research-tested messages to encourage unscreened Black and African American adults to seek colorectal cancer screening. https://www.nccrt.org/Black-Messaging-Guidebook  

Only 65% of Black adults aged 50 and older are up to date with potentially life-saving colorectal cancer screening. Download the newly released National Colorectal Cancer Roundtable messaging guidebook to uncover motivators and potential messaging mechanisms to encourage regular colorectal cancer screening among Black and African American adults. https://www.nccrt.org/Black-Messaging-Guidebook

Sample Tweets

Black & African American adults experience disproportionally higher incidence & mortality from #colorectalcancer. This new @NCCRTnews messaging guidebook can help strengthen your communications to promote #CRC screening. https://www.nccrt.org/Black-Messaging-Guidebook #80inEveryCommunity #getscreened

1 in 3 Black adults aged 50+ are not up to date with potentially life-saving #colorectalcancer screening. Download the new @NCCRTnews messaging guidebook for research-tested messages to encourage #CRC screening: https://www.nccrt.org/Black-Messaging-Guidebook #80inEveryCommunity #getscreened

Template Newsletter Blurbs

Brief version:

The National Colorectal Cancer Roundtable’s newly released 2022 Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening  highlights new market research focused on identifying barriers to colorectal cancer screening, understanding preferred and trusted sources for receiving healthcare information, and research-tested messages to help encourage unscreened Black and African American people to seek colorectal cancer screening.

Long version:

The National Colorectal Cancer Roundtable’s newly released 2022 Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening  highlights new market research focused on identifying barriers to colorectal cancer screening, understanding preferred and trusted sources for receiving healthcare information, and research-tested messages to help encourage unscreened Black and African American people to seek colorectal cancer screening.

Black and African American people experience disproportionately high incidence and mortality rates from colorectal cancer, with colorectal cancer death rates almost 40% higher than those of white people. While screening is only one element of the work to address these colorectal cancer disparities, it is essential to promote screening in the best way possible. This new guidebook is intended to provide recommendations to enhance marketing and communication efforts while providing tools to strengthen communication campaigns that resonate with Black and African American communities. 

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Webinar – 2022 Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening – June 21, 2022

This webinar provided an introduction to the 2022 NCCRT Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening. 

Speakers:

  • Kaitlin Sylvester, MPA, Director, NCCRT – Programs & Partnerships
  • Folasade (Fola) P. May, MD, PhD, MPhil, Director of Gastroenterology Quality, UCLA Health
  • Michelle Aubertine, MBA, Project Consultant, KS&R
  • Adjoa Anyane-Yeboa, MD, MPH, Gastroenterologist, Massachusetts General Hospital, Harvard Medical School

Attendees received an overview of the NCCRT market research findings, learned about identifying barriers to CRC screening, understanding preferred and trusted sources for receiving healthcare information, and learned which research-tested messages could help encourage unscreened Black and African American people to seek CRC screening.

 

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President’s Cancer Panel Cancer Screening Report

On February 2, 2022, President Joe Biden announced a relaunch of the “Cancer Moonshot” program with a goal of reducing the death rate from cancer by at least 50 percent over the next 25 years.

The same day, the President’s Cancer Panel released a timely report that spotlights innovative approaches to improve cancer screening uptake nationwide and calls for expanding evidence-based programs to better address equity in cancer screening access and outcomes. The report, Closing Gaps in Cancer Screening: Connecting People, Communities, and Systems to Improve Equity and Access, identifies four critical goals to improve cancer screening rates and close gaps in screening access:

  1. Improve and align cancer screening communication;
  2. Facilitate equitable access to cancer screening;
  3. Strengthen workforce collaborations to support cancer screening and risk assessment; and
  4. Create health information technology that promotes appropriate cancer risk assessment and screening.

The report recommends “Expand and strengthen National Cancer Roundtables that include a focus on cancer screening” and explicitly acknowledges the NCCRT as an exemplary model to promote evidence-based cancer screening strategies.

Following the release, Steven Itzkowitz, MD, shared: “As Chair of the NCCRT, I’d like to commend the Panel for their focus on the critical need to prioritize cancer screening and, in particular, for their recognition of the national roundtables. For 25 years, the NCCRT has been committed to increasing awareness and access to timely colorectal cancer screening in every community. It’s clear that our work is as important as ever and that our screening efforts are THE opportunity to end colorectal cancer as we know it.”

Permissions: Made publicly available online by the National Cancer Institute at the National Institutes of Health

Publication date: February 2022

Post date: June 13, 2022

 

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NCCN Guidelines for Patients: Colorectal Cancer Screening – 2021

The National Comprehensive Cancer Network (NCCN®) announced the publication of Guidelines for Patients: Colorectal Cancer Screening in December 2021. This free guide for patients and caregivers breaks down the different ways screening can be done and explains the recommended timing according to the latest research. It is available in 18 languages.

The guide is supported in part by NCCRT member Fight Colorectal Cancer.

The NCCN issued a corresponding press release.

Evaluation: NCCN Guidelines for Patients are based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), which are determined by multidisciplinary teams of experts from across NCCN Member Institutions.

Permissions: Made publicly available online by the National Comprehensive Cancer Network.

Publication date: December 2021

Post date: June 13, 2022

Contact: Email PatientGuidelines@NCCN.org