Setting: CHC/FQHC

Community health center/Federally Qualified Health Center

Return To Resources
Download Meeting Summary
Download Slide Deck

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). 

Return To Resources
Download the Full Steps Guide with Appendices
Download the Steps Guide without Appendices

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

Colorectal cancer screening saves lives, yet nearly 1 in 3 adults ages 50 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

As a companion to the new edition, we will release ten extensive case studies from diverse and exemplary clinical practices later this fall.

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

A primary care clinician recommendation is the most powerful influence on a patient’s decision to get screened for cancer. The National Colorectal Cancer Roundtable’s newly updated Steps Guide is your one-stop-shop for strategies to increase colorectal cancer screening. Get started now at 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

A primary care clinician recommendation is the most powerful influence on a patient’s decision to get screened for cancer. The newly updated @NCCRTnews Steps Guide is your one-stop-shop for strategies to increase #CRC screening. https://nccrt.org/StepsGuide #80inEveryCommunity

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 2022 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 newly released 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 2022 edition 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. Timely colorectal cancer screening is more important than ever now that major guidelines recommend screening for people at average risk start at age 45. 

Return To Resources
Link to Resource

Mailed FIT Implementation Guide

The Mailed FIT Implementation Guide provides a roadmap for how health systems and other entities can design and carry out mailed fecal immunochemical test (FIT) outreach programs, including information on key partnerships and what to have in place before launching a program. The guide was produced in partnership with the National Association of Chronic Disease Directors, the Kaiser Permanente Center for Health Research, and supported by the Centers for Disease Control and Prevention. 

The goal of this guide is to provide clinic and health system 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 an outreach program by addressing: Prerequisites (Technical Resources & Capacity); Getting Ready; Selecting a FIT; Executing a Mailed FIT Outreach Program; and Sustaining the Program. It also includes a section of mailed FIT references and resources.

Evaluation: The evidence provided in the Mailed FIT Implementation Guide is based on two recent primary sources. The first source is the five-year STOP CRC pragmatic trial of mailed FIT outreach in federally qualified health centers (2013-2018), which investigated whether the use of mailed FIT outreach, together with follow-up colonoscopy for abnormal FIT results, could increase CRC screening rates above those obtained with the usual care approach of opportunistic screening within 26 federally qualified community health center clinics in Oregon and California. The findings showed a significant improvement in CRC screening rates and an overall FIT return rate of 21%. The second source of evidence is from the 2019 CDC-sponsored and NACDD hosted Mailed FIT Summit, which 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 goals, process, and findings in detail.

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

Publication date: Published October 2021, last revised June 14, 2022

Post date: August 22, 2022

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

Return To Resources
Download Slides

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
Return To Resources
Download slides

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.

 

Return To Resources
Download Resource

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

 

 

 

Return To Resources
Download Age 45 Resource
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). 
Return To Resources
Link to Resource

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.

 

Return To Resources
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. 

Return To Resources
Download Resource

Improving Colorectal cancer Screening: Promising Practices for State Medicaid Agencies

This report follows up on a 2015 report commissioned by the NCCRT, Colorectal Cancer Initiatives in Medicaid Agencies—A National Review. That report broadly described the activities being undertaken by Medicaid programs in all 50 states, identifying ten states that had adopted more robust approaches to colorectal cancer screening.

To develop a deeper understanding of how these higher-performing states are approaching the challenges of colorectal cancer screening, follow-up research was conducted with several of the states (Arizona, Maryland, Minnesota, Montana, New York, and Oregon) that had progressed further on their efforts. 

Thus, this guide establishes nine practices that have shown sufficient promise to merit consideration by other state Medicaid agencies who wish to enhance their screening efforts for this important population.

The 9 promising practices described within this guide include: 

  1. Define a CRC Metric for State Medicaid Plans
  2. Support or Mandate Public Reporting of CRC Screening Rates
  3. Develop an Incentive Program/Value-Based Purchasing Measure for CRC
  4. Provide Education and Technical Support to Managed Care Organizations and Providers
  5. Collaborate with State Public Health Staff
  6. Work Closely with FQHCs that Serve Large Medicaid Populations
  7. Promote Evidence-Based Strategies and Interventions
  8. Facilitate Access by Covering Multiple Tests Without Cost-Sharing
  9. Promote Test Options to Overcome Compliance Barriers, Provider Shortages, Geographic Issues, and Logistical Constraints