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

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.  

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

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

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

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. 

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

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:

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

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

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

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. 

2019 Colorectal Cancer Screening Messaging Guidebook: Recommended Messages to Reach the Unscreened

In 2018, the NCCRT and the American Cancer Society researched screened and unscreened populations to better understand and address screening disparities. The goals of the market research were to:

  • Measure general awareness of colorectal cancer screening methods.
  • Understand the rationale, attitudes, and motivations for being screened or not.
  • Analyze priority populations such as adults aged 50-54, rural dwellers, and the marketplace insured.
  • Identify logical and emotional drivers that could encourage screening.
  • Use the drivers to create and test messages that would motivate unscreened individuals.

This guidebook shares the findings and recommendations gathered from that research and is further designed to help in the education, empowerment, and mobilization of those who are not getting screened for colorectal cancer. Our hope is that our partners can take this research and the recommended messaging provided to strengthen your own communications campaigns, creating resources that resonate with the target audiences even more by using your own creativity, innovation and spokespersons.

The NCCRT would like to thank the Public Awareness and Social Media Task Group members who participated in the conceptualization of this Guidebook’s research and content. Also, a very special thank you to the 80% in Every Community Market Research Advisory Group for their participation, expertise, and oversight. 

Other Guides and Resources: 

The Hispanics/Latinos and Colorectal Cancer Companion Guide and Asian Americans and Colorectal Cancer Companion Guide introduce market research about the unscreened from these populations and include tested messages in Spanish and several Asian languages. The 2017 Communications Guidebook is also still a useful resource for developing your messaging campaigns. 

2019 Messaging Guidebook – Table of Contents (Section Downloads Below)

Other tools were developed during the 80% by 2018 campaign and can still help you promote and evaluate your communications:

More communications tools and resources will be coming soon!

 

Colorectal Cancer Awareness Month Social Media Toolkit – March 2019

This toolkit, developed by the George Washington University (GW) Cancer Center, is designed to help public health professionals establish a Colorectal Cancer Awareness Month social media strategy, implement Facebook and Twitter best practices, disseminate Colorectal Cancer Awareness Month messaging, and manage and evaluate social media efforts.

This toolkit provides a short introduction to use of social media in a health system context, a list of Twitter and Facebook best practices for messages, a list of sample tweets and Facebook posts, other ideas for participating in colorectal cancer awareness month, tips on evaluating social media efforts, and a list of references and other resource links.

Public health professionals, cancer control professionals, coalitions, community-based organizations and stakeholders can all use this toolkit and adapt its messaging for their unique audiences and areas of expertise.

Evaluation: The recommendations and sample messages in the toolkit were designed using evidence-based social media and colorectal cancer messaging best practices.

Evaluation assets: The toolkit includes a section on Measuring Success, which explains how to use analytics to evaluate the impact of social media messages and campaigns.

Permissions: Made publicly available online by the GW Cancer Center.

Publication date: February 2019

Post date: September 2017, revised February 2019

Contact: Send comments, questions, and suggestions to cancercontrol@gwu.edu.

Penn State Health Electronic Employee Survey

Physician researchers at Penn State Health developed this colorectal cancer screening uptake and risk assessment tool for use by large entities such as employers and medical practices. The survey tool assesses whether an employee is up to date with screening based on 2016 USPSTF guidelines and also includes a risk assessment checklist to determine if the individual is at increased risk for colorectal cancer.

Penn State Health administered the survey to 6,188 employees, with a response rate of 45%. For respondents ≥50 years, 81% reported up-to-date colorectal cancer screening; thirty-three percent of all participants self-identified as high-risk.

Large employers are encouraged to adapt the survey tool and introduction letter for use with their employees.

Evaluation: The survey was administered electronically to all Penn State Health employees ≥40 years via an online platform. The survey anonymously collected demographic data. Associations between demographic/ risk factors and up-to-date screening status were examined using Fisher’s exact test for categorical variables and Wilcoxon Rank-Sum test for quantitative variables.

Permissions: These tools can be used by any large employer to measure their colorectal cancer screening rates.

Publication date: July 2018

Post date: December 18, 2018

Contact: Send comments, questions, and suggestions to Thomas McGarrity, MD at tmcgarrity@pennstatehealth.psu.edu.

Prevent Colon Cancer Throughout Your Life Poster

This poster from the Colon Cancer Prevention Project illustrates steps to prevent colorectal cancer throughout the life course.

The poster can be customized to include a local organization logo. See Contact section below for more information on how to use this resource in your own practice, office, or other location.

Evaluation: The content and messaging was developed based on the American Cancer Society’s 2018 Colorectal Cancer Screening Guideline and other evidence-based sources. 

Permissions: Made publicly available online by the Colon Cancer Prevention Project. See Contact section below for more information. 

Publication date: 2018

Post date: December 18, 2018

Contact:For partnership inquiries or for information regarding how you might use this infographic in your own practice, office, or other location, please contact Katie Pilkington at kpilkington@kickingbutt.org.

 

Sample Risk Assessment Screening Algorithm

These screening algorithms include recommended screening options for the average-risk and high-risk patient and provide a sample starter policy for your practice. A policy that incorporates the considerations of risk level, insurance coverage, local medical resources, and patient preference will lead to the best screening choice for each patient. These sample algorithms also provide a review of screening options, helpful definitions to improve understanding, and coding assistance for Medicare patients. Two samples are provided for practices considering either the USPSTF screening recommendations or the 2018 American Cancer Society Colorectal Cancer Screening Guideline. 

evaluation toolkit

“The 7-step process is helpful. It is a guide/outline that can be used to ensure that you have developed a great program and the ability to evaluate the effectiveness of your program.”

Evaluation Toolkit, Version 4:

How to Evaluate Activities to Increase CRC Screening and Awareness: Evaluation Toolkit – Now With Case Studies That Include Policy and Systems Change!

This latest version of the evaluation toolkit is intended to help organizations and communities evaluate a wide variety of interventions designed to increase awareness and use of colorectal cancer screening. The toolkit will help you learn the seven basic steps to evaluation, whether you are working to increase community demand for colorectal cancer screening, encouraging health care providers to recommend screenings, or trying to implement policy, systems, or environmental (PSE) changes.This toolkit will provide you with:

  • A basic understanding of evaluation strategies.
  • Tools that you can use and adapt to assess baseline screening rates, or the effectiveness or impact of the intervention.
  • Basic skills to collect outcome data to inform and improve decision-making.
  • Tips for incorporating evaluation results into grant proposals, reports, and other dissemination activities.
  • Practical yet comprehensive evaluation references and resources.

Download this comprehensive resource.

Evaluation Tip Sheets – designed to give you a quick overview of the evaluation process.

Click here to download four separate Evaluation 101 learning modules.  These four pre-recorded webinars are designed to walk you through the evaluation process in greater depth.

New! Guidance on Evaluation 80% by 2018 Messaging

best practices handbook for health plans

“Thank you! This is exactly the type of information health plans need to pass to one another to improve partnership/collaboration, as the consumer will benefit at the end.”

“I really enjoyed that each of the health plans featured in the toolkit highlights a different intervention or opportunity. That gives our partners many approaches to choose from.”

Colorectal Cancer Screening Best Practices Handbook for Health Plans

Health plans have an essential role to play in the effort to screen more Americans for colorectal cancer, particularly given that seven out of 10 people who are unscreened are covered by insurance.

Colorectal Cancer Screening Best Practices Handbook for Health Plans, provides a first-of-its-kind compilation of best practices, case studies, templates and tools, that will kick start or infuse health plans’ efforts to save more lives and prevent more cancers.

To develop the handbook, the NCCRT convened an advisory group of health plan experts and interviewed high-performing health plans to understand what works and what doesn’t when it comes to increasing screening among members. Thank you to the many individuals and organizations who contributed their time and expertise to developing this much requested resource.

In the future, we hope to update this handbook with more case studies from high-performing health plans. If you have a story to share about how your health plan has worked to raise colorectal cancer screening rates, please email nccrt@cancer.org.

NCCRT’s issue brief, The Importance of Waiving Cost-sharing for Follow-up Colonoscopies, provides additional information on the colonoscopy copay issue.

View the March 28, 2017 webinar introducing the Handbook for a guided tour of the best practices, case studies, and templates and tools found within the handbook, and hear from one of the profiled health plans.

80% by 2018 Communications Guidebook: Recommended Messaging to Reach the Unscreened

This Guidebook is based on market research from the American Cancer Society with guidance from the NCCRT Public Awareness Task Group. The Guidebook is designed to help educate, empower and mobilize three key audiences who are not getting screened for colorectal cancer:

  • The newly insured
  • The insured, procrastinator/rationalizer
  • The financially challenged

The goal of the Guidebook is to share what we know about reaching these hard-to-persuade groups using tested messages.

The 2017 Guidebook includes additional templates, tools and customized resources. (Note: Some versions of Internet Explorer create errors in the document. If you experience problems please use an alternate browser, such as Firefox or Google Chrome.)

The Hispanics/Latinos and Colorectal Cancer Companion Guide and Asian Americans and Colorectal Cancer Companion Guide introduce market research about the unscreened from these populations and include tested messages in Spanish and several Asian languages.

Use the following tools to help you promote and evaluate 80% by 2018 communications:

The Guidebook reviews what we know from market research about the unscreened and introduces and explains new tested messages. It also provides tools with the messages incorporated to get you started:

Our hope is that partners can take this research and messages provided in the Guidebook and make the message resonate with the target audiences even more by using their own creativity, innovation and spokespersons.

View the following webinars to learn more about the market research that went into this work, and the tools that are available.