Colorectal Cancer Test Choice
Adults are more likely to get screened when doctors talk to them about their options. Colorectal Cancer Control Program award recipients in Kentucky, South Dakota, and Virginia got results when health care providers talked to patients about the different colorectal cancer tests available.
Grace Health is a federally qualified health center in the Appalachian region of Kentucky. Many people there have low literacy and a low income. Grace Health used a colorectal cancer screening test kit that required three stool samples, and fewer than 10% of patients completed the test.
The Kentucky Colon Cancer Screening Program worked with Grace Health to find out if more people would complete the screening test if it required only one stool sample instead of three. At one clinic, they gave the simpler one-sample test kits to patients in a stamped return envelope with the estimated return date written on the front. Grace Health also changed the frequency of its provider assessment and feedback reporting from quarterly to monthly.
Nearly two-thirds of patients completed the simpler test kits, and the clinic increased its overall colorectal cancer screening from 10% in 2017 to 45% in 2019. Now, all clinics in the Grace Health system use the simpler screening test packaged in a postage-paid return envelope.
The Sanford Watertown Clinic tried but could not raise its colorectal cancer screening use. Patients said they didn’t get screened because of the cost, they didn’t like the preparation needed for a colonoscopy, they were afraid of a colonoscopy, or they couldn’t take time off from work.
Care managers at the clinic made a list of patients who needed to be screened. They called these patients to talk about why they should be screened and the different tests available to them.
As a result, 21 patients scheduled a colonoscopy. The care managers mailed 100 stool test kits to patients not getting a colonoscopy; more than half of the tests were completed and returned. Three completed test kits had positive results, and all three people then had a colonoscopy. The clinic’s screening use went up from 66% to almost 75% within a few months.
The Maryview Foundation Clinic in Portsmouth, Virginia focused on the immediate health needs of its patients who have low incomes and do not have health insurance. Preventive screening was not a priority. Only about one-fourth of its patients had been screened as recommended for colorectal cancer, and the clinic only offered colonoscopies for screening.
The Virginia Colorectal Cancer Control Program worked with the Bon Secours Hampton Road health system to send a Quality Improvement Coordinator and Cancer Screening Nurse Navigator to the clinic. They made it possible for the clinic’s electronic health record system to keep track of which patients had been offered stool test kits, and which patients had picked up and completed the test kits.
By offering patients stool test kits instead of colonoscopies and providing patient navigation, 66 people were screened in five months. Before, only six patients were screened in four months. The percentage of patients at Maryview who have been screened for colorectal cancer as recommended went up from 26% in April 2019 to 63% in August 2019. Even though there is no official clinic screening policy, most doctors at the clinic now use stool tests for most patients.