Focus Area: Screening Policies, Procedures, and Practices within Health Facilities
Colorectal Cancer Screening Change Package
The screening policies, procedures, and practices within health facilities focus area includes tools and resources to assess the status of cancer screening, make cancer screening a priority, reduce structural barriers, and use data to identify patients due for screening and opportunities to improve cancer screening rates within a clinical setting or system.

- Change concepts are “general notions that are useful for developing more specific strategies for changing a process.”1
- Change ideas are evidence-based or practice-based “actionable, specific ideas or strategies.”1
- Each change idea is linked to tools and resources that can be used or adapted to improve cancer screening.
Notes
- Tools and resources with a symbol may contain some information that does not reflect the current US Preventive Services Task Force (USPSTF) recommendations for colorectal cancer screening.
- Tools and resources with a symbol are patient resources.
See a list of acronyms used in this change package.
- Make cancer screening a priority.
- Implement population management strategies for all eligible patients.
- Establish standard operating procedures for screening.
- Use risk assessment tools and follow-up.
- Practice patient education, communication, and shared decision making.
- Implement patient and provider reminder systems.
- Reduce structural barriers in the health care setting.
Change Concept: Make cancer screening a priority.
Tools and Resources, by Change Idea
- AICAF and NIHB — Advancing Health Systems Toolkit [PDF-23.6MB], pages 5–7
- CDC, NACDD, and Kaiser Permanente CHR — Mailed FIT Implementation Guide [PDF-3MB], pages 11–14
- Health Promotion Practice Journal — The Health Promotion Practice Podcast: S2 Ep. 24 Exploring Sustainability Factors for a Colorectal Cancer Screening Program with Dara Schlueter
- NACHC — Value Transformation Framework: Cancer Screening [PDF-447KB], page 4
- NCCRT and ACS — Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Community Health Centers [PDF-7.6MB], page 19
- NCCRT, ACS, and The Jackson Laboratory — Risk Assessment and Screening Toolkit to Detect Familial, Hereditary, and Early Onset Colorectal Cancer [PDF-1.5MB], page 15
- CDC, NACDD, and Kaiser Permanente CHR — Mailed FIT Implementation Guide [PDF-3MB], pages 9–12
- Evidence-Based Cancer Control Programs (EBCCP) — Fecal Immunochemical Test and Colonoscopy Outreach, see Program Materials [English and Spanish]
- NCCRT and ACS — Colorectal Cancer Screening Best Practices: A Handbook for Hospitals and Health Systems [PDF-4.4MB], pages 37–40 and 76
- NCCRT and ACS — Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Community Health Centers [PDF-7.6MB], page 19–29
- NCCRT and ACS — Colorectal Cancer Screening: Best Practices Handbook for Health Plans [PDF-8.3MB], pages 14, 16–21, 27–33, and 39–47
- AICAF and NIHB — Advancing Health Systems Toolkit [PDF-23.6MB], pages 5–7
- NQF — ABCs of Measurement
Change Concept: Implement population management strategies for all eligible patients.
Tools and Resources, by Change Idea
- ACS — Cancer Facts and Figures for African American/Black People 2022–2024 [PDF-8.5MB]
- ACS — Cancer Prevention and Early Detection Facts and Figures 2022 [PDF-2.8MB], (tables and figures only) pages 35–36
- CDC — Use of Colorectal Cancer Screening Tests
- CDC — United States Cancer Statistics: Data Visualizations Tool (see Screening and Risk Factors tab)
- NACHC — Value Transformation Framework: Cancer Screening [PDF-447KB], page 5
- ACS and CCCNP — Comprehensive Cancer Control Plan: Colorectal Cancer Tip Sheet [PDF-562KB], pages 4–7
- BMC and AVON Foundation for Women — The Boston Medical Center Patient Navigation Toolkit 1st edition [PDF-807KB], pages 10–19
- AICAF and NIHB — Advancing Health Systems Toolkit [PDF-23.6MB], page 15
- Evidence-Based Cancer Control Programs (EBCCP) — Smart Options for Screening (SOS), see Program Materials: Implementation Guide and SOS ICD Codes
- CDC — United States Cancer Statistics (USCS): Data Visualizations Tool
- NACHC — Value Transformation Framework: Cancer Screening [PDF-447KB], page 5
- NIH, NCI, and CDC — State Cancer Profiles Interactive Maps
Change Concept: Establish standard operating procedures for screening.
Tools and Resources, by Change Idea
- NACHC — Value Transformation Framework: Cancer Screening [PDF-447KB], pages 6–7
- CDC, NACDD, and Kaiser Permanente CHR — Mailed FIT Implementation Guide [PDF-3MB], pages 11–14
- CCSPSC — CCSPSC Champions Program [PDF-3.2MB], see Phased Approach to Implementation with Partners (throughout document)
- CCSPSC — CCSPSC Champions Program [PDF-3.2MB], see Sandhills-Lugoff Provider Reminder Process, page 32
- Evidence-Based Cancer Control Program (EBCCP) — Fecal Immunochemical Test and Colonoscopy Outreach, see Program Materials: Colonoscopy Strategy Workflow and FIT Strategy Workflow
- FluFIT, Potter M — FLU-FOBT Program Components and Flow Diagram [PDF-199KB]
- NACHC — Value Transformation Framework: Cancer Screening [PDF-447KB], pages 5–8
- NCCRT and ACS — Colorectal Cancer Screening Best Practices: A Handbook for Hospitals and Health Systems [PDF-4.4MB], pages 18 and 56–59
- NCCRT, ACS, and The Jackson Laboratory — Risk Assessment and Screening Toolkit to Detect Familial, Hereditary and Early Onset Colorectal Cancer [PDF-1.5MB], pages 16 and 29
Change Concept: Use risk assessment tools and follow-up.
Tools and Resources, by Change Idea
- CDC — My Family Health Portrait
- NCCRT, ACS, and The Jackson Laboratory — Risk Assessment and Screening Toolkit to Detect Familial, Hereditary, and Early Onset Colorectal Cancer [PDF-1.5MB], pages 18–28, 31–33, 40–41, 48–49, 52–56, and 58
Change Concept: Practice patient education, communication, and shared decision making.
Tools and Resources, by Change Idea
- GW Cancer Center — Guide for Patient Navigators: A Supplement to the Oncology Patient Navigator Training: The Fundamentals [PDF-2.7MB], pages 83–88
- Kunneman M, Montori VM, Castaneda-Guarderas A, Hess EP, 2016 — What Is Shared Decision Making? (and What It Is Not)
- Ottawa Hospital Research Institute — Colon Cancer: Which Screening Test Should I Have?
- AICAF and NIHB — Advancing Health Systems Toolkit [PDF-23.6MB], page 10
- ASCO — Colonoscopy [English and Spanish]
- CDC — Colorectal Cancer Resources to Share [videos and print materials in English and Spanish]
- Kaiser Permanente CHR — Patient Frequently Asked Questions [PDF-210KB] [English and Spanish]
- ACS — Insurance Coverage for Colorectal Cancer Screening [English and Spanish]
- AGA — What to expect: Paying for your colonoscopy [PDF-282KB]
- GW Cancer Center — Health Equity Toolbox: Resources to Foster Cultural Sensitivity and Equitable Care for All [PDF-386KB]
- GW Cancer Center — Practice Patient-Centered Care Posters
- GW Cancer Center — Practice Patient-Centered Care Posters
- NCCRT, ACS, and The Jackson Laboratory — Risk Assessment and Screening Toolkit to Detect Familial, Hereditary, and Early Onset Colorectal Cancer [PDF-1.5MB], pages 34, 39–42, and 60
- Evidence-Based Cancer Control Programs (EBCCP) — Fecal Immunochemical Test and Colonoscopy Outreach, see Program Materials: Colonoscopy Invitation Letter [English and Spanish example letters] and Colonoscopy Bowel Prep Instructions [English and Spanish examples]
Change Concept: Implement patient and provider reminder systems.
Tools and Resources, by Change Idea
- AltaMed, Kaiser Permanente CHR — PROMPT Study Primer Calls for Never Completed FIT Screening: Outreach Team Call Scripts [PDF-144KB] [English and Spanish patient letter, personalized alert, and reminder prompts for FIT]
- CDC, NACDD, and Kaiser Permanente CHR — Mailed FIT Implementation Guide [PDF-3MB], pages 24, 28, 32, and 38
- Evidence-Based Cancer Control Programs – Against Colorectal Cancer In Our Neighborhoods (ACCION) — FIT Abnormal Results Letter [PDF-194KB] [English and Spanish]
- Evidence-Based Cancer Control Programs — Fecal Immunochemical Test and Colonoscopy Outreach [English and Spanish colonoscopy appointment reminder, FIT telephone scripts]
- Evidence-Based Cancer Control Programs – Smart Options for Screening (SOS) — Implementation Guide
- Kaiser Permanente CHR — Prevention Research Center Colorectal Cancer Mailed Patient Reminder Template [PDF-82KB] [English and Spanish]
- Kaiser Permanente CHR — Reminder Call Phone Scripts to Return FIT Tests [PDF-189KB]
- Kaiser Permanente CHR — Vendor Script: Colorectal Cancer Screening FOBT Kits [PDF-63KB]
- NIHB — Health Systems Improvement Toolkit: A Guide to Cancer Screenings in Indian Country [PDF-4.2MB], pages 15 and 21–24
- Washington State Department of Health — Colon Cancer Screening Provider Toolbox [PDF-286KB], page 1
- ACS and CCCNP — Comprehensive Cancer Control Plan: Colorectal Cancer Tip Sheet [PDF-562KB], page 9
- AICAF and NIHB — Advancing Health Systems Toolkit [PDF-23.6MB], page 15
- CCSPSC — CCSPSC Champions Program [PDF-3.2MB], see Provider Reminder Observation Form, pages 33–35 and Sandhills-Lugoff Provider Reminder Process, page 32
- CDC — Evidence-Based Interventions – Provider Reminder Planning Guide
- NIHB — Health Systems Improvement Toolkit: A Guide to Cancer Screenings in Indian Country [PDF-4.2MB], pages 15 and 17–19
- CCSPSC — CCSPSC Champions Program [PDF-3.2MB], see Provider Reminder Observation Form, pages 33–35
- CDC — Evidence-Based Interventions – Provider Reminder Planning Guide
- NIHB — Health Systems Improvement Toolkit: A Guide to Cancer Screenings in Indian Country [PDF-4.2MB], pages 15 and 17–19
Change Concept: Reduce structural barriers in the health care setting.
Tools and Resources, by Change Idea
- Activate Care — CMS releases standardized screening tool for health-related social needs [tool and article]
- President’s Cancer Panel — Closing Gaps in Cancer Screening: Connecting People, Communities, and Systems to Improve Equity and Access [PDF-14MB], pages 3 and 17–19
- BMC and AVON Foundation for Women — The Boston Medical Center Patient Navigation Toolkit 1st edition [PDF-807KB]
- Evidence-Based Cancer Control Programs (EBCCP) — Kukui Ahi (Light the Way): Patient Navigation – Addressing Barriers Worksheet; Implementation Guide
- GW Cancer Center — Guide for Patient Navigators: A Supplement to the Oncology Patient Navigator Training: The Fundamentals [PDF-2.7MB]
- NCCRT and Colorado School of Public Health — Paying for Colorectal Cancer Screening Patient Navigation Toolkit and Interactive Website
- NIHB — Health Systems Improvement Toolkit: A Guide to Cancer Screenings in Indian Country [PDF-4.2MB], pages 25–26
- Juckett G, Unger K, 2014 — Appropriate Use of Medical Interpreters
- BMC and AVON Foundation for Women — The Boston Medical Center Patient Navigation Toolkit 1st edition [PDF-807KB], pages 5–19
- CCSPSC — CCSPSC Champions Program [PDF-3.2MB], see Readiness Assessment, pages 1–5
- Evidence-Based Cancer Control Programs (EBCCP) — Kukui Ahi (Light the Way): Patient Navigation – Facility Tour Worksheet
Reference
1Centers for Disease Control and Prevention. Tobacco Cessation Change Package. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2019.