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.

Focus area, change concept, change idea, tools and resources
  • 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.


  • 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.

Change Concept: Make cancer screening a priority.

Tools and Resources, by Change Idea

Assess primary care clinics’ readiness to implement existing evidence-based interventions (EBIs) to increase cancer screening.
Prioritize screening by engaging leaders and identifying screening champions.
Use a whole office approach by delegating screening tasks across the health care facility team.
Provide economic incentives, such as the Centers for Medicare & Medicaid Services Electronic Health Record (EHR) Incentive Program and the Quality Payment Program, to health care providers, facilities, and settings.

Make cancer screening a quality improvement measure at the system level.

Change Concept: Implement population management strategies for all eligible patients.

Tools and Resources, by Change Idea

Benchmark or compare health care facility screening prevalence to state and national prevalence.
Use community assessment to identify barriers to and resources for screening.
Run EHR reports on eligible patient populations to generate lists or create a registry of patients who are due for screening and conduct outreach.
Use EHR tools to calculate and analyze cancer screening rates.
Analyze data by patient sub-populations to determine if screening disparities exist.

Change Concept: Establish standard operating procedures for screening.

Tools and Resources, by Change Idea

Develop formal written screening policies for the health care facility.
Use implementation guides and quality improvement tools to create workflows and address workflow barriers.

Change Concept: Use risk assessment tools and follow-up.

Tools and Resources, by Change Idea

Use a family history algorithm to assess a patient’s risk of developing cancer to help determine eligibility for screening.
Use a risk calculator to determine a patient’s eligibility for screening.

Change Concept: Practice patient education, communication, and shared decision making.

Tools and Resources, by Change Idea

Use tools and resources to facilitate shared decision making regarding screening.
Use patient education materials and small media such as videos and printed materials.
Use patient education materials to support discussions on potential out-of-pocket costs for screening and follow-up.
Use communication tools and strategies to improve patient-centered communication.
Personalize messaging to increase screening among patients.
Provide educational and instructional materials to patients on screening procedures.
  • 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

Use multi-modal screening reminders, such as mail, phone, or text messages, for patients.
Use electronic reminders, such as prompts in the EHR, for providers and staff.
Use physical reminders, such as stickers or cards, for providers and staff.

Change Concept: Reduce structural barriers in the health care setting.

Tools and Resources, by Change Idea

Identify health-related social needs.
Use telehealth for screening consultations and follow-up of results.
Ensure information or interpretation services are available in the patient’s primary language.
Streamline administrative procedures, such as simplifying patient paperwork, reducing the number of required visits, and offering flexibility for late arrivals.
Conduct an environmental scan and organizational assessment of cancer screening capacity.


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.