Screening More People Sustainably

Overview

CDC's Colorectal Cancer Control Program (CRCCP) provides funds to 38 award recipients. The award recipients help health clinics get their patients screened for colorectal cancer. The award recipients use strategies that have been shown to increase screening, called evidence-based interventions (EBIs). For more details, see How the Colorectal Cancer Control Program Increases Screening.

The EBIs include:

• Provider reminders.
• Provider assessment and feedback.
• Client (patient) reminders.
• Reducing structural barriers.

To increase colorectal cancer screening over the long term in these health clinics, the EBIs must be sustainable. That means the clinics make the EBIs part of their normal process and can keep doing the EBIs without funds or support from CRCCP. When a clinic can increase screening without help from a CRCCP award recipient, the award recipient can use CRCCP funds to help another clinic.

CDC researchers conducted studies to find out how many clinics are successful at making EBIs sustainable, and steps that award recipients take to help clinics make sustainable EBIs. Other public health programs can use the results of these studies to learn the best ways to work with clinic partners.

Percentage of clinic partners that make EBIs sustainable

This study looked at how many clinics made the EBIs sustainable and how they did so. The study included all 861 health clinics that worked with CRCCP award recipients for at least 1 year from 2015 through 2020.

The study found that sustainability varied widely by EBI:

• Provider reminders: This EBI was the most sustainable. After 5 years of program participation, more than 90% of clinics said provider reminders are sustainable. Computer systems can send provider reminders automatically.
• Provider assessment and feedback: This is also a sustainable EBI because many computer systems can make provider reports automatically. Also, some clinics reward doctors who get the most patients screened.
• Client (patient) reminders: This EBI was less sustainable. Depending on the way patients are reminded (phone calls, letters or post cards, or text messages), the reminders may require more staff time.
• Reducing structural barriers: This was the least sustainable EBI. This EBI can be done in many ways, such as providing patient navigation, transportation to the clinic, language translation, evening and weekend clinic hours, child care, and free stool test kits. Most of these activities require a lot of money and staff time, so they are hard to do without additional support from CRCCP.

The study also found that clinics with certain traits had more sustainable EBIs:

• The percentage of clinics that reported each EBI as sustainable was generally higher for clinics that had participated in CRCCP longer. For example, 65% of clinics said provider reminders were sustainable after their first year in the program. But 91% of clinics that had been part of CRCCP for 5 years said provider reminders were sustainable.
• EBIs were more likely to be sustainable if the clinic used two or more EBIs.
• Clinics that had a screening champion had higher sustainability for three of the four EBIs. A screening champion is a doctor or staff member who encourages practices that increase cancer screening.
• Clinics that offered free stool test kits also had higher sustainability for three of the four EBIs.

Citation

Sharma KP, DeGroff A, Beckman M, Juzhong S, Sallyann CK, Djenaba J. Sustainability of evidence based interventions implemented in CDC's Colorectal Cancer Control Program. Implement Sci Commun 2025;6(1):73.

Ways in which award recipients help clinics make sustainable EBIs

This study explored how CRCCP award recipients help clinics make sustainable EBIs. Researchers chose nine CRCCP award recipients to join this study. Each recipient chose two people to be interviewed: one who helps clinics put EBIs in place, and one who evaluates how well the EBIs work. From March 2023 to March 2024, researchers interviewed each award recipient's program manager as well as the two staff members they chose. Researchers also conducted focus groups with the program managers.

The study found:

• Before award recipients start working with a clinic, they learn about the clinic to see if it's ready to increase colorectal cancer screening. For example, the recipients find out if the clinic's leaders support screening, and if the clinic has enough staff and a good computer system.
• Recipients then provide funds and training so the clinic can start doing the EBIs.
• Recipients find a person at the clinic to serve as a screening champion.
• Recipients help the clinic make EBIs part of their normal process.

Researchers also asked recipients to list the most important factors that help make EBIs sustainable. The three most important factors were:

1. Making EBIs part of the clinic's normal processes.
2. Having support for colorectal cancer screening from the clinic's leaders.
3. Providing training and technical help to the clinic's staff.

Citation

Schlueter D, Arena L, Soloe C, et al. Promising approaches to support sustained colorectal cancer screening promotion strategies in primary care clinics. Prev Oncol Epidemiol 2025;3(1):2512477.