Table 4.

Clinical Lab Opportunities for Optimizing Colorectal Cancer Screening and Outcomes

Opportunity	Challenge	Intervention
Optimize screening participation	Suboptimal screening rates	Establish infrastructure to implement mailed outreach programs
		Implement embedded EHR tools to allow for standing orders at point of lab care for screening tests such as FIT for patients not up to date (“Lab-FIT”)
Optimize screening effectiveness	Subpar patient instructions	Distribute instructions following best practices for literacy, with consideration for wordless instructions, multiple translations, and links to instructional videos
	Distribution of low performance stool tests	Phase out gFOBT and more broadly adopt FIT
		Select FIT brands with consistently good performance characteristics
	Discarding of irreplaceable FITs due to missing collection dates	Result FITs missing collection dates or out of window from collection to processing and report abnormal results, and advise repeat testing for normal results
	Non-reporting of quantitative FIT values that correlate closely with probability of neoplasia	Support implementation of quantitative FIT reporting Report quantitative fecal hemoglobin values
	Low rates of colonoscopy follow up after an abnormal non-invasive CRC screening test	Flag abnormal results as critical values, provide education on test result interpretation, partner to create registries of patients with abnormal lab-based CRC screening test results
	Socioeconomic variability in access	Promote access to FDA/CMS approved testing
Reduce inappropriate screening test exposure	High rates of FIT overuse/misuse in emergency department and inpatient settings	Eliminate or restrict emergency department and inpatient use of CRC screening tests such as FIT and guaiac FOBT