| Identification if patient needs CRC screening test |
Identify patients by age (50-75), family history, symptoms. Part of the Medicaid Wellness Visit. Use EMR to identify if needed. |
| Selection of CRC screening test |
Providers (ie, physicians and nurse practitioners) often want to choose colonoscopy as it is perceived as the better test, but patients are more willing to do FOBT. Usually provider ends up choosing the test the patient is most willing to complete. FOBT is the most commonly ordered test compared to colonoscopy and Cologuard
FOBT: Usually the first-line screening test because of perception that patients are more accepting of the test and more likely to complete it than a colonoscopy. Colonoscopy: A desirable first-line test if the patient is willing and/or if the patient has a strong family history, blood in stool, pain, or other abnormal findings. Cologuard: Adoption has been slow and inconsistent across and within clinics. Those providers that use it do like it.
External (cost/transport) and internal (culture/psychological) barriers for patients to get a colonoscopy; therefore FOBT is generally better accepted by patients |
| How staff communicate with patient about the CRC screening test |
Providers present the pro and cons of doing the test (share reasons why important to do, CRC is easily treated when caught early, do not always have symptoms, convenience of doing it in your home, why it is recommended). Nurses conduct basic patient education of how to complete and return FOBT test Providers and nurses may also share their own experience of completing the test as patients |
| Ordering process for CRC screening test |
There are different ordering processes for the different tests, yet clinics have fairly consistent process for ordering tests.
FOBT: (1) Provider or nurse gives patient the kit; (2) note in the chart that they have provided the test; EMR is marked as “test given,” no requisition given; (3) patient returns the completed test to the clinic; (4) nurse marks order as received in EMR, prints requisition and packs with sample to LabCorp; (5) results from Labcorp are routed directly to provider. Colonoscopy: (1) Provider enters referral in chart, (2) SMHS referral staff take care of scheduling and contacting the patient, (3) mark as completed when they receive the results. NOTE: This process is the same for regular and urgent colonoscopies. Cologuard (used by only a few providers): (1) The provider enters the order, (2) the nurse sends form by fax to Cologuard, (3) Cologuard contacts the patient and sends the kit directly to them, (5) patient sends kit by mail back to Cologuard company, (6) company reports result to clinic, (7) clinic identifies as complete.
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| Patient actions to complete the CRC screening test |
Patients’ actions to complete the test and adherence vary by type of test.
FOBT: Completed kits are returned to the clinic (drop off at the front desk) instead of mailing directly to LabCorp. Nonreturned kits are a problem. Colonoscopy: Once referral is made, patients are on their own to make it to the appt. No-shows are a problem. Cologuard: Patient must mail sample (via only UPS?) within 24 hours of completion.
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| How clinics follow-up about non-completed test |
Approaches vary by test.
FOBT: No dedicated SMHS process for follow-up; therefore, FOBT follow-up usually happens at a subsequent appointment. Colonoscopy: Referral staff contact patient to reschedule. Cologuard: Cologuard company completes follow-up. No dedicated SMHS process for follow-up; therefore, FOBT follow-up usually happens at a subsequent appointment.
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| How clinics follow-up about abnormal CRC results |
Provider calls and sends a letter to the patient. Provider starts referral process to a gastroenterologist for colonoscopy. Considerations about which facility include patient insurance, distance, and patient preference. Most patients are compliant when their results come back abnormal and proceed to complete the colonoscopy. |
