Increasing Colorectal Cancer Screening Using a Quality Improvement Approach in a Nurse-Managed Primary Care Clinic

Abstract

According to the American Cancer Society, 1 in 23 Americans will be diagnosed with colorectal cancer (CRC) in their lifetime. Screening for CRC is an effective, yet underused preventive approach. This is especially true in rural areas, where only 35% of patients were found to be up to date on their screenings in 2014. Increasing CRC screening can produce positive patient outcomes by early recognition and removal of precancerous polyps. The purpose of this project was to use quality improvement (QI) interventions to increase CRC screening rates at a nurse-managed clinic in rural Indiana. Using Deming's Plan-Do-Study-Act QI model, multiple interventions were implemented which resulted in a 37% increase in the number of screenings ordered on eligible patients and an overall increase of 28% in the completion of the screenings. This project contributes to healthcare quality knowledge by also suggesting that the fundamental principles of encouraging staff feedback to gain buy-in, improving processes informed by patient data, and valuing frequent performance feedback to staff, strengthened this QI project and ensured adoption and sustainability of these results.

Faecal immunochemical testing implementation to increase colorectal cancer screening in primary care

“…There was objective evidence of increased physician knowledge related to CRC screening after implementation of interactive workshops. Several other initiatives have had relatively positive success rates in improving CRC screening using FIT,42–46 patient5 47 48 and physician education 49–51. Patient outreach by a navigator had a positive impact on FIT completion rates similar to previous studies 46 52–54.…”

Primary care practice-based interventions and their effect on participation in population-based cancer screening programs: a systematic narrative review

“…Twenty-two studies from the US (n = 18), Canada (n = 3) and Australia (n = 1) were multi-component non-randomized trials (Potter et al, 2011;Kaczorowski et al, 2013;Dorrington et al, 2015;Harris et al, 2015;Hills et al, 2015;Mader et al, 2016;Marx et al, 2016;Wu et al, 2016;Baxter et al, 2017;Green et al, 2017;Hountz et al, 2017;Weiner et al, 2017;Bakhai et al, 2018;Nguyen et al, 2020;Desai et al, 2021;Funes et al, 2021;Frissora et al, 2021;Hussain et al, 2021;Jones et al, 2022;Ruggeri et al, 2020;Walker-Smith and Baldwin, 2020;Willemse et al, 2022) (Table 3).…”

“…A positive effect on cervical screening rates was found. Hountz et al (2017) implemented reminders to nurses, promotional material, and simplified FOBT ordering processes, and Bakhai et al (2018) outlined the effect of eight PDSA cycles, with cycles including interventions such as provider reminders, patient navigation, and patient education. Both studies had a positive effect on bowel screening rates.…”

Nursing Care During the Surgical Treatment of Colorectal Cancers

“…Sosyokültürel faktörlerin (siyah ırkta beyazlardan daha fazla) ve sosyoekonomik durumun (yüksek gelir düzeyinde düşük gelir düzeyinden daha fazla) KRK gelişiminde etkili olduğu ve kırsal bölgede yaşayanlara oranla kentsel bölgede yaşayanlarda KRK insidansının daha fazla olduğu da bildirilmektedir (Bray et al, 2018;Liang et al, 2020). Kolorektal kanser gelişiminde; değiştirilebilen (çeşitli yönlendirmelerle dışarıdan müdahale edilebilen, örneğin sigara kullanımı, sağlıksız beslenme alışkanlıkları, aşırı alkol tüketimi, fiziksel aktivite kısıtlılığı, obezite) ve değiştirilemeyen (kişilerin kontrol altına alamayacağı, örneğin genetik, yaş) faktörlerin etkili olduğu bildirilmektedir (Aytaç, 2020;Hountz et al, 2017;Koç, 2017;Siegel et al, 2020;Simonson, 2018). Kolorektal kanser yayılımında; direk komşuluk, lenfatik ve hematojen yol, gravite ve ameliyat alanında oluşan implantasyon etkilidir (Özçelik, 2018).…”

“…Uzun yıllar boyunca iyi huylu oluşumlardan yavaşça ve herhangi bir bulgu vermeden gelişebilen KRK' de tanılama aşaması önemli yer tutar. Çoğunlukla, ölüm ve hastalıkların tanımlanabilen lezyonların uygun tarama yöntemleri ile kanser oluşmadan uzaklaştırılabileceği ve tedavi-bakım maliyetlerinde de azalma olabileceği bildirilmektedir (Hountz et al, 2017;Koç, 2017;Siegel et al, 2020;Simonson, 2018). Beş yıllık sağ kalım oranı lokal hastalık ile tanılananlarda %90 iken yayılım varlığında bu oran sadece %14'tür (Bray et al, 2018;Liang et al, 2020).…”