Improving Colorectal Cancer Screening Decision Making Processes

Authors

Kathleen M. Fairfield, Maine Medical CenterFollow
Christine B. Peura, Maine Medical CenterFollow
Elizabeth Herrle, Maine Medical CenterFollow
Lauren G. Daniels, Cape Cod Health CenterFollow
Debra L. Pyle, Maine Medical CenterFollow
Mary McDonough, Maine Medical CenterFollow
Mark P. Bouchard, Maine Medical CenterFollow
Donald Medd, Maine Medical CenterFollow
Neil Korsen, Maine Medical CenterFollow
Paul K. J. Han, Center for Outcomes Research and Evaluation (CORE) and Maine Medical Center Research InstituteFollow

Submission Type

Patient Safety and Quality Improvement Exemplars

Abstract

Introduction:

Although shared decision making is recommended for cancer screening, it is not routinely completed in practice because of time constraints. We evaluated a process for improving decision making about colorectal cancer (CRC) screening using mailed decision aids (DA) with follow-up telephone support in primary care practices.

Methods:

We identified patients aged 50-75 who were not up to date with CRC screening in three primary care practices. DA were distributed via mail with telephone follow-up to eligible patients, and charts were reviewed six months later for CRC screening completion.

Results:

Among 1,064 eligible patients who received the mailed DA, 513 (48.2%) were reached by phone. During the six months after the intervention, 148/1064 (13.9%) patients were screened for CRC (4.8% underwent FIT, 9.1% underwent colonoscopy). Younger patients (aged 50-54) had higher rates of any screening (32.4%) compared with all other age groups (range 12.8%-19.6%), p=0.026, while Medicaid patients had the lowest rates of screening (4.0%), and insured patients had the highest rates (45.3%), p=0.003. Overall, 113/513 (22.0%) who were reached by phone went on to complete screening within 6 months, compared with 35/551 (6.4%) of patients who were not reached by phone (p

Conclusion:

A standard process for identifying patients unscreened for CRC and DA distribution via mail with telephone decision support modestly increased CRC screening and is consistent with the goal of providing preference-sensitive care and informed decision making. Improving care processes to include decision support outside of office visits is possible in primary care practices.

Recommended Citation

Fairfield, Kathleen M.; Peura, Christine B.; Herrle, Elizabeth; Daniels, Lauren G.; Pyle, Debra L.; McDonough, Mary; Bouchard, Mark P.; Medd, Donald; Korsen, Neil; and Han, Paul K. J. (2019) "Improving Colorectal Cancer Screening Decision Making Processes," Journal of Maine Medical Center: Vol. 1 : Iss. 1 , Article 6.
Available at: https://doi.org/10.46804/2641-2225.1006