What to know
The screening policies, procedures, and practices within health facilities focus area includes tools and resources to: assess the status of cancer screening, make cancer screening a priority, reduce structural barriers, and use data to identify patients due for screening and opportunities to improve cancer screening rates within a clinical setting or system.
Introduction
This page is part of the Colorectal Cancer Screening Change Package.
Change concepts are "general notions that are useful for developing more specific strategies for changing a process."1 Change ideas are evidence-based or practice-based "actionable, specific ideas or strategies."1 Each change idea is linked to tools and resources that can be used or adapted to improve cancer screening.
Note: See a list of acronyms used in this change package.
Change concept: Make cancer screening a priority.
Assess primary care clinics' readiness to implement existing evidence-based interventions (EBIs) to increase cancer screening.
- CDC — Field Guide for Assessing Readiness to Implement Evidence-Based Cancer Screening Interventions
Prioritize screening by engaging leaders and identifying screening champions.
- AICAF and NIHB — Advancing Health Systems Toolkit,A pages 5–7
- CDC, NACDD, and Kaiser Permanente CHR — Mailed FIT Implementation Guide, pages 11–14
- Health Promotion Practice Journal — The Health Promotion Practice Podcast: S2 Ep. 24 Exploring Sustainability Factors for a Colorectal Cancer Screening Program with Dara Schlueter
- NACHC — Value Transformation Framework: Cancer Screening, page 4
Use a whole-office approach by delegating screening tasks across the health care facility team.
- CDC, NACDD, and Kaiser Permanente CHR — Mailed FIT Implementation Guide, pages 9–12
- Evidence-Based Cancer Control Programs (EBCCP) — Fecal Immunochemical Test and Colonoscopy Outreach,A see Program Materials [English and Spanish]
Make cancer screening a quality improvement measure at the system level.
- AICAF and NIHB — Advancing Health Systems Toolkit,A pages 5–7
- NQF — ABCs of Measurement
Change concept: Implement population management strategies for all eligible patients.
Benchmark or compare health care facility screening prevalence to state and national prevalence.
- ACS — Cancer Facts and Figures for African American/Black People 2022–2024
- ACS — Cancer Prevention and Early Detection Facts and Figures 2022, (tables and figures only) pages 35–36
- CDC — Use of Colorectal Cancer Screening TestsA
- CDC — United States Cancer Statistics: Data Visualizations ToolA (see Screening and Risk Factors tab)
- NACHC — Value Transformation Framework: Cancer Screening, page 5
Use community assessment to identify barriers to and resources for screening.
- ACS and CCCNP — Comprehensive Cancer Control Plan: Colorectal Cancer Tip Sheet, pages 4–7
- BMC and AVON Foundation for Women — The Boston Medical Center Patient Navigation Toolkit, 1st ed, pages 10–19
Run EHR reports on eligible patient populations to generate lists or create a registry of patients who are due for screening and conduct outreach.
- AICAF and NIHB — Advancing Health Systems Toolkit,A page 15
- Evidence-Based Cancer Control Programs (EBCCP) — Smart Options for Screening (SOS),A see Program Materials: Implementation Guide and SOS ICD Codes
Analyze data by patient sub-populations to determine if screening disparities exist.
- CDC — United States Cancer Statistics (USCS): Data Visualizations Tool
- NACHC — Value Transformation Framework: Cancer Screening, page 5
- NIH, NCI, and CDC — State Cancer Profiles Interactive Maps
Change concept: Establish standard operating procedures for screening.
Develop formal written screening policies for the health care facility.
- NACHC — Value Transformation Framework: Cancer Screening, pages 6–7
Implement standing orders for screening.
- AAFP — Developing Standing Orders to Help Your Team Work to the Highest Level
- NACHC — Value Transformation Framework: Cancer Screening, pages 6–7
Use implementation guides and quality improvement tools to create workflows and address workflow barriers.
- CDC, NACDD, and Kaiser Permanente CHR — Mailed FIT Implementation Guide, pages 11–14
- CCSPSC — CCSPSC Champions Program, see Phased Approach to Implementation with Partners (throughout document)
- CCSPSC — CCSPSC Champions Program, see Sandhills-Lugoff Provider Reminder Process, page 32
- Evidence-Based Cancer Control Program (EBCCP) — Fecal Immunochemical Test and Colonoscopy Outreach, see Program Materials: Colonoscopy Strategy Workflow and FIT Strategy Workflow
- FluFIT, Potter M — FLU-FOBT Program Components and Flow DiagramA
- NACHC — Value Transformation Framework: Cancer Screening,A pages 5–8
Change concept: Use risk assessment tools and follow-up.
Use a family history algorithm to assess a patient's risk of developing cancer to help determine eligibility for screening.
Use a risk calculator to determine a patient's eligibility for screening.
Change concept: Practice patient education, communication, and shared decision-making.
Use tools and resources to facilitate shared decision-making regarding screening.
- GW Cancer Center — Guide for Patient Navigators: A Supplement to the Oncology Patient Navigator Training: The Fundamentals, pages 83–88
- Kunneman M, Montori VM, Castaneda-Guarderas A, Hess EP, 2016 — What Is Shared Decision Making? (and What It Is Not)
- Ottawa Hospital Research Institute — Colon Cancer: Which Screening Test Should I Have?A
Use patient education materials and small media such as videos and printed materials.
- AICAF and NIHB — Advancing Health Systems Toolkit,A B page 10
- ASCO — ColonoscopyB [English and Spanish]
- CDC — Colorectal Cancer Communication ResourcesB [videos and print materials in English and Spanish]
- Kaiser Permanente CHR — Patient Frequently Asked QuestionsB [English and Spanish]
Use patient education materials to support discussions on potential out-of-pocket costs for screening and follow-up.
- ACS — Insurance Coverage for Colorectal Cancer ScreeningB [English and Spanish]
- AGA — What to Expect: Paying for Your ColonoscopyB
Use communication tools and strategies to improve patient-centered communication.
- GW Cancer Center — Health Equity Toolbox: Resources to Foster Cultural Sensitivity and Equitable Care for All
- GW Cancer Center — Practice Patient-Centered Care Posters
Personalize messaging to increase screening among patients.
- GW Cancer Center — Practice Patient-Centered Care Posters
Provide educational and instructional materials to patients on screening procedures.
- Evidence-Based Cancer Control Programs (EBCCP) — Fecal Immunochemical Test and Colonoscopy Outreach,A Bsee Program Materials: Colonoscopy Invitation Letter [English and Spanish example letters] and Colonoscopy Bowel Prep Instructions [English and Spanish examples]
Change concept: Implement patient and provider reminder systems.
Use multi-modal screening reminders, such as mail, phone, or text messages, for patients.
- AltaMed, Kaiser Permanente CHR — PROMPT Study: Primer Calls for Never Completed FIT Screening: Outreach Team Call Scripts [English and Spanish patient letter, personalized alert, and reminder prompts for FIT]
- CDC, NACDD, and Kaiser Permanente CHR — Mailed FIT Implementation Guide, pages 24, 28, 32, and 38
- Evidence-Based Cancer Control Programs — Against Colorectal Cancer In Our Neighborhoods (ACCION) — FIT Abnormal Results LetterA B[English and Spanish]
- Evidence-Based Cancer Control Programs — Fecal Immunochemical Test and Colonoscopy Outreach [English and Spanish colonoscopy appointment reminder, FIT telephone scripts]
- Evidence-Based Cancer Control Programs — Smart Options for Screening (SOS) — Implementation Guide
- Kaiser Permanente CHR — Prevention Research Center Colorectal Cancer Mailed Patient Reminder TemplateB [English and Spanish]
- Kaiser Permanente CHR — Reminder Call Phone Scripts to Return FIT Tests
- Kaiser Permanente CHR — Vendor Script: Colorectal Cancer Screening FOBT Kits
- NIHB — Health Systems Improvement Toolkit: A Guide to Cancer Screenings in Indian Country,A pages 15 and 21–24
- Washington State Department of Health — Colon Cancer Screening Provider Toolbox, page 1
Use electronic reminders, such as prompts in the EHR, for providers and staff.
- ACS and CCCNP — Comprehensive Cancer Control Plan: Colorectal Cancer Tip Sheet, page 9
- AICAF and NIHB — Advancing Health Systems Toolkit,A page 15
- CCSPSC — CCSPSC Champions Program, see Provider Reminder Observation Form, pages 33–35, and Sandhills-Lugoff Provider Reminder Process, page 32
- CDC — Evidence-Based Interventions — Provider Reminder Planning Guide
- NIHB — Health Systems Improvement Toolkit: A Guide to Cancer Screenings in Indian Country,A pages 15 and 17–19
Use physical reminders, such as stickers or cards, for providers and staff.
- CCSPSC — CCSPSC Champions Program, see Provider Reminder Observation Form, pages 33–35
- CDC — Evidence-Based Interventions – Provider Reminder Planning Guide
- NIHB — Health Systems Improvement Toolkit: A Guide to Cancer Screenings in Indian Country, pages 15 and 17–19
Change concept: Reduce structural barriers in the health care setting.
Identify health-related social needs.
- Centers for Medicare and Medicaid Services — Accountable Health Communities Model [social needs screening tool]
Offer nontraditional facility hours.
- NIHB — Health Systems Improvement Toolkit: A Guide to Cancer Screenings in Indian Country, page 25
- The Community Guide — Cancer Screening: Reducing Structural Barriers for Clients — Colorectal Cancer
Use telehealth for screening consultations and follow-up of results.
- President's Cancer Panel — Closing Gaps in Cancer Screening: Connecting People, Communities, and Systems to Improve Equity and Access, pages 3 and 17–19
Use patient navigation to improve completion of screening.
- BMC and AVON Foundation for Women — The Boston Medical Center Patient Navigation Toolkit 1st ed
- Evidence-Based Cancer Control Programs (EBCCP) — Kukui Ahi (Light the Way): Patient Navigation — Addressing Barriers Worksheet; Implementation Guide
- GW Cancer Institute — Guide for Patient Navigators: A Supplement to the Oncology Patient Navigator Training: The Fundamentals
- NCCRT and Colorado School of Public Health — Paying for Colorectal Cancer Screening Patient Navigation Toolkit and Interactive Website
- NIHB — Health Systems Improvement Toolkit: A Guide to Cancer Screenings in Indian Country, pages 25–26
Ensure information or interpretation services are available in the patient's primary language.
- Juckett G, Unger K, 2014 — Appropriate Use of Medical Interpreters
Streamline administrative procedures, such as simplifying patient paperwork, reducing the number of required visits, and offering flexibility for late arrivals.
- NIHB — Health Systems Improvement Toolkit: A Guide to Cancer Screenings in Indian Country, page 25
- The Community Guide — Cancer Screening: Reducing Structural Barriers for Clients — Breast Cancer
- NACHC — Value Transformation Framework: Cancer Screening, pages 6–9
Conduct an environmental scan and organizational assessment of cancer screening capacity.
- BMC and AVON Foundation for Women — The Boston Medical Center Patient Navigation Toolkit 1st ed, pages 5–19
- CCSPSC — CCSPSC Champions Program, see Readiness Assessment, pages 1–5
- Evidence-Based Cancer Control Programs (EBCCP) — Kukui Ahi (Light the Way): Patient Navigation — Facility Tour Worksheet
- This resource may contain some information that does not reflect the current US Preventive Services Task Force recommendations for cervical cancer screening.
- Indicates a patient resource.
- Centers for Disease Control and Prevention. Tobacco Cessation Change Package. US Department of Health and Human Services; 2019.