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Improving Colorectal Cancer Screening in Primary Care Practice: Innovative Strategies and Future Directions

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Abstract

Colorectal cancer (CRC) screening has been supported by strong research evidence and recommended in clinical practice guidelines for more than a decade. Yet screening rates in the United States remain low, especially relative to other preventable diseases such as breast and cervical cancer. To understand the reasons, the National Cancer Institute and Agency for Healthcare Research and Quality sponsored a review of CRC screening implementation in primary care and a program of research funded by these organizations. The evidence base for improving CRC screening supports the value of a New Model of Primary Care Delivery: 1. a team approach, in which responsibility for screening tasks is shared among other members of the practice, would help address physicians’ lack of time for preventive care; 2. information systems can identify eligible patients and remind them when screening is due; 3. involving patients in decisions about their own care may enhance screening participation; 4. monitoring practice performance, supported by information systems, can help target patients at increased risk because of family history or social disadvantage; 5. reimbursement for services outside the traditional provider—patient encounter, such as telephone and e-mail contacts, may foster enhanced screening delivery; 6. training opportunities in communication, cultural competence, and use of information technologies would improve provider competence in core elements of screening programs. Improvement in CRC screening rates largely depends on the efforts of primary care practices to implement effective systems and procedures for screening delivery. Active engagement and support of practices are essential for the enormous potential of CRC screening to be realized.

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Financial Support and Disclosure

Funding support for this review was provided by the National Cancer Institute and the Agency for Healthcare Research and Quality.

Potential Financial Conflicts of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, EPN 4005, 6130 Executive Boulevard, Bethesda, MD, 20892-7344, USA

    Carrie N. Klabunde Ph.D.

  2. Center for Primary Care, Prevention, and Clinical Partnerships, Agency for Healthcare Research and Quality, Rockville, MD, USA

    David Lanier M.D.

  3. Applied Cancer Screening Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA

    Erica S. Breslau Ph.D.

  4. Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston, SC, USA

    Jane G. Zapka Sc.D.

  5. Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA, USA

    Robert H. Fletcher M.D., M.Sc.

  6. School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    David F. Ransohoff M.D.

  7. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Sidney J. Winawer M.D.

Authors
  1. Carrie N. Klabunde Ph.D.
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  2. David Lanier M.D.
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  3. Erica S. Breslau Ph.D.
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  4. Jane G. Zapka Sc.D.
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  5. Robert H. Fletcher M.D., M.Sc.
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  6. David F. Ransohoff M.D.
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  7. Sidney J. Winawer M.D.
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Corresponding author

Correspondence to Carrie N. Klabunde Ph.D..

Appendices

Appendix A

Table 1 Appendix A. NCI and AHRQ Funded Studies: Colorectal Cancer Screening in Primary Care Practice
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Appendix B

Table 2 Appendix B. Participants in Improving Colorectal Cancer Screening Delivery, Utilization, and Outcomes: the State of the Science
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Klabunde, C.N., Lanier, D., Breslau, E.S. et al. Improving Colorectal Cancer Screening in Primary Care Practice: Innovative Strategies and Future Directions. J GEN INTERN MED 22, 1195–1205 (2007). https://doi.org/10.1007/s11606-007-0231-3

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  • DOI: https://doi.org/10.1007/s11606-007-0231-3

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