Date of Award
Projects: SPU Access Only
Doctor of Nursing Practice (DNP)
Christine Hoyle, DNP, ARNP, FNP-BC
Background and Significance: Colorectal cancer is the third most common type of cancer among both men and women in the United States (American Cancer Society, 2021). Substantial benefits to completing colorectal cancer screening have been found as well as considerable evidence proving screening reduces colorectal cancer mortality (USPSTF, 2021). There are several methods of completed screening including stool tests or direct visualization methods such as colonoscopies. Studies have not shown one screening strategy is more effective at reducing colorectal cancer mortality than another (USPSTF, 2021). Despite these findings, a considerable portion of eligible individuals are not up to date with screening recommendations (CDC, 2021a).
Problem and Purpose: Screening metrics from a primary care clinic, located in the suburbs of a large city in Washington state, demonstrate low colorectal cancer screening rates among its eligible patients. Lack of knowledge of overdue status or screening recommendations may play a role in the clinic’s decreased screening rates. The purpose of this project was to determine if sending electronic reminder messages to patients due for colorectal cancer screening and placing reminder messages on provider’s appointment schedule for patients overdue for colorectal cancer screening, increased colorectal cancer screening completion rates in the primary care clinic.
Methods: The IHI Model for Improvement and the Social Cognitive Theory were utilized for the implementation. The overall aim of this quality improvement project was to increase screening completion rates by 5%. Plan-Do-Study-Act (PDSA) cycles were used to implement effective change when implementing electronic reminder messages to patients and providers. Three providers and their eligible patients participated in the project. Data collection was done via the organizations electronic health records system and monthly care gap reports produced by the organization.
Results/Outcomes: Overall clinic screening completion rates increased 3.96% after the first PDSA cycle but failed to increase screening rates by 5%, with only a 3.89% increase at the end of the project. However, screening rates among the three participating providers increased by over 5%, with provider 1 increasing by 5.28%, provider 2 by 5.87% and provider 3 by 6.56%. A major outcome of the use of electronic reminder messages was participants scheduling appointments with their provider. A total of 30%, 21% and 28% of participants scheduled an appointment after each of the 3 PDSA cycles. Additionally, data analysis revealed a higher percentage of women responded to electronic reminders by scheduling appointments and completing screening compared to men.
Sustainability: To ensure patients continue to receive electronic reminder messages of overdue screening status, a reminder message template was created. Multiple technological issues were found, including failed capturing of completed screenings and missing results. Additionally, there was no follow up for patients who had screening ordered but did not complete the screening. Assigning a clinic champion to work with IT when issues are found or work on follow up may help increase rates further. To encourage sustainability, additional quality improvement projects are needed to address the frequency of electronic reminder messaging sent to patients. Strategies to improve screening among patients without electronic messaging capabilities and ways to bridge the gap between the clinic, where screening colonoscopies are completed, and patient’s primary care clinic should be addressed in the future.
Implications: Completion of colorectal cancer screening can help prevent colorectal cancer and detect cancer at earlier stages. Sending patients electronic reminder messages regarding screening is a quick and cost-effective intervention. Electronic reminder messages help facilitate communication of health information among health care professionals and patients. This is especially important as technology continues to play a bigger role in health care.
American Cancer Society. (2021, January 12). Key Statistics for Colorectal Cancer. https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html
Centers for Disease Control and Prevention. (2021a, February 8). What should I know about screening?. https://www.cdc.gov/cancer/colorectal/basic_info/screening/
US Preventative Services Task Force. (2021, May 18). Screening for colorectal cancer US preventive series task force recommendation statement. JAMA, 325(19), 1965-1977. doi:10.1001/jama.2021.6238
Brogan, Arely Nohemi, "Increasing Colorectal Cancer Screening in a Primary Care Clinic" (2022). Doctor of Nursing Practice (DNP) Scholarly Projects. 31.