Posted: April 29th, 2024

Assessing provider adherence to screening guidelines for colorectal cancer

Assessing provider adherence to screening guidelines for colorectal cancer.
Colorectal cancer (CRC) is a major cause of morbidity and mortality worldwide. Screening for CRC can reduce the incidence and mortality of the disease by detecting and removing precancerous lesions or early-stage cancers. However, screening rates for CRC remain suboptimal in many countries, and there is a need to assess the adherence of providers to the evidence-based screening guidelines.

The screening guidelines for CRC vary depending on the risk level, age, and preference of the individual. For average-risk individuals, who do not have a personal or family history of CRC or inflammatory bowel disease, the most common screening modalities are stool-based tests and visual exams of the colon and rectum. The United States Preventive Services Task Force (USPSTF) recommends that all adults aged 45 to 75 be screened for CRC with either a fecal immunochemical test (FIT) every year, a multi-targeted stool DNA test (mt-sDNA) every 3 years, a colonoscopy every 10 years, a CT colonography (virtual colonoscopy) every 5 years, or a flexible sigmoidoscopy (FSIG) every 5 years [1]. The American College of Gastroenterology (ACG) also suggests starting CRC screening at age 45 in average-risk individuals and using either colonoscopy or FIT as the primary screening modality [2]. Other screening options include colon capsule endoscopy, which is a wireless device that captures images of the colon as it passes through the digestive tract.

For individuals with increased or high risk of CRC, such as those with a strong family history of CRC or certain types of polyps, a personal history of CRC or certain types of polyps, a personal history of inflammatory bowel disease, or a known family history of a hereditary CRC syndrome, the screening guidelines recommend starting CRC screening earlier than age 45, being screened more often, and/or using specific tests. For example, the ACG recommends starting CRC screening at age 40 in individuals with one or two first-degree relatives with CRC or advanced polyps. If the first-degree relative is younger than 60, or there are two or more first-degree relatives with CRC or advanced polyps at any age, colonoscopy should be used and repeated at five-year intervals [2].

Assessing provider adherence to screening guidelines for CRC is important to identify gaps and barriers in the delivery of quality care and to implement interventions to improve screening rates. Provider adherence can be measured by various indicators, such as the proportion of eligible individuals who are offered screening, the proportion of individuals who complete screening according to the recommended modality and interval, and the proportion of individuals who receive appropriate follow-up after abnormal screening results. Provider adherence can be influenced by several factors, such as provider knowledge, attitudes, beliefs, preferences, skills, communication, feedback, incentives, and system-level factors [3].

Several strategies have been proposed to enhance provider adherence to screening guidelines for CRC, such as provider education, reminders, audit and feedback, academic detailing, decision support tools, patient navigation, electronic health records, quality improvement programs, and policy changes [4]. These strategies can be tailored to the specific needs and characteristics of different settings and populations. Evaluating the effectiveness and cost-effectiveness of these strategies can help inform best practices and optimize the use of resources for CRC screening.

References:

[1] US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965-1977. doi:10.1001/jama.2021.6238

[2] Shaukat A., Kahi C.J., Burke C.A., et al. ACG clinical guidelines: colorectal cancer screening 2021. Am J Gastroenterol. 2021;116(3):458-479. doi:10.14309/ajg.0000000000001122

[3] Holden D.J., Jonas D.E., Porterfield D.S., Reuland D., Harris R. Systematic review: enhancing the use and quality of colorectal cancer screening i need help with my assignment. Ann Intern Med. 2010;152(10):668-676. doi:10.7326/0003-4819-152-10-201005180-00239

[4] Naylor K., Ward J., Polite B.N. Interventions to improve care related to colorectal cancer among racial and ethnic minorities: a systematic review. J Gen Intern Med. 2012;27(8):1033-1046. doi:10.1007/s11606-012-2025-4

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