Tailoring an evidence-based approach to colorectal cancer screening for Community Health Centers in North Carolina

As a first step to increasing adherence to colorectal cancer screening guidelines in community health centers in NC, we have modified an existing curriculum produced by the National Colorectal Cancer Roundtable called “How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Care Clinician's Evidence-Based Toolbox and Guide©”. Using a combination of expert opinion from guideline developers and focus groups with health center clinicians, we tailored the content for healthcare professionals who work primarily with indigent, uninsured patients. First, we updated the original toolbox with the PHS guidelines published in 2008 and collaborated with consultants to determine which components to include. Second, we held two focus groups with providers to review the draft toolbox and make recommendations. Third, we worked with an educational design company to incorporate the focus group findings and produce a cd for distribution. The final content consists of an introduction, three essentials for screening, and sample tools. The Three Essentials include: 1) An Office Policy that centers on risk assessment, algorithms for each type of screening, standardized counseling scripts, and patient materials; 2) A Provider Recommendation that advocates an opportunistic approach to screening and takes into account patient-level and local-level resources; 3) An Office Reminder System that utilizes standing orders, standardized documentation, and patient-level reminders. The Toolkit in the appendix contains laminated, easy-to-use tools that correspond to the recommendations in the Three Essentials. Our plans are to test a public health detailing approach by examining differences between randomly assigned intervention and control clinics.