P0253 - Colorectal Cancer Screening: Quality Improvement and Education at a Resident-Led Clinic

Melanie N. Cabezas, MD¹, Rachael E. Mahle, MD², Nancy Yang, MD¹, Pooja Patel, MD¹, Sukrit S. Jain, MD¹, Joel Boggan, MD, MPH¹, Brian Sullivan, MD, MHS¹, Lynn A. Bowlby, MD¹, Diana M. Mosquera, MD^3
1Duke University, Durham, NC; ²Duke University, Boston, MA; ³University of Miami, Jackson Memorial Hospital, Miami, FL

Introduction: Colorectal cancer (CRC) is a leading cause of cancer-related death, yet only ~65% of age-eligible adults receive appropriate screening. In a resident-led primary care clinic, lack of provider recommendation presents a barrier to screening. This quality improvement project aimed to improve resident confidence in recommending various CRC screening modalities and increase the number of age-appropriate screening referrals made.

Methods: A CRC educational module and decision algorithm were designed and presented to internal medicine residents at a single primary care clinic. Each resident was provided a list of patients due for CRC screening. Resident knowledge of and confidence in recommending various CRC screening modalities were assessed on a 5-point Likert scale and with questionnaires via pre- and post-intervention surveys. CRC screening referral rates from 30 months before and 6 months after the intervention were evaluated. Statistical process control (SPC) charts were created to determine if CRC screening referrals significantly increased following the intervention.

Results: Of the 60 residents, 59 participated in the pre-survey and 41 in the post-survey. After the educational intervention, residents reported significantly increased confidence in obtaining a list of patients on their panel not up to date on screening (p < 0.05), identifying screening options available at their practice (p < 0.001), and discussing options for CRC screening with patients (p < 0.05). Confidence in recommending guideline-based screening, follow-up, and assisting patients in overcoming barriers for Cologuard (p < 0.001) and FOBT (p < 0.05) also increased. Residents identified inadequate provider training, lower prioritization, and financial limitations as major barriers to successful screening. There was a significant increase in Cologuard referrals and decrease in FOBT (p < 0.01), but there was no significant change in total CRC screening or colonoscopy referrals after the intervention.

Discussion: This study demonstrates that a resident-led curriculum on CRC screening can improve provider confidence in counseling patients on CRC screening modalities and follow-up. Our intervention resulted in a statistically significant increase in referral rates for Cologuard, but did not show an increase in the number of total CRC screening or colonoscopy referrals. Ongoing data collection will evaluate for trends that may suggest a delayed improvement in CRC screening referrals with additional educational interventions.


Figure: Title: Monthly CRC Screening Referrals by Modality
Legend:
Screening Method
Blue - Colonoscopy
Orange - Cologuard
Yellow - Fecal Occult Blood Test
Dashed - Intervention Start Date

Question/Statement	Pre-Intervention		Post-Intervention
	Mean (SD)	N	Mean (SD)	N	p-value*
How confident are you in:
Identifying a comprehensive list of patients in your panel who are not up-to-date on colon cancer screening	2.82 (1.10)	50	3.43 (1.07)	35	0.009
Identifying the available colon cancer screening options available in your current clinical practice	3.16 (0.82)	50	3.80 (0.90)	35	< 0.001
Discussing options for colon cancer screening with patients and participating in shared decision making to assist patients in selecting the most appropriate option for them	3.42 (0.84)	50	3.82 (0.82)	35	0.046
For the following, how confident are you in recommending guideline-based colon cancer screening and follow-up:
FOBT	2.95 (0.77)	49	3.34 (0.94)	35	0.044
Cologuard	2.63 (0.78)	49	3.31 (0.99)	35	< 0.001
Colonoscopy	4.2 (0.71)	49	4.46 (0.51)	35	0.118
For the following, how confident are you in predicting and assisting patients in overcoming potential barriers to successful completion:
FOBT	2.68 (0.82)	50	3.29 (0.86)	35	0.002
Cologuard	2.48 (0.74)	50	3.14 (0.88)	35	< 0.001
Colonoscopy	3.46 (1.01)	50	3.74 (0.82)	35	0.214

Table: Title: Pre- and Post-Intervention Survey Responses

* Significance calculated using the Mann-Whitney U test


Disclosures:
Melanie Cabezas indicated no relevant financial relationships.
Rachael Mahle indicated no relevant financial relationships.
Nancy Yang indicated no relevant financial relationships.
Pooja Patel indicated no relevant financial relationships.
Sukrit Jain indicated no relevant financial relationships.
Joel Boggan indicated no relevant financial relationships.
Brian Sullivan: Exact Sciences – Grant/Research Support.
Lynn Bowlby indicated no relevant financial relationships.
Diana Mosquera indicated no relevant financial relationships.


Melanie N. Cabezas, MD¹, Rachael E. Mahle, MD², Nancy Yang, MD¹, Pooja Patel, MD¹, Sukrit S. Jain, MD¹, Joel Boggan, MD, MPH¹, Brian Sullivan, MD, MHS¹, Lynn A. Bowlby, MD¹, Diana M. Mosquera, MD³. P0253 - Colorectal Cancer Screening: Quality Improvement and Education at a Resident-Led Clinic, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.