Establish an Individualized Patient Education Program
Patients who are knowledgeable about guidelines for CRC screening are more likely to follow prescribed guidelines and proactively discuss issues or problems with their healthcare providers. However, experience in dealing with patients has shown that knowing what to do does not always equate with compliance. Even when the patient is motivated to comply, barriers (e.g., inadequate healthcare insurance, physical limitations making it difficult to perform adequate colon preparation, family factors) may impede patient follow-through with prescribed screening tests.
Key Points for Establishing an Individualized Patient Education Program
The office policy for CRC screening needs to be very clear. Since the approach to screening differs based on risk category, it will probably be more understandable if visually presented in the form of an algorithm or flow chart. Many of these resources can be found in How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Care Clinician's Evidence-Based Toolbox and Guide.
- Decide who in the office will be the CRC screening patient educator
- Prior to initiating education, determine the patient's current knowledge of CRC screening and whether the patient has made any personal decisions about being screened
- Tailor education to the patient's readiness for/decision about screening:
- If unaware of CRC screening, provide information about risks of CRC and benefits of screening as well as options available to the patient
- If aware of but not considering CRC screening, remind patient of CRC risks and the benefits of screening
- If considering CRC screening, assist patient in selecting a screening option. Help identify any barriers and possible solutions
- If patient has decided to do CRC screening, discuss options and logistics
- If patient has decided against CRC screening, ask for reasons and address them
- Barriers or limitations to helping patient reach a decision to have CRC screening include: patient's language, literacy, cultural background, physical limitations, and financial ability to pay or otherwise follow through with recommended care
- Follow the office policy for CRC screening when recommending testing
- If patient has a choice of screening procedures, review the pros and cons of each option that is available to the patient based on patient's risk and office policy using information found in the table below1
Tests That Detect Adenomatous Polyps and Cancers
Every 5 years
Every 10 years
Double contrast barium enema (DCBE)
Every 5 years
Every 5 years
Tests That Detect Cancer Only*
High sensitivity guaiac-based fecal occult blood test (gFOBT)
Fecal immunochemical test (FIT)
Stool DNA (sDNA)
Optimal interval for follow-up of negative test unknown
*Tests that detect cancers only are not preferred. If used for screening fecal tests combined with sigmoidoscopy, DCBE, or CTC are preferred over fecal tests alone.
Obtain high-quality patient education materials for the office. There are many resources for brochures, pamphlets, and posters available in a variety of languages. For additional information, see: How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Care Clinician's Evidence-Based Toolbox and Guide
- Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA: A Cancer Journal for Clinicians. 134(5): 1570-1595.