Colorectal cancer is the second leading cause of cancer death in the United States. Colorectal cancer screening is widely recommended but generally under-utilized. Previous studies have shown that only a minority of people over the age of 50 is screened for colorectal cancer with either focal occult blood testing or flexible sigmoidoscopy. Barriers to screening include patient and provider-related factors. In particular, patients who are not screened report some misconceptions, lack of knowledge or inconsistent provider recommendations about screening. Additionally, there are many barriers to providers recommending screening, including failure to recognize that screening tests are needed, lack of time for counseling and education about screening, and insufficient support to provide colorectal cancer screening tests. An alternate program to support primary care providers in providing necessary education about colorectal cancer screening, to provide reminders when screening tests are due, and to facilitate requesting and follow-up of screening tests may help address some of these barriers to providing screening services. We will develop and implement a primary care based colorectal cancer screening program to supplement clinical services provided in a primary care practice network. This network uses an electronic medical record and has established referral patterns for gastrointestinal endoscopy services, radiology, and pathology. In the proposed screening program, we will develop a colorectal cancer-screening module to supplement the existing electronic medical record. Information from this module will be obtained from patients and from prior medical records. This system will enable providers to review risk factors for colorectal cancer, prior screening history, and need for future screening in one easily accessible location. The information provided by this module will be supplemented by the services of a cancer prevention specialist. This person will oversee enrollment of patients into the program, provide patient education about colorectal cancer screening, and facilitate ordering or referral for screening or follow-up tests. Outcome measures will include utilization of screening rates, patient knowledge about screening tests, and provider acceptance of the program. If successful, this program may be useful to other large primary care practices, and may also help to improve utilization of other types of cancer prevention services
