Colorectal cancer (CRC) is the third most common cancer in both men and women in the United States and the second most common cause of cancer-related death. Ample evidence shows that screening with several available strategies significantly decreases CRC incidence and mortality. Furthermore, African Americans bear a disproportionate burden, with a 20% higher CRC incidence than whites and other ethnicities. Particularly, African Americans are more often diagnosed with CRC at an earlier age and with more advanced disease.
Several screening tools for CRC are available for patients 50 years and older, including fecal occult blood testing (FOBT), fecal immunochemical testing (FIT), flexible sigmoidoscopy, and colonoscopy. FIT measures intact human globin protein (as opposed to heme) in the stool and is replacing FOBT in many screening programs because it offers several advantages such as. It requires only 1 stool specimen and requires less stool handling. Dietary restrictions are unnecessary because animal heme from meat will not trigger a false-positive result. FIT is also more specific for lower gastrointestinal bleeding because human globin degrades as it passes through the small intestine. The biggest potential advantage of FIT is evidence suggesting that it detects more advanced adenomas than FOBT, without significant loss of specificity or increased false-positive results.
FIT Testing at Saban Community Clinic
Review of 90 patient charts in the EPIC-OCHIN, conducted by Jim Slotnick Fellow Jeremy-Ann Ham, reveals that:
- Only 50% returns FIT cards.
- Only 38.9% of patients tested for FIT is male even though colorectal cancer equally affects men and women.
- A decreasing trend among people who have previously done FIT, who are less likely to repeat the test.
Improve the rate of FIT kits returned by patients through PDSA cycle by increasing awareness and knowledge. In addition, increase awareness among patients and educate them about the importance of FIT testing and its advantage over colonoscopy.
The project design follows the PDSA cycle framework:
Plan: Patient chart review: Identify barriers to patients return-mailing completed FIT kits.
Do: QI Intervention--Informational brochure was given to patients due for FIT, explaining more about what it is, how often to test, and other helpful information to increase patient compliance rate
Study: Post-intervention analysis--Approximately 1 week post-QI intervention, the charts of the 25 patients given FIT kits were reviewed on EPIC to track how many patients return-mailed the kits to Quest laboratory. As of July 16th, 4 out of 25 patients returned the FIT kits.
Act: Future recommendations
- Deploy “Poop-On-Demand” program—emphasize on-site FIT testing.
- Mail FIT kits to patients with informational sheet.
- Combine different intervention options—brochure + on-site FIT testing.
This project illuminates how healthcare facilities can implement an intervention to improve health-screening tools—in this case, CRC screening through FIT. Further, using PDSA in pragmatic research can help uncover implementation challenges and may enable the clinic to integrate a research-based intervention into everyday care processes. Future ongoing evaluations will require a larger sample size, and timelines must be considered when implementing multiple PDSA cycles.