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Table 3 Lessons learned: implementation successes (n= 55)

From: Implementation challenges and successes of a population-based colorectal cancer screening program: a qualitative study of stakeholder perspectives

Summary of themes

PCP (n = 20)

Specialist (n = 23)

Leader (n = 12)

Sample of illustrative quotes (stakeholder group identified)

Use of automated telephone outreach

Helped to improve screening rates from previous years

  

“I think the work that we’re doing in outreach with those modalities has been the reason we have significantly increased our screening rate… I think we’ve gone up six or seven percent in the last year.” —HP leader

An effective and resource sustainable method for increasing and maintaining CRC screening in a large population

  

“I think it’s the way to address all kinds of things. And we’ve done it in a number of other areas… I think you want to have a centralized approach.” —HP leader

Patient-centered, friendly, easy to follow and use

  

“It was amazing… we were able to keep members on the phone for up to five minutes because it was so interactive.” —HP leader

Decreased workload burden for providers/health care teams for conducting outreach calls for screening

 

“For colon cancer screening, what we pretty much have always done is in-reach during a visit… having an automated program makes it easier for us—especially for reaching those people whom we never see [in a visit] and tend to miss.” —PCP

Made PCP/health care team discussions with patients about CRC screening easier by reinforcing awareness and knowledge of importance of screening

 

“Ironically, lately I’ve been finding a lot of patients who, when I say, ‘Well, now we need to do that poop test.’ They’ll say, ‘Oh, I just turned that in.’ [Laughs] They’ve already done it… So it [a reminder program] just makes those conversations about screening easier.” —PCP

Use of fecal immunochemical tests

Transition to FIT further increased the organization’s. CRC screening rate from prior years/increased patient compliance with the fecal test method of screening

“And it’s just remarkable how many more of them are getting done. Now, part of that is that you only have to do one. You don’t have to do three. You don’t have to worry about the diet, like you did with the FOBT. So, it’s a lot easier, I think.” —HP leader

Adoption of FIT has given providers a fecal test method they have greater trust in and enthusiasm for due to increased patient compliance and test sensitivity

“From a population perspective, it is the most effective because people will do it. And it’s easy, and it’s efficient. And it has literature to support it. So, it’s got all the right stuff.” —HP leader

Removed common barriers to fecal test completion for patients and made motivation/discussion about. CRC screening easier and more efficient

 

“But I think now, with the FIT test, it’s so much easier to have the conversation and just explain it’s different and really easy to use. How you collect your sample and how you send it out is so much easier. You don’t have to change your diet. So I think that has improved.” —HP leader

Communication about organizational screening approach

Improved ability to provide a more unified message to all providers to encourage/discuss FIT for average-risk patients first, followed by offering colonoscopy if patient prefers or demands

“It’s clear a lot of time and effort has been invested in communicating to Kaiser clinicians to see colonoscopy as not a better test than these other tools, and to offer stool card testing. I’ve probably been brought around to that line of thinking… I certainly think the newer stool card testing [FIT] has more merit… so it’s been a little bit easier for me to make my peace with that.” —PCP

Provides confidence in automated reminders, yearly FIT cards, and ongoing ability to offer screening colonoscopy

“It’s a wonderful thing that we finally have turned on a screening program.” —GI specialist

Fewer organizational barriers to CRC screening than before implementation efforts

 

“Things are moving in a positive direction. I don’t see a whole lot of challenges necessarily, compared with a couple of years ago… I really think the barriers have been reduced. I think there’s been more provider satisfaction, and patient satisfaction as a result of those activities.” —PCP

Education and communication about resource stewardship and evidence based outcomes as it pertains to CRC screening seen as helpful

 

“Just recently, we’ve actually fed back to physicians, what their colonoscopy rate was versus their colleague who has the same risk adjusted population. And, some doctors were just mortified that they were sending out twenty times more than the doctor down the hall who had patients that weren’t that different… so as an organization, we owe all of our patients a research stewardship perspective.” HP leader

  1. Check symbol indicates theme brought up by more than half the stakeholder group.