Abstract B75: Referral and completion rates for colorectal cancer screening with fecal immunochemical test (FIT) in a medical home for underserved populations
Authors: Dobra Sarah , Aliffi Krista , Bond Sandra 
Published: May 2015

Abstract
This study assessed the referral and completion rates of colorectal cancer screening with fecal immunochemical test (FIT) in a primary care medical home serving an underserved population.
The Good Samaritan Clinic (Clinic) provides medical care to over 600 uninsured clients annually and is staffed by volunteer health care providers (Providers). All clients have an income at or below 200 % of the Federal Poverty Line; 63.8 % are Latino or Hispanic, 22.3 % are non-Hispanic Caucasians, and 10.1 % are African American. Acute client care for co-morbidities such as hypertension and uncontrolled diabetes is often the focus of clinical visits, thus limiting health promotion referrals, including routine cancer screenings. To promote evidence-based recommended cancer screenings the Clinic and the Lewis Cancer & Research Pavilion utilized guidelines from the American Cancer Society, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network to create a Cancer Assessment Tool (CAT) with age and sex appropriate screenings for breast, cervical, prostate, colorectal, and head and neck cancers.
This cancer screening intervention was implemented in March 2013. During clinic visits, Providers used the CAT to review age and sex recommended cancer screenings and then, based on the CAT, referred clients as indicated. For example, if colorectal cancer screening was indicated based on age or family history, the CAT prompted the Provider to give the client a FIT to take home and to also counsel the client on how to collect the sample and return the test. No other interventions to promote FIT referral, FIT completion, or other colorectal screening methods were implemented during this time.
To evaluate Provider FIT referrals and client FIT return compliance, data on CAT implementation was collected from March 28 – July 31, 2013. Measurements collected included the number of clients eligible for age-appropriate colorectal cancer screening; the number of clients with whom the CAT was completed; the number of clients given FIT; the number of FIT returned; and the number of positive FIT.
Providers utilized the CAT to consider screening for colorectal cancer based on age and family history with 25.5 % (110) of the 431 total clients seen at the Clinic during this time period. Review of medical records indicate that 34.8 % (150) of total clients met age only criteria (over age 50) for colorectal cancer screening. Of the 150 total age-eligible clients (not considering additional clients with family history), 44.7 % (67) were referred for colorectal screening and were given a take-home FIT. Of the 67 clients given a FIT, 53.7 % (36) returned the results, resulting in a FIT completion rate of 24 % of all 150 age-eligible clients. 100 % (36) of FIT exams returned were negative.
FIT drop-off occurred at both the provider referral level (55.3 % non-referral rate) and the client completion level (46.3 % non-completion rate). Based on these drop-off points several provider and client-based interventions recommended by the Guide to Community Preventive Services (Community Guide) may support improved colorectal cancer screening completion. First, strengthening provider-based interventions such as provider feedback and reminder systems so that the CAT is utilized for all client visits may support increased referral for FIT screening. Second, client-based interventions such as one-on-one education, client reminders such as follow-up phone calls, and reducing structural barriers such as putting postage stamps on the FIT may support client compliance to complete and return the FIT. Potential exists to conduct similar analysis of the CAT with breast, cervical, prostate, and head and neck cancers.
Citation Format: Sarah Dobra, Krista Aliffi, Sandra Bond. Referral and completion rates for colorectal cancer screening with fecal immunochemical test (FIT) in a medical home for underserved populations. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B75. doi:10.1158/1538-7755.DISP13-B75