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Advisor: Mona Sarfaty, MD, FAAFP-Thomas Jefferson University


Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Screening is proven to be effective in reducing incidence and mortality of CRC; however screening rates remain low. While many physicians screen their patients for CRC, few practices have effective systems that guarantee that screening recommendation is delivered to every age-appropriate patient. The office context of CRC screening was explored by examining thirteen primary care practices affiliated with the Lehigh Valley Physician Hospital Organization. A survey of clinicians revealed which steps were completed when using stool blood test (SBT) and colonoscopy (CX) as screening tools. Focus groups and key informant interviews followed the survey. Practices were labeled high, medium or low based on clinicians reported completion of procedural steps by themselves or staff members for SBT and CX. Practices that completed screening steps 100% of the time and those that completed them less than 50% of the time were further analyzed using focus group discussions with staff members and key informant interviews with office managers. Five practices reported completing steps 100% of the time while two practices completed steps less than 50% of the time. Thematic analysis was used to determine which characteristics of the practices correlated with completion of steps. Two of the highest performing practices possessed a physician’s recommendation for every patient, an office policy, an office reminder system and an effective communication system. All of the high performing practices had reminder and tracking systems for screening. Two of the lowest performing practices delivered a physician’s recommendation for screening but did not utilize reminders, or effective communication systems. All of the low performing practices lacked an office policy for CRC screening and did not track whether recommendations were made and followed through. Future research will correlate completed screenings with these practice characteristics.