Graduation Semester and Year
Spring 2026
Language
English
Document Type
DNP Project
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Dr. Kirsten Drake
Second Advisor
Dr. Yungfei Kao
Abstract
Background
As the second leading cause of cancer-related deaths in the United States, colorectal cancer (CRC) is a prevalent but highly preventable form of cancer (American Cancer Society National Colorectal Cancer Roundtable [ACSNCCR], 2026; Maratt et al., 2024). Screening for CRC is fundamental to prevention and early detection. Despite advances in screening measures, CRC screenings remain suboptimal (Tonini & Zanni, 2024). In the US, more than one in three adults 45 years or older are not screened as recommended (ACSNCCR, 2026).
Purpose
As a safety-net county health network primarily serving the under-resourced population, the organization is uniquely positioned to impact CRC incidence and mortality rates. However, in Fall 2024, only 312 of the 820 patients due or overdue for CRC screening with fecal occult blood by immunoassay ordered in the organization’s ambulatory clinic had the recommended CRC screening test completed (personal communication, May 29, 2025). With a CRC screening rate of 38.05%, well below the national, state, and county average, interventions to improve CRC screening adherence were warranted.
Methods
A Quality Improvement (QI) Plan-Do-Study-Act (PDSA) framework was used to implement the intervention bundle to improve CRC screening adherence. The CRC screening adherence intervention bundle included patient education on CRC and Fecal Immunochemical Test (FIT) kits, patient navigation with reminders for FIT kit returns, and EMR reporting and tracking of CRC screening orders and completions.
Results
The chi-square test comparing the fecal occult blood by immunoassay order completion and incompletion rates at baseline and post intervention bundle implementation showed a non-significant result: X2(1, n=867) = 3.172, p=.075. However, a 51.06% screening completion rate was achieved post intervention in comparison to the baseline of just 38%.
Conclusion/ Implications for Practice
Evidence-based interventions implemented strategically can increase CRC screening completion rates in patients especially living in under-resourced communities. Heightened staff awareness and patient education, in addition to technology leveraging for order status tracking and patient navigation are a few supportive measures to help raise the CRC screening rates, meet the national standards, and improve patient morbidity and mortality.
Keywords
Colorectal cancer, Colorectal cancer screening, Colorectal cancer screening barriers, Colorectal cancer education, FIT kit, FIT kit return, Colorectal cancer screening adherence, Reminder calls, Patient care navigation
Disciplines
Community Health and Preventive Medicine | Oncology | Preventive Medicine | Primary Care | Public Health and Community Nursing
License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Recommended Citation
Abraham, Albin, "Improving Colorectal Cancer Screening Adherence" (2026). Doctor of Nursing Practice (DNP) Scholarly Projects-Archive. 136.
https://mavmatrix.uta.edu/nursing_dnpprojects/136
Included in
Community Health and Preventive Medicine Commons, Oncology Commons, Preventive Medicine Commons, Primary Care Commons, Public Health and Community Nursing Commons
Comments
Grateful to the UTA faculty team, and the organizational leaders, staff, and patients.