(230) Improving the number of completed colonoscopies among eligible adults with cystic fibrosis

Background: The Cystic Fibrosis Foundation (CFF) recommends that colonoscopy be performed for all patients with Cystic Fibrosis (CF) over 39 years of age. The average lifetime risk for colorectal cancer among those without CF is approximately 4% [1], but for adults with CF, this risk is 5–10 times higher and warrants initial screening 10 years earlier, at 40 years of age and at intervals of 5 years or less thereafter. Providers for all patients recognize that it is difficult to convince patients to have a colonoscopy performed, and very difficult to coordinate scheduling and completion. By 2019, colon cancer screening of the general U.S. population > 50 years old done by colonoscopy or flexible sigmoidoscopy was 63 .1% [2]. Total colon cancer screening rates have increased over the past several years due to adoption of home test kits, but these tests are not proven valid for those with CF. The National Cancer Institute has a goal of increasing overall U.S. colon cancer screening rates to 74.4% of eligible adults by 2030 [2]. Our aim is to increase the percentage of adult CF patients >40 years old seen at the Nationwide Children’s Hospital (NCH) Adult CF Program with up-to-date colonoscopies from 43% in August 2020 to 70% by May 1, 2022.

Methods: A group consisting of a nurse, an administrative assistant, nurse practitioners, and physicians was formed, in consultation with a member of The Ohio State University gastroenterology program. Standard quality improvement techniques using the Plan Do Study Act (PDSA) cycles were used. These cycles included: pre-screening visits so that all appropriate patients were identified, tracking of patient education related to colonoscopy at 38 years of age (materials included information about need for colonoscopy, prep and adjustments for Trikafta administration, developed with a gastroenterologist), tracking of referrals placed, and, for gastroenterologists, inclusion of materials including prep and the reasons for early screening. We are instituting follow-up phone calls to both patients and gastroenterologists to assure that appointments for colonoscopy were scheduled, the procedure performed, and the results received by our program. Measurement of the percentages of patients over 40 years of age completing colonoscopies (Chart 1) was tracked monthly and plotted using a P-Chart.

Results: We provided educational discussion and printed materials to 94% of our adult patients. The completed colonoscopy rate for adult patients is now 73% (54 of 74 patients), increased from 43%.

Conclusions: The process of completing patient colonoscopies is complex with barriers beginning with patient education and acceptance and ending with receiving the report for a colonoscopy. We have demonstrated that developing a process to address all obstacles can dramatically improve the rate of completed colonoscopies.

Acknowledgements: Mitchell Ramsey, MD, The Ohio State University Division of Gastroenterology

Jenah Estep, NCH Center for Clinical Excellence

References: [1] Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022 [Internet]. CA: a cancer journal for clinicians. U.S. National Library of Medicine; 2022 [cited 2022Mar22]. Available from: https://www.doi.org 10.3322/caac.21708. Epub 2022 Jan 12. PMID:35020204.

[2] National Cancer Institute. Online Summary of Trends in U.S. Cancer Control Measures, Colorectal Cancer Screening, https://www.https://progressreport.cancer.gov/detection/colorectal_cancer; July 2021[accessed 17 March 2022]