A provider feedback intervention to increase uptake of colorectal cancer screening in a Swiss academic general practice

Abstract

Colorectal cancer (CRC) cancer screening uptake is low in our diverse, outpatient teaching clinic. A state-level public screening programme was recently launched that provides faecal immunochemical tests or screening colonoscopy to all citizens aged 50-69 years via mailed invitations, with the possibility of earlier, opportunistic inclusion. Mailed outreach is expected to be rolled out over the next 5 years. In the interim, we aimed to increase CRC screening by accelerating the inclusion of patients into the programme by implementing a provider feedback programme with residents. We used billing reports to define the eligible target population and monthly lists of included patients to track progress. All residents received a standard intervention that provided basic training and communication tools facilitating shared decision making in CRC screening decisions. We then developed and implemented the intervention over 3 Plan-Do-Study-Act cycles in 2 of 4 groups of residents, each with 7 residents and approximately 250 eligible patients. The intervention consisted of individualised reports on the proportion of each resident's patients that had been included in the screening programme and the names of patients who had not yet been included. The first group that received the intervention had included 58 of 232 eligible patients (25%) at 8 months after the feedback intervention and the second group 51 of 249 eligible patients (20%) at 4 months. In comparison, the 2 groups with only the standard intervention had included 32 of 252 (13%) and 27 of 260 (10%) of their patients, respectively, at 11 months after the baseline intervention. These results suggest that provider feedback to medical residents can promote resident self-awareness and increase the proportion of patients included in a public programme when provided in addition to educational interventions.