Successful applicants to the ASGE Endoscopy Unit Recognition Program submit a summary of a recently conducted quality improvement (QI) project as part of the application process. The quality assurance and performance improvement (QAPI) project in the spotlight this month looked at improving adherence to the 2017 Multi-Society Task Force on Colorectal Cancer screening recommendations for first-degree relatives of patients with an advanced adenoma.
Define
In 2017, the Multi-Society Task Force on Colorectal Cancer recommended that an individual with a first-degree relative with an advanced adenoma or colorectal cancer should begin screening at the age of 40 years. An advanced adenoma is defined as an adenoma that is at least 10 mm in size or has significant villous component or high-grade dysplasia. While recommendations for familial screening may be discussed with patients diagnosed with colon cancer by their oncologists, it is infrequently communicated to patients in whom an advanced adenoma is removed. In our unit, there was no formal or systematic approach to disseminating this recommendation to patients with an advanced adenoma.
Aim
The aim of this QI project is to notify at least 90 percent of patients with a colonic advanced adenoma removed during colonoscopy at our facility of the recommendations for early screening of first-degree relatives for colon cancer.
Methods
A retrospective review of our pathology letters confirmed that there was no formal recommendation for familial screening when patients had an advanced adenoma removed. This pathology letter is prepared by one health care provider, a GI APRN, C.M. With consensus from endoscopists, the following language was added to the biopsy results report letter when an advanced adenoma was removed: "Because one (or more) of your polyps was an advanced polyp (large in size), we recommend that your first-degree relatives (siblings & children & parents) begin colon cancer screening at age 40; or if over age 40 then as soon as possible." Some patients were informed via in-person or a telephone call with the same instructions and documentation in their charts.
Results
A review of the formal GI pathology result-letter template confirmed no recommendation for familial screening when advanced adenoma was detected. All endoscopists agreed with including the 2017 Multi-Society Task Force recommendations in pathology letters sent to patients. The intervention was initiated on June 1, 2023. Since then, 127 patients have had advanced adenomas removed and all received notification, including 92 letters, 32 phone calls and three in-person visits. Less than five patients expressed concern about receiving this advanced polyp information, and over 20 percent expressed that they felt the GI staff really cared about them and their families to provide the recommendation.
Conclusion
A simple modification of the GI result-letter template and provider education resulted in 100 percent adherence to notifying patients about the 2017 Multi-Society Task Force on Colorectal Cancer screening recommendation that individuals with a first-degree relative with an advanced adenoma should begin screening at the age of 40 years.
We hope sharing this project summary will be useful to you and your practice. Learn more about gaining honoree status in the ASGE Endoscopy Unit Recognition Program. EURP honoree units may use the ASGE Quality Star logo in promotion of their units, receive premium educational content via an exclusive e-newsletter The Huddle, and enjoy a range of additional benefits. Questions should be directed to eurp@asge.org.