Mapping colorectal cancer screening workflows in primary care.

Introduction: Colorectal cancer (CRC) is preventable and treatable when detected early, but mortality from the disease remains high due to low uptake of preventive screening. Primary care plays a crucial role in CRC screening, but still often falls short of screening targets. We sought to map the CRC screening workflows of primary care clinics to describe how preventive CRC screening for normal risk patients is conducted, and how these workflows differ across clinic types. Methods: Eight primary care clinics were recruited with 'high' or 'low' rates of CRC screening. Clinicians and staff from each clinic were interviewed about their CRC screening workflow. Workflow maps were created based on individual interview responses, then reviewed and revised in collaboration with each clinic. Interview data and resulting workflow maps were evaluated for similarities and differences across clinic characteristics. Results: CRC screening rates ranged from 54.5% to 90% across the eight clinics. Clinics shared similarities in how they identified patients eligible for CRC screening, how they communicated the need for screening, the types of screening tests offered and how they communicated test results. Clinics with higher rates of CRC screening particularly described more communication of screening need, more emphasis on screening during the clinical conversation and workflow processes to follow up on missing results. Conclusions: The CRC screening workflows described by clinics shared common pathway stages, but variation in how these stages were executed indicates the benefit of patient decision tools, clinical communication strategies, patient navigation and results tracking to increase CRC screening uptake.