Improving Colorectal Cancer Screening in Average-Risk Adults in Custody: Effects of Provider Education, Educational Brochure, and Reminders

In the United States (US), the incarcerated population is disproportionately overrepresented by people from lower social economic status including racial minorities, those with low education background and poor health literacy. As such, this population tends to have a high rate of chronic medical disease, mental health disorders, high rates of substance use and preventable cancer including colorectal cancer (CRC). As noted in the general population, there is also an increase in early age onset (EAO) of CRC in the justice involved individual with most professional organizations including the American Cancer Society (ACS), US Preventive Service Task Force (USPSTF) and others, adjusting the age of initial CRC screening to begin at age 45 and extend to age 75 years. Screening with a guaiac Fecal Occult Blood Test (gFOBT) decreases the incident and mortality but is underutilized in correctional facilities. To increase the uptake of CRC in a Minimal Security Facility in Southeastern (MSFS) US, we implemented an Evidence-Based Practice (EBP) strategy to increase the uptake of CRC screening to 80% using gFOBT in every community as recommended by the National Colorectal Cancer Roundtable (NCCRT). The strategies included Health Care Provider Education, Adult in Custody (AIC) education, email reminder, face to face meetings including town hall meetings, posting educational resources about CRC screening in the housing unit and in the medical unit to increase awareness for CRC screening. At project conception, baseline data indicated 116 AICs eligible for CRC screening, 58.6% (68) completed screening, 36.2% (42) needed CRC screening and 5.2% (6) refused. At project initiation, 101 AICs were eligible for CRC screening, 70.2% (71) completed screening, 22.2% (22) needed CRC screening, and 7.9% (8) refused representing an 11% increase from six months earlier. Following EBP intervention implementation, there CRC screening rate among the 101 eligible increased from 70.2% to 74%. However, no AIC among the 45-49 aged, predominantly African American and Hispanic, completed CRC screening during the project.