1. What are the recent trends in the use and quality of colorectal cancer screening?

• Demographic: Age, gender, ethnicity, race, language, literacy, socioeconomic status (SES), education, culture.
• Type of tests: colonoscopy, sigmoidoscope, computed tomography (CT) colonography, stool tests (DNA stool, fecal immunochemical testing [FIT], fecal occult blood test using guaiac [gFOBT]).
• Geographic areas, State.
• Health insurance.
• Health systems.
• Provider characteristics by specialty training, age, experience.
• Exclusions: familial adenomatous polyposis (FAP), hereditary nonpolyposis colorectal cancer (HNPCC), ulcerative colitis (UC), Crohns, other hereditary polyposis syndromes.
• Quality: Office or home FOBT.
• Too frequent screening or surveillance/overutilization.

2. What factors influence the use of colorectal cancer screening?

• By:
  • Providers.
  • Individuals.
• Perceived effectiveness.
• Guideline recommendations.
• Insurance coverage.
• Cost to patient (out of pocket).
• Marital status-someone to go with you.
• Provider reimbursement.
• Invasiveness, complexity, amount of patient time/effort.
• Physical and psychological comfort.
• Social networks.
• Changes over time.
• Profitability.
• Other health behaviors.
• Provider characteristics, age, or years since med school graduation.
• Access and capacity.
• Number of specialists per population.
• Media coverage.
• Provider recommendation.
• Perceived risk.
• Knowledge.
• Comorbidities.

3. Which strategies are effective in increasing the appropriate use of colorectal cancer screening and followup?

• Appropriate means.
• Includes repeat screening.
• Any recommended test (screened/not screened) excluding in-office digital rectal examination (DRE) and FOBT.
• Strategies.
• Informed decision making.
• Popular media.
• Reminder systems: provider and patient.
• Financial incentives (Reimbursement policies, patient copayment, pay for performance).
• Patient navigators (staffing and rearrangements).
• Increase in capacity.
• Governmental.
• Use of technology in monitoring.
• Appropriate use.
• Differential levels of benefit.
• At what levels.
• Patient.
• Provider.
• Health system.
• Community.

4. What are the current and projected capacities to deliver colorectal cancer screening and surveillance at the population level?

• Endoscopy.
• Sigmoidoscopy.
• Colonoscopy.
• CT colonography or virtual colonoscopy.
• Scalability, speaker to cover.
• Future demand, speaker to cover.
• Tracking Systems (Surveillance).
• Coordination (tracking systems).
• Communication (tracking systems).
• Referral backlog.
• Trained workforce.
• Geographic distribution, urban/rural, urban/inner city.

5. What are the effective approaches for monitoring the use and quality of colorectal cancer screening?

• Levels.
• Practice.
• Program.
• Population.
• What kinds of monitoring.
• Healthcare Effectiveness Data and Information Set (HEDIS) measures.
• Primary care practices.
• Quality control by objective methods.
• Detection rates.