Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics-Clinic Support Staff

Clinic Support Staff Post-Intervention Survey

Clinical Care and Health Survey: Colorectal Cancer Screening

Clinical Support Staff Opinion and Practice Questionnaire

MCO Research Arm Name and Battelle are inviting you to participate in this study of clinical support staff at MCO Name. The CDC is collaborating with Battelle and MCO Research Arm Name, to study ways to improve colorectal cancer screening in primary care.

We know that clinical support staff are involved in many different ways in patient care and preventive service provision, including colorectal cancer screening with patients over age 50. We are interested in your training, clinical responsibilities, and opinions about screening for colorectal cancer. We are also interested in the institutional systems you use to facilitate routine screening.

Your answers are private. Collected survey data will only be reported in aggregate. We appreciate your taking the time to complete this survey. This questionnaire asks questions about your demographic and practice characteristics. It also includes sections that ask about your clinical practices and opinions regarding colorectal cancer screening. The survey was designed with input from Medical Assistants and Clinical Service Representatives like you.

Your participation in this study is voluntary. You may refuse to answer any or all questions on the survey. You are being paid $25 to compensate you for your time and effort. You will be contacted one more time in the future so we may learn more about your training, clinical responsibilities and opinions about colorectal cancer screening.

People who reviewed this survey estimated that it took between 15 and 30 minutes to complete.

We appreciate your help in improving patient care at MCO Name.

Support Staff Questionnaire

Part I: Tell us about you!

This first section asks a few questions about your personal background, your training, and your clinic.

1. What is your age? _________________

2. What is your gender?

 Male  Female

3. What is your title or position? ___________________________________ (Please specify)

4. On average, how many hours per week total do you work at your clinic?

Average number of hours ______________

5. How many physicians, physicians’ assistants or nurse practitioners do you provide support to? _______ Physicians _______ Nurse Practitioners _______ Physicians’ Assistants

6. Approximately how many patients are seen in the clinic in a typical week? ______________

7. Approximately how many of these patients are seen for health maintenance exams in a typical week? __________

8. How many other medical assistants work in your clinic? __________

9. How many nurses work in your clinic? __________

10. How long have you worked at HMO name? ____________ Years ___________ Months

11. How long have you worked at this clinic? ____________ Years ____________ Months

For the next question, your best guess is all we need. You don’t need to look at charts or records to answer this question!

12. On average, approximately what percent of the patients who come to your clinic are 50 years of age or older? __________ %

Health Maintenance Exam Responsibilities

1. Which of the following activities are you responsible for when a patient, aged 50 or older, comes in for a health maintenance exam?

Activity	Never	Sometimes	Half the Time	Usually	Always
a. Schedule health maintenance exam appointments					
b. Schedule lab visits if blood work is required					
c. Schedule follow-up or referral appointments					
d. Pull patient charts and review them					
e. Flag charts with required screening tests or discussion topics to be covered					
f. Have patient fill out an intake health questionnaire					
g. Discuss initial questions or concerns					
h. Take vital signs (height, weight, blood pressure)					
i. Answer patient questions after the physician’s exam					
j. Distribute tests or materials to patients after the exam					
k. Track lab results					
l. Track whether patients did follow-up tests or treatment					
m. Other? (specify) ________________________					

Part II: Preventive Services Opinions

1. How worthwhile do you consider each of the following preventive services for asymptomatic patients, age 50 and over, during health maintenance exams? (Check one box for each test)

Test and interval	Not at all worthwhile	Slightly worthwhile	Somewhat worthwhile	Quite worthwhile	Very worthwhile
a. Pap smear (every 3 years)					
b. Mammogram (annual)					
c. Digital rectal exam with hemoccult (annual)					
d. Fecal occult blood test (FOBT, hemoccult, or stool cards) (annual)					
e. Flexible sigmoidoscopy (every 5 years)					
f. Colonoscopy (every 10 years)					
g. Cholesterol test (annual)					
h. Prostate specific antigen (annual)					
i. Digital rectal exam to check prostate (annual)					

2. How often do you ask about the following issues with patients age 50 and over when they come in for a health maintenance exam? (Check one box for each test). If the doctor always talks to patients about that issue, check N/A.

Issues Discussed	Never	Sometimes	Half the Time	Usually	Always	N/A
a. Smoking						
b. Alcohol use						
c. Exercise or physical activity						
d. Dietary practices						
e. Stress						
f. Depression						
g. Breast cancer screening						
h. Prostate cancer screening (for men)						
i. Cervical cancer screening (for women)						
j. Colorectal cancer screening						
i. Fecal occult blood test (FOBT)						
ii. Flexible sigmoidoscopy						
iii. Colonoscopy						

3. How often do patients (age 50 and over) bring up the following issues during a health maintenance exam? (Check one box for each issue)

Issues brought up	Never	Sometimes	Half the Time	Usually	Always
a. Cholesterol or heart disease risk and screening					
b. High blood pressure risk and screening					
c. Diabetes risk and screening					
d. Breast cancer risk and screening (for women)					
e. Cervical cancer risk and screening (for women)					
f. Prostate cancer screening (for men)					
g. Colorectal cancer screening					

The remainder of this survey is about colorectal cancer screening. We are interested in your opinions and practices about screening patients age 50 and over who are asymptomatic and are coming to your clinic for a health maintenance exam.

When we say FOBT we mean the fecal occult blood test home kit (hemmoccult, stool, or guiac cards) that patients take home and complete.

Part III: Colorectal Cancer Screening: Your Training and Experience

1. In the past year, have you received specific training on how to discuss colorectal cancer screening with patients who visit your clinic?

 Yes  No

2. Among the last 10 patients aged 50 and older who came to your office for a health maintenance exam, for approximately how many did you:

Please write “0” if you did not give the test to any of the 10 patients.

Distribute Fecal occult blood test (FOBT) kits _______

Assist with scheduling a Flexible sigmoidoscopy _______

Assist with scheduling a Colonoscopy _______

3. At your clinic, who is responsible for:

	Doctor	Nurse	Medical Assistant	Patient
a. Handing out the FOBT cards?			
b. Patient instructions for the FOBT cards?			
c. Tracking the return of the lab results from the FOBT cards?			
d. Reporting negative lab results from the FOBT cards to the patient?			
e. Reporting positive lab results from the FOBT cards to the patient?			
f. Making screening Flexible Sigmoidscopy appointments?				
g. Patient instructions for the Flexible Sigmoidscopy?			
h. Tracking the screening Flexible Sigmoidscopy appointments?				
i. Tracking the results from the screening Flexible Sigmoidscopy appointments?			
j. Discussing results of the screening Flexible Sigmoidscopy with the patient?			
k. Making screening Colonoscopy appointments?				
l. Patient instructions for the Colonoscopy?			
m. Tracking the screening Colonoscopy appointments?				
n. Tracking the results from the screening Colonoscopy appointments?			
o. Discussing results of the screening Colonoscopy with the patient?			

Part IV: Colorectal Cancer Screening Practices

Answer the questions in this section thinking about patients age 50 years and over who are asymptomatic, and are coming to your clinic for a health maintenance exam.

For each statement below, please check how often you take each of the following actions when patients come to the clinic for health maintenance exams.

	Never	Sometimes	Half the time	Usually	Always
a. Reminding the physician which screening tests the patient is due for.					
b. Printing out a computer summary for each patient and including it in the chart before the visit.					
c. Distributing a questionnaire or intake form that includes questions about colorectal cancer screening and risk.					
d. Distributing FOBT kits to patients over age 50.					
e. Distributing FOBT kits when the physician asks you to.					
f. Helping patients schedule appointments for screening flexible sigmoidoscopy.					
g. Helping patients schedule appointments for screening colonoscopy.					
h. Explaining to patients how to complete the FOBT kit.					
i. Explaining the preparation for Flexible sigmoidoscopy or Colonoscopy and what they can expect during the test.					
j. Answering patients’ questions about the FOBT kit.					
k. Answering patients’ questions about Flexible Sigmoidoscopy and Colonoscopy.					
l. Other, (specify)._____________________					

Part V: Opinions about CRC Screening

For each statement below, please check () the box that best represents your opinion.

1. Discussing colorectal cancer screening with patients aged 50 and older would:	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
a. take too much of my time and effort					
b. be higher priority with male patients					
c. be low priority in the average health maintenance exam					
d. reassure patients					
e. give me an opportunity to provide reliable information and educate patients					
f. be a topic that patients do not want to talk about					
g. cause patients to feel uncomfortable or embarrassed					
h. be something that I feel prepared to discuss					
i. be something that the doctor should cover with the patients					
j. distract from other patient needs					

2. Distributing screening fecal occult blood tests (FOBT) to patients aged 50 and older is:	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
a. a practice standard					
b. easy to do					
c. a low risk test for patients					
d. difficult due to cultural or language barriers					
e. an opportunity for education about CRC screening					
f. a method to increase patient’s role in own health care					
g. cost effective					
h. difficult due to time constraints					
i. something I feel prepared to do					
j. something the doctor should do					
k. other, (specify)_________________					

3. Having patients aged 50 and older complete screening fecal occult blood test (FOBT) kits at home would:	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
a. be convenient for patients					
b. be a way to find CRC at an early stage					
c. be effective in decreasing mortality					
d. result in patients doing it wrong					
e. result in patients not returning cards					
f. be distasteful for patients					
g. be difficult for patients					
h. worry the patients because of false positive results					
i. produce inaccurate results					
j. other, (specify)_________________					

4. Having patients aged 50 and older complete screening flexible sigmoidoscopy would:	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
a. find colorectal cancer at early stage					
b. be cost-effective					
c. reassure patients					
d. take too much of my time and effort to answer patient questions					
e. take too much time for patients					
f. miss a large part of the colon					
g. be effective in decreasing mortality					
h. be difficult/unpleasant for patients to prepare for					
i. be inconvenient for patients					
j. expose patients to significant risk of complications					
k. be something that patients would refuse to do					
l. be something that I feel prepared to discuss					
m. result in a long wait time for an appointment					
n. other, (specify)_________________					

5. Having patients aged 50 and older complete screening colonoscopy would:	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
a. be appropriate only for high-risk patients					
b. be appropriate only as follow-up to other tests					
c. find colorectal cancer at an early stage					
d. reassure patients					
e. be preferred by most patients					
f. be the best test we can provide					
g. view the entire colon					
h. be effective in decreasing mortality					
i. take too much time for patients					
j. be difficult/unpleasant for patients to prepare for					
k. be inconvenient for patients					
l. expose patients to significant risk of complications					
m. be expensive for the patient					
n. be cost-effective					
o. take too much of my time and effort to talk about					
p. be something that patients would refuse to do					
q. be something that I feel prepared to discuss					
r. result in a long wait time for an appointment					
s. other, (specify)_________________					

Part VI. Facilitators and Barriers to CRC Screening

We are interested in how various factors affect the difficulty or ease of colorectal cancer screening.

1. Do you use any of the following methods to remind the doctor or patients when the patient is due to be screened for colorectal cancer? (Check the appropriate response for each item)

	Yes	No
a. Flow charts, “tickler files,” or prompts to remind the doctor if patients are due for a CRC screening via an FOBT		
b. Flow charts, “tickler files,” or prompts to remind the doctor if patients are due for a CRC screening via a flexible sigmoidoscopy		
c. Flow charts, “tickler files,” or prompts to remind the doctor if patients are due for a CRC screening via a colonoscopy		
d. Computerized printouts of patients’ status on screening tests		
e. Reminder phone calls to patient		
f. Reminder cards by mail to patient		
g. Materials (e.g., handouts) or programs to educate patients		
h. Other (Please specify) _______________________		

2. On average, how long does it take for an asypmtomatic, average risk patient, aged 50 years or older, in your health care system to:

Get lab results to an Fecal occult blood test (FOBT) ____________________________

Get a Flexible sigmoidoscopy appointment ___________________________

Get a Colonoscopy appointment ____________________________

Get a Double contrast barium enema appointment ____________________________

3. How adequate do you find each of the following at your facility to support CRC screening? Using the scales below, please mark your opinion.

	Not available	Not at all adequate				Very adequate
a. A summary record of the patient’s screening tests (e.g., stable events summary)						
b. A computer-generated prompt or flag to remind you when a patient is due for a screening test						
c. A medical assistant generated prompt or flag to remind the doctor when a patient is due for a screening test						
d. Tracking system to follow-up patients after referral to a flexible sigmoidoscopy appointment						
e. Tracking system to follow-up patients after referral to a colonoscopy appointment						
f. A patient reminder or recall system						
g. Materials (e.g., handouts) to educate patients about CRC screening						
h. Materials about CRC screening in languages other than English						
i. A convenient ordering, appointment, or referral system for flexible sigmoidoscopy						
j. A convenient ordering, appointment, or referral system for colonoscopy						
k. Staff trained to do patient education about FOBT (hemoccult) cards						
l. Staff to make patient appointments for flexible sigmoidoscopy and colonoscopy						
m. Reminder system for patient appointments for flexible sigmoidoscopy and colonoscopy						
n. Staff trained to do patient education about flexible sigmoidoscopy and colonoscopy preparation						
o. Facilities to perform colonoscopy in your health system						
p. Availability of FOBT kits (Hemoccult cards)						
q. Availability of timely flexible sigmoidoscopy appointments						
r. Availability of timely colonoscopy appointments						

Part VII. Support for CRC Screening

1. Conducting colorectal cancer screening with asymptomatic patients over 50 years of age who come to the clinic for a general health maintenance exam is something that:
	Strongly Encourage	Encourage	Neither Encourage nor Discourage	Discourage	Strongly Discourage
a. Patients generally					
b. The doctor I work with generally					
c. Doctors in my clinic generally					
d. Governmental health organizations (e.g., CDC, NIH, Public Health Departments)					
e. Voluntary and non-profit health organizations (e.g., ACS)					
f. US Preventive Services Task Force and other independent working groups					
g. Health insurance policies					
h. Medicare coverage policies					
i. The popular media (TV, radio, magazines)					
j. My MCO policies					

Part VIII. Satisfaction with CRC Training, Materials and Reminders

For each statement below, please check () the box that best represents your opinion.

1. Information, Training and Reminders:
	Strongly Disagree	Disagree	Neither	Agree	Strongly Agree
a. I have adequate information about colorectal cancer screening.					
b. I have the latest information about colorectal cancer screening guidelines.					
c. I have the skills I need to address colorectal cancer screening with patients.					
d. I feel prepared to answer patient questions about colorectal cancer screening.					
e. I have had trouble keeping up with flagging charts for physicians.					
f. My clinic has seen an increased volume of consulting nurse phone calls about colorectal cancer screening.					
g. Colorectal cancer screening distracts me from my other duties.					

2. CRC Screening Materials:
The materials that we currently use in our practice:	Strongly Disagree	Disagree	Neither	Agree	Strongly Agree
a. Are helpful tools for our clinic.					
b. Are easy for patients to understand.					
c. Have been well received by patients.					
d. Helped me gain new skills for talking about colorectal cancer screening with patients.					
e. Helped me feel more able to answer patient questions about colorectal cancer screening.					

The End

Thank you very much for completing your survey

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