Outcomes associated with use of the Cancer Risk Intake System among primary care safety-net patients identified as needing colorectal cancer screening

Celette Sugg Skinner, Chul Ahn, Amit G. Singal, Rasmi G. Nair, Ethan A. Halm, Wendy Pechero, Katharine McCallister, Joanne M. Sanders, David Farrell, Noel Santini

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Despite demonstrated primary and secondary prevention benefits, screening for colorectal cancer (CRC) is sub-optimal. We implemented the Cancer Risk Intake System (CRIS) among a convenience sample of patients presenting for primary care in Dallas County safety-net clinics. CRIS, which assesses individuals’ CRC risks and generates guideline-based screening recommendations for them and their providers, had been found in a randomized trial to facilitate risk-based screening, compared to usual care. Here, of 924 patients ages ≥50 who used CRIS, 699 were identified as needing screening, with 39.2% needing colonoscopy rather than FIT. However, following use of CRIS and patients’ and providers’ receipt of guideline-concordant recommendations, 20.9% elevated-risk patients received no screening orders, only 44.1% received guideline-concordant colonoscopy orders, and less than half of these (48.4%) completed colonoscopy. Guideline-concordant screening orders were more common for average-risk patients (62.5% received orders for FIT and 26.6% for colonoscopy). However, like their elevated-risk counterparts who received screening orders, more than half of average-risk patients in each order group (52.3% for FIT and 52.8% for colonoscopy) did not complete screening. We found no correlates for receiving screening orders, but higher comorbidity scores were associated with less screening completion among the average-risk group. We had hoped CRIS would facilitate risk-based screening but, although orders for and receipt of colonoscopy were more common for elevated- than average-risk patients, they were still suboptimal in this clinical setting with a “FIT-first” strategy. A stronger intervention may be necessary to increase guideline-concordant recommendations and screening among patients 50 and older.

Original languageEnglish (US)
Article number101003
JournalPreventive Medicine Reports
StatePublished - Dec 2019


  • Colorectal cancer screening
  • Primary care
  • Tailored

ASJC Scopus subject areas

  • Health Informatics
  • Public Health, Environmental and Occupational Health


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