Document Type
DNP Project
Publication Date
2026
Degree Name
Doctor of Nursing Practice
Faculty Advisor
Constance Glenn, DNP, MSN, APRN, FNP-BC, CNE
Abstract
Background
Colorectal cancer (CRC) remains a leading cause of cancer-related morbidity and mortality, with disproportionately low screening rates among underserved populations. Barriers such as limited access to colonoscopy, transportation challenges, and low health literacy contribute to persistent screening gaps. Evidence supports home-based stool testing as an effective and accessible alternative for average-risk patients.
Project Goals
This quality improvement project aimed to increase CRC screening completion rates among average-risk adults aged 45-75 at a Federally Qualified Health Center by implementing an “at-home-first” screening approach using fecal immunochemical test (FIT) or stool DNA (Cologuard®) kits over 12 weeks.
Methods
This project utilized the Institute for Healthcare Improvement Model for Improvement and Plan-Do-Study-Act (PDSA) cycles to implement a workflow prioritizing on-site distribution of home-based screening kits, supported by staff education, patient education, and follow-up reminders. Eligible patients were identified through electronic health record care gaps and offered screening during clinical encounters. Outcomes were compared between baseline and implementation periods using descriptive analysis.
Results
Implementation resulted in increased on-site distribution and return of home-based screening kits, with a corresponding reduction in reliance on external orders and colonoscopy referrals for average-risk patients. On-site kit return rates improved from 34% to 46%, indicating clinically meaningful improvement despite the short implementation period. Two positive results were identified, and both patients received timely colonoscopy or gastroenterology follow-up referrals.
Conclusion
An “at-home-first” CRC screening approach improved access and participation in screening within an underserved population. Integration into existing workflows and team-based care supported implementation success. Although the target screening rate was not fully met, clinically meaningful improvements were observed, supporting the effectiveness of patient-centered, noninvasive screening strategies in reducing disparities in preventive care.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Recommended Citation
Beltz, A. I. (2026). Improving colorectal cancer screening rates in underserved adults in primary care at a federally qualified health care center using an “at-home” screening approach: An evidence-based quality improvement project [Unpublished DNP project]. Sacred Heart University.
Comments
A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.