Use a Multidisciplinary Team in Conjunction With Office Policies and Standing Orders

An alternate approach to the physician assuming sole responsibility for screening recommendations during an annual check-up is to involve the office staff in making cancer screening recommendations to every appropriate patient at all office visits. An office staff that collaborates as a multidisciplinary team with the physician can be a more effective and efficient way of managing the care of patients in the practice. This approach involves creating an office culture that promotes involvement of the office staff in caring for patients, delegating roles and responsibilities to selected members of the staff, and providing training and support to staff as they take on new responsibilities. The extent of the responsibilities that staff in the office will ultimately assume will vary and should be introduced gradually. Some suggested additional staff assignments are:

  • Have the receptionist give the patient a questionnaire to provide information on risk factors and screening history when patient presents to the waiting room
  • Have a staff member ask the patient about family history and previous screenings when taking vital signs prior to physician exam
  • Assign a staff person who will check the screening status of the patient before the patient leaves the office
  • Have the patient fill out a reminder card at checkout and file it by the month and year of the planned notifications for the next screening test
  • Assign staff to send reminders to the patient as per the planned notification
  • Arrange for staff to contact patient by phone or E-mail at a specified time frames when they are due for CRC screening


Key Points for Using a Multidisciplinary Team in Conjunction With Office Policies and Standing Orders

The office policy for CRC screening needs to be very clear. Since the approach to screening differs based on risk category, it will probably be more understandable if visually presented in the form of an algorithm or flow chart. Many of these resources can be found in How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Care Clinician's Evidence-Based Toolbox and Guide.

  • The staff must be formally instructed on implementing the policy by educating the staff on both the clinical aspects of the policy and how it should be implemented. An effective presentation of the policy to the staff is critical for its success
  • Since risk determination (average, increased, or high) is the first step, the staff must be provided with a questionnaire for the patient to complete that will provide information on risk status
  • The policy (algorithm or flow chart) should be posted where the staff have ready access to it
  • Assign responsibilities for each step of the policy. Get buy-in from the staff for their expanded roles
  • Use standing orders to empower medical staff to dispense FOBT cards and to provide instructions for use, and/or to make referrals to a specialist for a flexible sigmoidoscopy or colonoscopy
  • Monitor the success of the office policy after implementation. Share the results. If the policy is not achieving its desired outcome, identify reasons so changes can be made (e.g., revise policy, re-educate staff, reassign staff)
  • Empower the office staff to make suggestions for improvement
  • Provide incentives to staff to assume additional roles, including non-financial incentives, such as recognition and status. Make participation in the cancer screening effort part of the annual evaluation for assigned staff