The Results of Implementing Colorectal Cancer Screening Access Guidelines for High-Risk Populations Through Participatory Networks at Udon Thani Hospital Primary Care Units

Abstract

This quasi-experimental research aimed to evaluate the effectiveness of an accessibility enhancement protocol for colorectal cancer screening among at-risk populations through a community-based network approach at the primary healthcare unit of Udon Thani hospital. The study was conducted in collaboration with the local health network and primary healthcare services under systems theory and integrated with nursing process, implementing a newly developed protocol designed to improve timely access to colonoscopy. The protocol streamlined the hospital service processes, reducing the previous three-step hospital visit requirement to a two-step process by allowing blood sample collection at subdistrict health-promoting hospitals (SHPHs) instead of requiring travel to Udon Thani hospital. This modification increased convenience, reduced barriers; reducing the burden of traveling to Udon Thani hospital by allowing patients to receive services closer to home, which also shortens the service time and improved screening accessibility for at-risk populations.The study assessed the results of the protocol by comparing the colorectal cancer screening rate using the fecal immunochemical test (FIT test) and the colonoscopy uptake rate among individuals with positive FIT test results before and after implementation. The sample consisted of (1) 31 primary healthcare staffs and 3 hospital staffs and (2) 470 at-risk individuals aged 50–70 years old. Sample size estimation was conducted using the proportional comparison formula and calculations were performed using the n4studies application. Participants were selected through purposive sampling under responsibility of Moomon Subdistrict Health-Promoting Hospital. Data collection was performed using structured questionnaires with content validity was assessed by three expert reviewers, yielding (IOC) ranging from 0.67 to 1.00. The study was conducted on Thai fiscal year 2024 (October 2023 to September 2024). Quantitative data analysis using descriptive statistics, chi-square and independent T-test.

Results showed that among the 470 at-risk individuals, 100% underwent colorectal cancer screening using the fecal immunochemical test (FIT test). Among 28 persons those with positive FIT test results, the colonoscopy uptake rate were 50.00% increased from fiscal year 2023 (18.64%) with statistically significant difference (p = 0.003). These findings indicate that the newly implemented protocol effectively enhanced screening accessibility and significantly reduced waiting time in colonoscopy uptake among at-risk individuals.

Conclusion: the implementation of colorectal cancer screening access guidelines successfully increased the colonoscopy uptake rate among high-risk populations who had positive FIT test results from 18.64% to 50.00%. This improvement was achieved through the participation of primary care networks in providing blood collection services to high-risk individuals in their local areas, which effectively streamlined the process to two steps.