Evaluation of the Federal Bureau of Prisons’ Colorectal Cancer Screening Practices for Inmates and Its Clinical Follow-up on Screenings

Evaluate the colorectal cancer screening practices of the 40 facilities that are meeting the sustained, demonstrated, or developed colorectal cancer screening performance levels and use that assessment to identify any best practices that may be effective BOP-wide.

Require each BOP facility to develop a written plan for consistent colorectal cancer screening that details: how the facility will identify the average-risk population; the screening process, to include timeframes; assigned employee responsibilities; and plans for providing colorectal cancer screening education to inmates. Each facility's evaluation should take into account staffing challenges and the other factors identified in this report that contribute to the BOP's failure to consistently offer colorectal cancer screening, as well as any best practices identified during the BOP's evaluation of the 40 facilities referenced in the report.

Establish a process for the Central or Regional Offices to periodically review the facilities' written colorectal cancer screening and education plans and to work with the facilities to make changes to the plans that address new and ongoing factors that affect the ability to consistently provide screening.

Transition to using the fecal immunochemical test as the primary stool-based screening method for colorectal cancer.

Update the Preventive Health Care Screening Clinical Guidance and National Performance Measures to match the age range described in the U.S. Preventive Services Task Force and American Cancer Society recommendations on preventive colorectal cancer screening.

Require facilities to review positive fecal immunochemical test and guaiac fecal occult blood test results from the past 12 months to determine whether appropriate follow-up on positive test results occurred in all cases, and develop an after-action plan to correct deficiencies, which could include developing standardized guidance and training to ensure that appropriate follow-up occurs and is properly documented, as needed.

Consider strategies and practices to eliminate the need for off-site pre-colonoscopy evaluations at each facility.

Develop and distribute best practices for facilities to establish relationships with external medical providers in the community.

Implement a reliable, consistent process throughout all BOP facilities to monitor and analyze wait times for outside inmate appointments and the causes for canceled or rescheduled appointments in order to ensure that inmates receive timely medical care.

Develop and distribute guidance on how to consistently input International Classification of Diseases-10 codes for colorectal cancer increased-risk factors within the Bureau Electronic Medical Records System so they can more completely and accurately identify inmates at increased risk for colorectal cancer.

Following completion of Recommendation 10, ensure that increased-risk inmates are properly categorized in the increased-risk roster within the Colorectal Cancer Screening Dashboard based on their specific risk factor(s) (e.g., family history).

Institute or append to the current peer review process for Clinical Directors and other BOP physicians who directly supervise clinical employees, as appropriate, an evaluation of the management of inmates at increased risk for colorectal cancer.

Standardize the process for ordering, or otherwise documenting within the Bureau Electronic Medical Records System, when a future screening is required for inmates at increased risk for colorectal cancer.