Thank you all for joining us today. My name is Francesca Daniels and I'm a public relations and marketing manager for the American Association of Medical Assistance, and I'll be the moderator for this panel discussion. We'd like to begin by acknowledging our funding source for this event. The double AMA received a 2021 80% in every community National Achievement Award for developing initiatives that support the goal of achieving colorectal cancer screening rates of 80% and higher. We thank the American Cancer Society and the National Colorectal Cancer Roundtable for hosting the award and funding this event. The American Association of Medical Assistance is a proud partner to the National Colorectal Cancer Roundtable. Joining us today, we have the American Association of Medical Assistance CEO and legal counsel, Donald Abeleza, double AMA Vice Speaker of the House and certified medical assistant Amy Wicker, co-director of the National Colorectal Cancer Roundtable and National Coalition co-founded by the American Cancer Society and the Center for Disease Control and Prevention, Emily Bell, assistant professor and section chief of colon and rectal surgery in the Department of Surgery at the University of Texas Medical Branch, UTMB in Galveston, Texas, Uma Fatak, and colorectal cancer advocate and founder of Race for Hope, Carleen Taylor. We thank you for joining us today to discuss the barriers to colorectal cancer screening tests and the role medical assistance play in improving screening rates. So how's everyone doing today? Good. Great. To start off, I'd like each panelist to introduce themselves, talk a little bit about your work history and give a brief background to your involvement with colorectal cancer. Donald, you can begin. Thank you, Francesca. My name is Donald Abeleza. I am the CEO and legal counsel of the American Association of Medical Assistants. I've been with the association since 1990. Prior to that, I was on staff with the American Dental Assistance Association and I am committed to this cause of fighting colorectal cancer. And we really think it's an honor that the AAMA can partner with the NCCRT and the American Cancer Society. Perfect. Amy, you're up next. Sure. Hi, I'm Amy Wicker, CMA AAMA. I am currently the vice speaker of the House for the AAMA Board of Trustees. And then I am also the network manager of ambulatory quality for Kettering Health in Ohio, which is a large CIN that has employed practices as well as independent practices that I currently work with them on all their preventative care measures and value based contracts. I have worked in ambulatory practices for 20 plus years in different practices. And then in the last eight years, I've moved into the quality realm and population health, working on preventative screenings and care gaps. Great. And next, we have Emily Bell. Hi, everyone. Thank you for having me. Hi, everyone. Thank you so much for inviting me to be here. It's really an honor and I've really enjoyed my partnership with the AAMA. So I co-direct the National Colorectal Cancer Roundtable, one of the American Cancer Society's six national cancer focused roundtables. And I've been working with the NCCRT for seven years. Before that, I worked on a CDC funded project to increase colorectal cancer screening in federally qualified health centers in Washington state. And while I've been at this work for over 10 years now, my passion and drive for saving lives from colorectal cancer is as strong as ever. We have so many opportunities to impact lives and so many incredible leaders and leadership around the country to partner in this work. And next, we have Dr. Uma Phatak. Thank you so much for inviting me to be on this panel. I'm a colon and rectal surgeon at the University of Texas Medical Branch in Galveston, Texas, and a large part of my practice is taking care of patients with colorectal cancer, whether it's, you know, in the OR, out of the OR, or also just teaching people who come in for other reasons about screening. So super relevant to my practice and thank you again for inviting me to be on this panel. Thank you so much, Uma. Finally, we have Carleen Taylor. Can you briefly talk us through your experience with colorectal cancer and your vision behind Race for Hope? Oh, yes. Hi, my name is Carleen Taylor. I actually became an advocate for colorectal cancer for young onset colorectal cancer back in 2004 when one of my good friends was diagnosed with colorectal cancer. She was 42. We each had four boys. And I started a race, Race for Hope, Dairy or Dash, back then, to raise awareness for colorectal cancer. Very tragically, after all those years of trying to help others and to raise awareness that this cancer is increasing in the younger population, our own 22-year-old son was diagnosed with colorectal cancer in 2016. He was misdiagnosed for months because of his young age, and very sadly, he passed away in September of 2016. He was 23. Yesterday was his birthday. So my passion and focus is to raise awareness that this cancer is increasing in our younger people and that there needs to be more done to detect this cancer earlier in our younger people. Thank you so much, Carlene. So quickly to go over the agenda, we will focus on three primary learning objectives. Panelists will explain and provide their thoughts on the current American Cancer Society guidelines for colorectal cancer screening. They will discuss the barriers to colorectal cancer screening and early detection among young adults, and explain medical assistance role in improving colorectal cancer screening rates. So let's get started. Dr. Fattah, can you please introduce yourself? Dr. Fattah, can you please talk us through the current American Cancer Society guidelines for colorectal cancer screening? Absolutely. So the biggest change to colorectal cancer screening guidelines in the last two to three years has been changing the start of the age of screening from the age of 50 to the age of 45, and that applies to people who are at otherwise average risk for cancer. So that doesn't include people who already have a family history or diagnosis that would predispose them to developing cancer. So for people who are average risk, the recommendation is to start screening at the age of 45, and that screening can include colonoscopy, stool-based testing, or a shorter version of a colonoscopy called a flexible sigmoidoscopy. I think that maybe Emily can chime in on this too, but the general consensus among all of the national organizations is that any sort of screening you do is better than no screening at all. Yeah, I think that's a helpful foundation and overview. The ACS guidelines were updated in 2018 following the previous guideline that was from 2008, and it was changed in part based on new data showing rates of colorectal cancer are increasing in younger populations. So the update was made to save more lives by finding colorectal cancers earlier when treatment is more likely to be successful. The guideline differs from the previous guideline not only in the starting age, but as was mentioned, the emphasis on the choice of tests for screening and really an emphasis on no matter which test you choose, the most important thing is to get tested. And Dr. Von Hocker, Emily, can you go a little bit deeper into the different options patients have for colorectal cancer screening? Standard option is a colonoscopy, which is where patients would prepare the day before by doing a bowel cleanse, come in for the procedure, which is typically done under some form of anesthesia, and it involves having a lighted camera to take a direct look at the colon and the rectum. And this device allows you to biopsy anything that looks suspicious or remove things like polyps and have them sent to pathology for evaluation. Flexible sigmoidoscopy is the same instrument as a colonoscopy, except you just don't go as far into the colon. And so the preparation for that is a little bit easier for people to tolerate, and it only really looks at the rectum and the left side of the colon. There are stool-based tests. I think Colgard is probably the most well-known, and that's something that patients can do at home, privacy of their own home, send it back to the company for analysis, and the caveat there is that any positive result would then trigger a colonoscopy for a definitive diagnosis. There's also FIT testing, which is also a stool-based test that can be done at home, and then an older form of testing, which is a fecal occult blood test that can be done at home or in the office. And Amy Wicker, can you describe your duties in the screening process as a medical assistant? Sure. So over the years, it's kind of changed a little bit. So when I was in the practice working as a medical assistant, clinically, of course, it was really educating the patient on the needs for testing, possibly doing those fecal occult bloods in the office. If we had the patient doing that, we would process those in the practice, and just really identifying who needed screening. So of course, as I've moved into the quality role and working with our payers on value-based incentive programs and working with our practices in their practice transformation, things like that, my focus is still the same. We want to get the patients to get the screening done. And just like has been mentioned, there are different ways, and we're trying to kind of break the barrier sometimes of the patient thinks they think colorectal screening, and they think, oh, I have to have a colonoscopy. And of course, as we want that to be the gold standard of what the patient can get, we kind of go down through that process of if they're just so resistant, they will not get a colonoscopy. So we at least try to get the DNA-based Cologuard, the FIT test done. If they still won't do that, then we go down to the fecal occult. So just really trying to work with that patient. And it is truly about education, helping them understand why they need to have it done. If they think that, oh, I don't have any symptoms, nothing's wrong, I don't need to have it done, I don't have a family member. So just really, it's truly educating and really, and I work with the practices now to get processes in place. So when they're prepping charts, they're doing pre-visit planning so they can identify those patients that have not had those screening tests done. And then also, a lot of payers will offer incentive programs to the patients for getting their testing done. So really kind of just working the whole piece. And again, it really just goes back to educating and not just saying, hey, you're due for your screening, but helping them understand why they need the screening and what the value is in it. And there are patient-level barriers to CRC screening, which include fear, embarrassment, and bowel preparation. There are also own detection barriers for young adults. We've also identified socionomic barriers that are associated with health insurance and also racial ethnic disparities in the awareness, knowledge, and utilization of colorectal cancer screening. We'd like to touch on all these points during our discussion. Amy, have you seen patient-level barriers and what is your experience with working with health insurance providers as a medical assistant? Yes. So as you mentioned, there's cultural issues. There's fear. Someone was afraid they're going to have a bill. There's kind of all things you've got to kind of work through. And again, it goes back to that education. If you're opening up that discussion with the patient, and a lot of times it is the medical assistant who's talking to that patient first, or they may have talked to the physician and they've agreed to it, and then the medical assistant is coming back in to get that scheduled. So the patient may have a lot of questions. Most of the payers are paying very well for screenings. We do try to educate a little bit to the patients that if they're having issues, we really try to encourage them to get the colonoscopy because if they go for the fit DNA or something like that and it comes back positive, the colonoscopy changes from a screening to a diagnostic and there could be a bill with that. Of course, payers are all different and their policies are all different on that. So it's really about being open with the patient and trying to help them work through it. Not just saying, you need the screening, here's the order. Just trying to be the advocate for the patient and really ensuring they understand that process. And if they have fears, it may be just walking through with them of putting those fears and helping to address them and maybe just misinformation that they have. I think the PrEP is better than what it has been years past and so I think that it's just an understanding and kind of maybe educating them on some of the false rumors out there and really letting them know what the process is. Emily, can you talk us through the barriers and disparities NCCRT has identified and the different guides NCCRT offers for specific populations? Absolutely. Despite increased awareness and numerous policy successes that have improved access and affordability for colorectal cancer screening, there are still many barriers and disparities that persist. Regarding those disparities, one of the major disparities is actually age. So the screening rate among the population that's 50 to 64 years of age is just at 66% as of 2020. And among those 65 to 75, it's 82.5%. So we see a much lower screening rate among those that are pre-Medicare or below 65. And while there are really scant data so far on the age 40 to 49, it appears that screening rates are still very low in that population too. So a huge potential there. We also see screening and morbidity and mortality disparities by race and ethnicity. So just looking at screening, as of 2020 data, screening was the lowest among American Indian and Alaska Native people at around 63%. Also low among Asian American people at 64%. Hispanic people at 65%. And also lower than overall rates in people with lower education levels, lower income, people without insurance, and people without a regular healthcare provider. And then also, in spite of widespread knowledge that Black people have higher colorectal cancer incidence than white people, Black people are still less likely than white people to receive a recommendation for colorectal cancer screenings. So major disparities that unfortunately have also, to some degree, been exacerbated by the impacts of COVID-19. But it suggests that we have tremendous potential to reduce morbidity and mortality in those racially and ethnically diverse and socioeconomically challenged communities across the country. And then looking at barriers, we've done a series of market research projects over the years, starting in 2014, and we're actually wrapping up a project right now to really understand who are the unscreened, who are the screened, and what are their perceptions about colorectal cancer, about screening tests, what can motivate them to take that step and get screened. So by and large, the biggest barrier that comes up in that market research is procrastination. So unscreened people may be knowledgeable about colorectal cancer screening, but tend to prioritize other life demands over the need for screening or life gets in the way, especially if a patient is getting a colonoscopy that's a significant amount of time away from life and work. Other major barriers that come up are unpleasantness about the test or perceived unpleasantness, cost or perceived cost because there are some in many cases screening is free, but in some cases it's not and then perception that some people. Have a belief that if there's no family history, they may not be at risk or may not need to be screened. So to address those barriers, a couple of the big things that we can do are focus on the why of screening really explain how screening can not only detect early but also prevent some cloroxal cancer cases and then perhaps breaking the screening process into smaller tasks So if getting the procedure feels overwhelming to really help manage the process and perhaps navigate through those steps to get screened. So we have a suite of materials around messaging guidance are sort of overview document is called our messaging guidebook that looks at specific populations and across the US as a whole. So there's specific information about rural populations 45 to 49 year olds, different racial and ethnic groups and others to really try to understand their unique barriers and what channels to reach them. We also have a couple companion guides to that research looking at Hispanic and Latino adults and Asian Americans specifically with some non-English language messaging materials as well and then right now we're wrapping up a new market research project and guidebook around reaching black and African American adults for screening will actually be released June 21st in a webinar so we'll be sure to get that link to register out to anybody that's interested and then later into the fall we'll be releasing a market research project that looked at messaging specifically for the newly eligible and soon to be eligible. So people ages 45 to 49 especially but also those that may be getting ready to be screening age eligible or perhaps under 45 that may need to be screened early due to medical conditions or family history. And then I did want to point out to another we have numerous materials that can help address these barriers and disparities, but we do have some materials that address provider barriers too so we know that many providers are still only recommending colonoscopy instead of the menu of options and that some may have a bias toward colonoscopy as what they consider to be the gold standard even though we know that offering the menu of options can result in more patients getting screened and so we do have a clinician's reference brief on stool based testing that really walks through the efficacy of the different non-invasive tests how to go about setting up an organized stool based testing program so that's an excellent one to use especially if there are any providers in your practice that are really could learn more about stool based testing as an option. Exciting things are coming. Carlene, we understand you have a very personal connection to colorectal cancer screenings. Can you briefly talk to us about your son's experience and the early detection barriers he faced? OK, so my son Connor Taylor was a student in college when he was first starting to have symptoms and he was misdiagnosed. After he moved home, he was still having issues and I'm a medical technologist so when I got a hold of his blood work I saw that his hemoglobin was a little bit low so I called the doctor and asked them to do a iron TIBC folate B12 to find out why his hemoglobin was a little bit low and his iron came back way, way low and he was told to take iron pills so I called the doctor back and said well he's a 22 year old healthy male he works out, he eats properly, he's in great shape so there shouldn't be a reason for his iron to be low and so then I asked them to do a fecal blood test the IFOBT and they did that and it came back positive for blood and at that point and we went ahead and did a CAT scan because honestly I thought that he had developed an ulcer maybe because he was studying so hard he graduated magna cum laude in public health and then he was in the 70th percentile when he took his grad school exams to get into grad school so that's what I thought was happening and that came back totally normal it showed everything was fine so then we did the colonoscopy and that came back positive that he did have cancer and he had stage 3 cancer we were told everything was going to be fine that he would be able to start his public health masters in September of 2016 and he was diagnosed in February of 2016 and five months into his treatment we were told that the cancer tricked him and got away from them and he ended up passing away in September so obviously my main goal is sharing Connor's story and so that we can educate the primary cares the nurse practitioners the doctors that that this cancer is happening in younger people and and we need a way to find it we need new we need new chemotherapies there hasn't been a new care new chemotherapy since 2004 and we need new new ways to find this in our younger population I do a lot with colorectal cancer advocacy right now I'm on a couple different boards and we've got 15 year olds 17 year olds 13 year olds that are dying of this cancer now and so there's got to be something better and I actually just got a letter in my in my email today about a young onset colorectal cancer symposium and in it it states that by 2030 colorectal cancer is expected to be the leading cause of cancer deaths in the United States among 20 to 49 year olds so something has to be done to to stop this cancer in our young kids because as a mom that watched her vibrant 22 year old son who had his whole life ahead of him he wanted to do good things in the world uh suffer the way he did and undergo the surgeries that he did and then to be told that the cancer tricked them and got away from them I mean that that's not acceptable there's got to be something more that can be done to stop this cancer and find it sooner in our younger kids can you speak to us about the work NCCRT has done to address early onset colorectal cancer definitely but I first want to thank Carlene's for so honestly and eloquently sharing your story it's impossible to over estimate underestimate the role that survivors and caregivers play in bringing light to this issue and what an impact sharing that story can make even on those of us that have been working in this field for years it really um you know makes brings the data to life and and we need to keep hearing these stories so thank you um so this this issue has been um you know at the center of our work for several years now um one of the researchers at the American Cancer Society Rebecca Siegel put out a essential paper around early age onset colorectal cancer and so we um I think the first time that we had a an organized event around addressing the issue we hosted a summit in 2017 to help try to understand what data we have on you know what is happening um and potential causes and then to try to help set the research agenda and then we've been part of other subsequent there's actually an annual early age onset um larger cancer summit hosted every year that that we've been a part of um so I will say you know I think we have applied a lens to all of our work to ensure that we try to get the message out that about the trends in early age onset cases and then also to you know bring to the attention of primary care to be on the lookout for symptoms because there is research that shows that patients under age 50 are diagnosed many months later after the appearance of symptoms than than patients over age 50 that with the same types of symptoms um one thing that I think would be of use to to medical assistants and an audience would be in 2020 we released a toolkit for primary care providers around risk assessment so it's aimed to help providers detect familial hereditary and early onset colorectal cancer and so it's it's essentially a risk assessment tool to embed risk assessment in the primary care setting in order to try to catch those cases earlier and and put in place the appropriate diagnostic testing um and so I but I will say we're always interested in hearing from our partners and survivors on what more they can do if I can make a comment onto that because and I don't know what the percentage is but it's a high percentage of sporadic young onset colorectal cancer so many of these kids do not have family history so I would just caution in the toolkit which I believe is probably what happened in Connor's case because he was fit he worked out all the time there is no family onset of colorectal cancer so when the doctor is looking at stuff they're like oh he's in shape oh he eats healthy check check oh his his there's no young onset colorectal cancer in the family check so then you know they just go on to a different path I mean he was told that he had acid reflux so you go down a different path I mean I'm in contact with a lot a lot of parents of young kids that have gotten his cancer all of these kids are active I mean one he he was a marathon runner and in a couple weeks after he finished running a marathon he was diagnosed stage four so a lot of these young adults are active they're they're not overweight they they're not inactive so there's got to be something that I don't know what the paper looks like that you're handing out in the toolkit but there's got to be a caution on that fact so that it doesn't lead doctors immediately off the path of colorectal cancer in these kids that's such a great point and I I think it was fairly well addressed I know that we've had researchers present recently on new research on the proportion of early age onset colorectal cancer that's potentially preventable meaning that we know that some cases can be caught earlier by looking at that family history but that many of them as you said are sporadic and it's just so crucial that the primary care providers and staff are on the lookout for those symptoms and and appropriate diagnostics even when there's no family history so thank you so much for bringing that up So the AMA is a strong supporter of NCCRT's 80% in every community campaign to substantially reduce colorectal cancer as a major public health problem. Don, why have medical assistance been so effective in increasing the rate of colorectal cancer screening and do you have any empirical evidence to demonstrate this? Thank you Francesca. Medical assistants have been shown to be very effective in increasing the rate of colorectal cancer primarily because their education involves patient communication they learn how to communicate with patients of different ethnic background economic background etc so because of that medical assistants are often the intermediaries between the licensed provider and the patient and they can speak the patient's language and sometimes they can be more effective in persuading patients of the necessity of being screened for colorectal cancer in terms of empirical studies there are quite a few that show specifically that medical assistants are effective in raising the percentage of patients who do comply with a screening recommendation. I wrote an article in 2019 that's available on our website entitled The Role of Medical Assistants in Increasing Colorectal Cancer Screening Rates. I discussed six case studies I'm just going to talk about three of those and summarize those for you. The first one was done by the University of Utah Community Clinics and what they did was educate the medical assistants on colorectal cancer screening and also empowered them to enter preliminary orders for a screening following the guidelines which were provided by the licensed provider. The provider then after the entry of orders and the pending of the orders by the medical assistant into the electronic health record would review the order and then finalize it and approve it. The encouraging news is that with the medical assistants playing this role the percentage of patients that were screened increased from 6% to 13.4% which is a relative improvement of 123%. Another study was sponsored by the NCCRT and the American Cancer Society and specifically this study was looking at ways that colorectal cancer screening rates could be increased within the context of a patient-centered medical home. The study found that the electronic reminders that were sent to patients did not increase the screening rate. However, the study did find that medical assistants through their in-reach and outreach screening efforts proved to be highly effective in increasing the rate of colorectal cancer screening. And then finally, there was a North Carolina study in a federally qualified health center in which medical assistants were educated on how they were to relate to the patients and communicate the importance of screening. Once again, the results are really astounding. The percentage of eligible patients with a colorectal screening recommendation that actually did comply increased from 15% to 29%. So we have documented evidence that medical assistants are very crucial in getting patients to go through with the screening. And the AAMA does offer a continuing education course in conjunction with the 80% in every community initiative. How did the continuing education course medical assistance role in improving colorectal cancer screening rates getting to 80% come about, Don? Dorado Brooks, Dr. Dorado Brooks, who is the former Vice President of Cancer Control Interventions of the American Cancer Society, realized the effectiveness of medical assistance in increasing the rate of screening. So he was kind enough to author a continuing education article entitled Medical Assistance Roles in Colorectal Cancer Screening Rates Getting to 80%. This article, this piece was very successful within the medical assistant community and even beyond in other health care provider communities. The AAMA did feature this in our Cancer Awareness Month and Medical Assistance Recognition Week. So the number of individuals, medical assistants, and other professionals who took this course was almost 4000. And this is the highest return that we've ever experienced in terms of a course being taken by so many individuals. So we're very grateful to Dr. Brooks in writing this article that was specifically focused on medical assistance and how they could increase the rate of colorectal cancer screening. This course is still available on the AAMA website and we can provide information to anyone who is interested in that course. Perfect, thank you, Don. You're welcome. So this is an open question for any of the panelists to answer. What successes have you seen around screening rates in team-based care? I can definitely share. I will say that, so we've had an awards program for seven years now, in which any organization or individual can be nominated for their work around increasing colorectal cancer screening. And we've had a number of community health centers and a few health systems or private primary care practices win one of our 80% of every community National Achievement Awards, and every single one of them credits team-based care as an essential element of them having such a dramatic increase in their screening rates. A couple of things that really have resonated with me that we've told multiple times is that team-based care even includes educating and training and bringing on board front desk staff. If a patient is leaving the clinic and mentions something about their colonoscopy and the front desk staff says, oh, what a terrible thing to do, I'm never doing that again, that's going to make an impression. At the same time, if they say, what an incredible thing to do to potentially prevent or catch cancer early, I did it and you can too, that can make a big impact in the other direction. So really just how important it is to have all team members trained and working together around getting the message to patients. And then lastly, we've heard time and again that medical assistants, patients are often sometimes more comfortable with medical assistants and asking potentially embarrassing questions. And so when a practice has the medical assistants going over the specifics of how to do a test or what they might experience in preparing for the test, that has often been really successful in helping the patients feel comfortable and asking their questions and having enough time because that visit with their primary care provider is often very short. And then lastly, I did want to share another case that we found really interesting is that our awardee, grand prize awardee from last year was Pueblo Community Health Center based out of Pueblo, Colorado. And they said their team-based approach to colorectal cancer screening, which actually started in COVID, they had planned in 2019 to make the focus for 2020 colorectal cancer screening, it was actually such an important team building exercise for them to come together around increasing colorectal cancer screening at a time when they felt, you know, so nervous and unsure of what was happening with COVID, having those successes and working together as a team brought tremendous value to them. So you know, we hear time and again that the team-based approach is, adds such value to the work around increasing screening. And some of the things that we have found through our working in the practices and through some practice transformation, I think one of the keys is really utilizing pre-visit planning or chart prep, and that is really helping to identify before the patient gets in the room, what preventative screenings that they're due for. And of course, it includes colorectal, of course, but it may also capture if they need the mammograms or any type of lab testing, etc. And, you know, again, educating the staff so they understand the why. I think a lot of times it's really important to engage your staff so that they understand why we're doing this and not that we're just telling them, oh, you have to click this box or check this box. But getting them engaged in the why, I think goes a long way with having them be engaged in the process. And, you know, creating tools for the staff to use. One of the things we did, went back to paper, a little cheat sheet of checkboxes, things that the patient may be due for, and as they're doing their pre-visit planning or their chart prep, they're looking, check, check, check, do they need this done? Giving that, carrying that piece of paper into the exam room and talking to the patients, have you had any of this done? Handing that piece of paper off to the provider as a reminder, hey, they're due for this. You know, that's a super manual paper process that go into the basics at work. A lot of the EMRs now have pop-ups where they'll tell you what the patients do for us. And it's just, you know, really taking the time to look at that. And I think the medical assistant is super important in that piece because the provider is so busy trying to see so many patients and they may miss some of that. So it's very important for the medical assistant to be part of that team and remind the provider, hey, they're due for this today. Start that conversation with them. Another thing we use, the American Cancer Society has some really good tip sheets on what the different testing is. We laminated them and started the conversation with the patient, handed the sheet to them and said, hey, look this over while you're waiting on the doctor and then let them know which one you would be most comfortable with having done. So again, and we're just really focused on some scripting to the staff. So not just saying, hey, you're due for your colonoscopy. And the patient's like, no. You know, again, going down that, well, if you're, you know, this is why you should have a colonoscopy. If it's still a no, then going to the DNA-based testing, then going, you know, the FOBT, you're trying to get something. I think that's been stated. I forget who said it, but some testing is better than no testing. And so just it's, again, educating, empowering your staff, getting them engaged and make sure they're comfortable with talking to the patient about maybe they don't feel comfortable because they don't feel like they have enough knowledge to talk to the patient or empowering them to understand that they are part of a team and it's not just the physician's responsibility to talk to about it. So again, I know Emily stated, it goes back to that team-based care mentality that we're all together to educate that patient. Dr. Fattah, do you have anything else you'd like to add to that? I really think that Amy and Emily just hit it right on the nose. It's that every professional a patient encounters, you know, in a hospital or clinic setting has some responsibility. And so making sure that everybody a patient meets has the same, at least baseline level of understanding about colorectal cancer screening, you know, is vital. And it is often that, you know, we'll wrap up a visit and then my MA will just come back in and say, you know what, the patient had one more thing that they mentioned to me. Do you mind going back in there and addressing it? They didn't feel comfortable bringing it up themselves during the visit. So I think all of these encounters are important. And just making sure that everybody on the team understands that is definitely crucial. So NCCRT published a steps guides for increasing colorectal cancer screening and federally qualified health centers back in 2014. And they're currently in the process of revising it with updated science and to expand to general primary care. Emily, can you talk to us about the guide and what will it entail and who will benefit from it? Yes, thank you. So we are really excited about this update. As you shared, it was first published in 2014. And we've had numerous federally qualified health centers credit it with increasing rates, some even to 80%. There's one that there's a case study in the guide based out of New Orleans that Noella Community Health Center, their colorectal cancer screening rates were in the teens starting in 2012. And using the guide, they reached 80% in 2018, just phenomenal success. And so the newly updated guide includes, you know, of course, the current guidelines, including starting at age 45, all of those different test options, new information about fit DNA, which is color guard that wasn't in the original guide, the latest science and best practices, expert indoor strategies, and it now includes 10 case studies of exemplary practice sites. So the scope is expanded beyond federally qualified centers to any primary care settings. And in those case studies, there are seven federally qualified health centers and three primary care practices set within health systems that share, you know, what, what their challenges were, what they did, lessons learned, and their results. And then lastly, there are numerous templates and tools, sample reminder scripts, chart audit tools, you name it, it's all in there, and ready to be picked up and repurposed. So the audience, I would say would be anybody working in primary care, could be clinicians, maybe even more commonly could be medical assistant, nursing level staff, administrators, quality improvement staff, and you don't have to be taking on a major project to look at colorectal cancer screening. If you want to improve the way that you're doing a reminder letter, there's a script for it. So it's also should be easy to jump in and get just what you need. And so it's, it's nearing completion. And we're looking at dates in early July to have a webinar release. And we'll definitely share that with double AMA to get that out to everyone and anyone is welcome to register and join. And there are ways students, advocates and medical professionals to get involved. Can you talk to us about what options your organization provides for those who are interested? Emily. So for the NCCRT, our, our most active partners are member organizations. So it's typically more at the organization level than than the individual. But for each organization, there would be a couple different member representatives. So definitely consider whether you know your organization might want to be have an ongoing engagement with the National Colorectal Cancer Roundtable as a member, the representatives are invited to our annual meeting, there are some members only opportunities and webinar discussion series. But almost everything that we do truly is open to the public. So, you know, just by visiting our website, nccrt.org, you can sign up to get our newsletter, engage with us on social media on Twitter, at NCCRT news, and share what you're learning. So we have a hashtag, hashtag AV in every community. And we love to hear your successes on Twitter. And then also in the fall, we have our nomination period open for that awards program. So share your successes with us. Ask any questions that you have, our emails nccrt at cancer.org. We love to hear from the Boots on the Ground staff and clinical settings to hear what your challenges are and what successes you're seeing. And Carlene, is there any other ways that the individuals can get involved with with Race for Hope or for any of the boards that you're on? Oh, yes. The website for Race for Hope is raceforhope.com. So we welcome anybody to come join that. And it can be anybody that has an interest in the the work that we do. An interest in the the awareness piece, especially for the young onset. Last year, I had a new mom that joined me. Her 17-year-old son was diagnosed with colorectal cancer. One is well, about nine years ago, and he ended up passing away in May last year when he was 26. So she came on because she's as passionate about saving the young lives as I am. And she brought in a lot of family members and a lot of friends to help. So whatever anybody wants to do to help that way. So there's different organizations, just depending on what people want to do. I'm on the advisory board for the Colorectal Cancer Alliance for their young onset. I've been involved with Fight CRC. And actually, as a little bit of a background, when I was on one of the first times I went to a Fight CRC meeting, Dr. Dennis Annen, A-H-N-E-N, he worked with the, as far as coming up with the age for the 45. He was one of the people involved with that. He was talking at that meeting and was saying that they knew that there was an increase in young onset, but they didn't know why, and that they needed to collect more data points. So Connor had just passed away a few years, or not a few years, a couple months before that meeting. And so I just sort of, you know, stood up, said, hey, I've been an advocate for colorectal cancer since 2004. You know, people are dying here. My son, he's one of your data points. My friend that died, she's one of your data points. All the people in this room that are stage four, they're your data points. So we need somebody to take action. And after he talked, he wanted to hear more about Connor's story. So I told him. And before the age was lowered to 45, he sent me a letter telling me that he thought about Connor when he was making the recommendations. And he knew that it wouldn't help Connor because it was down to 45, but at least it did get moved and they know that there is an issue and it will save thousands of lives. So anybody that wants to get involved at any point, the main thing is we have to keep telling our stories. We have to be persistent so that the right person that has the right capabilities to help can take our stories and then make significant change happen with our stories. And we truly do appreciate you taking the time and sharing Connor's story with us, with our audience. Thank you. Since we're almost out of time in 30 seconds, what is the main message that you would like the audience to take away? Or what would your best piece of advice be for future medical assistance? This is an open question for all the panelists. I would encourage medical assistance to be challenged. As we've seen during the pandemic, health professionals react to challenges and stepped up to the occasion. So it's important to let your medical assistants know about the importance of colorectal cancer screening. And we have some resources on our website, which is aama-ntl.org that could help with that. And I would say for medical assistance, just remember you are an important piece of the puzzle. You are part of a team that's making a difference. And I think a lot of times they feel I'm not the physician, but you, the medical assistants are such an important piece of making that connection with the patient, making them feel comfortable getting their questions answered and helping them to get that screening done and knowing what they need to be done and feeling comfortable with it. And I would like to say that to keep an open mind, that look at the symptoms, not necessarily the age, especially in the colorectal cancer world, since it appears that it's an ever-changing mutations that are happening and it is happening to younger and younger people. So just to keep an open mind and look at the symptoms as opposed to the physical fitness or the age or the health habits of the person in front of you. And I'd like to share, just to reiterate, we have such an incredible opportunity in front of us to save more lives from colorectal cancer. And for medical assistance, you never know when your screening recommendation, your, you know, walking through a patient, how to use a fit test, a simple reminder phone call, or even words of encouragement, when any of those could save a life. And you have such a tremendous potential to spread awareness, break down stigma, and empower patients to be healthy and get screened for colorectal cancer. I would also just say that medical assistance play a vital role in patient care. And, you know, to just never forget that, that you're often the frontline person, the first person that you're going to meet in the clinical setting. And any sort of support and education that you provide really has a big impact on patients and their outcomes. Great. Thank you. Thank you all so much for joining this panel discussion. For more information about the American Association of Medical Assistants membership benefits, please visit our website at www.aama-ntl.org. Don't forget to subscribe to our newsletter. If you sign up for our newsletter through the AAMA website, then you'll get updates on upcoming events, CEU opportunities, nationwide medical assistant news, legal victories, and more. Thank you all.

colorectal cancer screening

panel discussion

Francesca Daniels

American Association of Medical Assistance

National Achievement Award

screening rates

American Cancer Society guidelines

medical assistants

disparities in screening rates