Colorectal Cancer Screening and Management (CRCSM) Clinical Decision Support (CDS) Implementation Guide
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: DecisionToScreen_FannyFamiglietti - XML Representation

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<Bundle xmlns="http://hl7.org/fhir">
  <id value="DecisionToScreen_FannyFamiglietti"/>
  <type value="collection"/>
  <entry>
    <fullUrl
             value="http://cancerscreeningcds.github.io/crcsm-cds/CarePlan/134"/>
    <resource>
      <CarePlan>
        <id value="134"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="CarePlan_134"> </a><p class="res-header-id"><b>Generated Narrative: CarePlan 134</b></p><a name="134"> </a><a name="hc134"> </a><a name="134-en-US"> </a><p><b>instantiatesCanonical</b>: <a href="PlanDefinition-flow-DecisionToScreen.html">Decision to Screen</a></p><p><b>status</b>: Draft</p><p><b>intent</b>: Proposal</p><p><b>subject</b>: <a href="Bundle-FannyFamiglietti.html#Patient_FannyFamiglietti">Fanny Famiglietti</a></p><p><b>created</b>: 2024-12-10 00:00:00+0000</p><h3>Activities</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Reference</b></td></tr><tr><td style="display: none">*</td><td><a href="Bundle-DecisionToScreen_FannyFamiglietti.html#RequestGroup_135">Bundle: type = collection</a></td></tr></table></div>
        </text>
        <instantiatesCanonical
                               value="http://cancerscreeningcds.github.io/crcsm-cds/PlanDefinition/flow-DecisionToScreen"/>
        <status value="draft"/>
        <intent value="proposal"/>
        <subject>
          <reference value="Patient/FannyFamiglietti"/>
          <display value="Fanny Famiglietti"/>
        </subject>
        <created value="2024-12-10T00:00:00.0Z"/>
        <activity>
          <reference>
            <reference value="RequestGroup/135"/>
          </reference>
        </activity>
      </CarePlan>
    </resource>
  </entry>
  <entry>
    <fullUrl
             value="http://cancerscreeningcds.github.io/crcsm-cds/RequestGroup/135"/>
    <resource>
      <RequestGroup>
        <id value="135"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="RequestGroup_135"> </a><p class="res-header-id"><b>Generated Narrative: RequestGroup 135</b></p><a name="135"> </a><a name="hc135"> </a><a name="135-en-US"> </a><p><b>instantiatesCanonical</b>: <a href="PlanDefinition-flow-DecisionToScreen.html">Decision to Screen</a></p><p><b>status</b>: Draft</p><p><b>intent</b>: Proposal</p><p><b>subject</b>: <a href="Bundle-FannyFamiglietti.html#Patient_FannyFamiglietti">Fanny Famiglietti</a></p><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>FamilyHistoryIncreasedRisk</blockquote><p><b>title</b>: Family history increased risk screening/surveillance</p><p><b>description</b>: For patients with a single first-degree relative (mother, father, full sibling, child) with colorectal cancer or an advanced polyp(s):
* If relative diagnosed at &gt;= 60 years:
    * Start screening at 40 years old. Tests and intervals are as per average risk screening recommendations.
* If relative diagnosed at &lt; 60 years old:
    * Start screening 10 years before relative's age at diagnosis or age 40, whichever is earlier. Repeat colonoscopy every 5 years.
    * If no significant neoplasia appears by age 60 years, can offer expanding the interval between colonoscopies.

For patients with 2 or more first-degree relatives with colorectal cancer or an advanced polyp:
* Start screening colonoscopy 10 years before the reatives' youngest age at diagnosis or age 40, whichever is earlier. Repeat colonoscopy every 5 years.

Patients with a history of potentially precancerous polyps should follow shortest interval between recommendations above and recommendations based on colonoscopy findings.</p><h3>Documentations</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Label</b></td><td><b>Display</b></td><td><b>Citation</b></td></tr><tr><td style="display: none">*</td><td>Citation</td><td>USMSTF (2017)</td><td>Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer</td><td><div><p>Rex, D. K., et al. (2017). Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 153(1), 307-323. https://doi.org/10.1053/j.gastro.2017.05.013</p>
</div></td></tr><tr><td style="display: none">*</td><td>Citation</td><td>ACG Average Risk (2021)</td><td>ACG Clinical Guidelines: Colorectal Cancer Screening 2021</td><td><div><p>Shaukat, A., et al. (2021). ACG Clinical Guidelines: Colorectal Cancer Screening 2021. American Journal of Gastroenterology, 116(3), 458-479. https://doi.org/10.14309/ajg.0000000000001122</p>
</div></td></tr><tr><td style="display: none">*</td><td>Citation</td><td>USMSTF Follow-Up After Colonoscopy and Polypectomy (2020)</td><td>Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer</td><td><div><p>Gupta, S., et al. (2020). Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 158(4), 1131–1153.e5. https://doi.org/10.1053/j.gastro.2019.10.026</p>
</div></td></tr></table><p><b>resource</b>: <a href="Bundle-DecisionToScreen_FannyFamiglietti.html#ServiceRequest_136">Bundle: type = collection</a></p></blockquote></div>
        </text>
        <instantiatesCanonical
                               value="http://cancerscreeningcds.github.io/crcsm-cds/PlanDefinition/flow-DecisionToScreen"/>
        <status value="draft"/>
        <intent value="proposal"/>
        <subject>
          <reference value="Patient/FannyFamiglietti"/>
          <display value="Fanny Famiglietti"/>
        </subject>
        <action id="FamilyHistoryIncreasedRisk">
          <title
                 value="Family history increased risk screening/surveillance"/>
          <description
                       value="For patients with a single first-degree relative (mother, father, full sibling, child) with colorectal cancer or an advanced polyp(s):
* If relative diagnosed at &gt;= 60 years:
    * Start screening at 40 years old. Tests and intervals are as per average risk screening recommendations.
* If relative diagnosed at &lt; 60 years old:
    * Start screening 10 years before relative's age at diagnosis or age 40, whichever is earlier. Repeat colonoscopy every 5 years.
    * If no significant neoplasia appears by age 60 years, can offer expanding the interval between colonoscopies.

For patients with 2 or more first-degree relatives with colorectal cancer or an advanced polyp:
* Start screening colonoscopy 10 years before the reatives' youngest age at diagnosis or age 40, whichever is earlier. Repeat colonoscopy every 5 years.

Patients with a history of potentially precancerous polyps should follow shortest interval between recommendations above and recommendations based on colonoscopy findings."/>
          <documentation>
            <type value="citation"/>
            <label value="USMSTF (2017)"/>
            <display
                     value="Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer"/>
            <citation
                      value="Rex, D. K., et al. (2017). Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 153(1), 307-323. https://doi.org/10.1053/j.gastro.2017.05.013"/>
          </documentation>
          <documentation>
            <type value="citation"/>
            <label value="ACG Average Risk (2021)"/>
            <display
                     value="ACG Clinical Guidelines: Colorectal Cancer Screening 2021"/>
            <citation
                      value="Shaukat, A., et al. (2021). ACG Clinical Guidelines: Colorectal Cancer Screening 2021. American Journal of Gastroenterology, 116(3), 458-479. https://doi.org/10.14309/ajg.0000000000001122"/>
          </documentation>
          <documentation>
            <type value="citation"/>
            <label
                   value="USMSTF Follow-Up After Colonoscopy and Polypectomy (2020)"/>
            <display
                     value="Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer"/>
            <citation
                      value="Gupta, S., et al. (2020). Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 158(4), 1131–1153.e5. https://doi.org/10.1053/j.gastro.2019.10.026"/>
          </documentation>
          <resource>
            <reference value="ServiceRequest/136"/>
          </resource>
        </action>
      </RequestGroup>
    </resource>
  </entry>
  <entry>
    <fullUrl
             value="http://cancerscreeningcds.github.io/crcsm-cds/ServiceRequest/136"/>
    <resource>
      <ServiceRequest>
        <id value="136"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="ServiceRequest_136"> </a><p class="res-header-id"><b>Generated Narrative: ServiceRequest 136</b></p><a name="136"> </a><a name="hc136"> </a><a name="136-en-US"> </a><p><b>basedOn</b>: <a href="ActivityDefinition-ColorectalCancerScreeningServiceRequest.html">Colorectal Cancer Screening Service Request</a></p><p><b>status</b>: option</p><p><b>intent</b>: Proposal</p><p><b>code</b>: <span title="Codes:{http://cancerscreeningcds.github.io/crcsm-cds/CodeSystem/plan-definition-action-code-system increasedriskscreening}">Increased risk screening for colorectal cancer</span></p><p><b>subject</b>: <a href="Bundle-FannyFamiglietti.html#Patient_FannyFamiglietti">Fanny Famiglietti</a></p><p><b>reasonCode</b>: <span title="Codes:{http://snomed.info/sct 1421000119104}">Family history of colorectal cancer (situation)</span></p></div>
        </text>
        <basedOn>🔗 
          <reference
                     value="http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/ColorectalCancerScreeningServiceRequest"/>
        </basedOn>
        <status value="option"/>
        <intent value="proposal"/>
        <code>
          <coding>
            <system
                    value="http://cancerscreeningcds.github.io/crcsm-cds/CodeSystem/plan-definition-action-code-system"/>
            <code value="increasedriskscreening"/>
            <display value="Increased risk screening for colorectal cancer"/>
          </coding>
        </code>
        <subject>
          <reference value="Patient/FannyFamiglietti"/>
          <display value="Fanny Famiglietti"/>
        </subject>
        <reasonCode>
          <coding>
            <system value="http://snomed.info/sct"/>
            <code value="1421000119104"/>
            <display value="Family history of colorectal cancer (situation)"/>
          </coding>
        </reasonCode>
      </ServiceRequest>
    </resource>
  </entry>
</Bundle>