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Barriers of and Facilitators to Physician Recommendation of Colorectal Cancer Screening

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Abstract

BACKGROUND

Colorectal cancer screening (CRCS) has been demonstrated to be effective and is consistently recommended by clinical practice guidelines. However, only slightly over half of all Americans have ever been screened. Patients cite physician recommendation as the most important motivator of screening. This study explored the barriers of and facilitators to physician recommendation of CRCS.

METHODS

A 3-component qualitative study to explore the barriers of and facilitators to physician recommendation of CRCS: in-depth, semistructured interviews with 29 purposively sampled, community- and academic-based primary care physicians; chart-stimulated recall, a technique that utilizes patient charts to probe physician recall and provide context about the barriers of and facilitators to physician recommendation of CRCS during actual clinic encounters; and focus groups with 18 academic primary care physicians. Grounded theory techniques of analysis were used.

RESULTS

All the participating physicians were aware of and recommended CRCS. The overwhelmingly preferred test was colonoscopy. Barriers of physician recommendation of CRCS included patient comorbidities, prior patient refusal of screening, physician forgetfulness, acute care visits, lack of time, and lack of reminder systems and test tracking systems. Facilitators to physician recommendation of CRCS included patient request, patient age 50–59, physician positive attitudes about CRCS, physician prioritization of screening, visits devoted to preventive health, reminders, and incentives.

CONCLUSION

There are multiple physician, patient, and system barriers to recommending CRCS. Thus, interventions may need to target barriers at multiple levels to successfully increase physician recommendation of CRCS.

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Acknowledgement

Dr. Guerra acknowledges the National Cancer Institute (Public Health Service Grant K01 CA97925) and the Robert Wood Johnson Foundation (fund number 051895) for their grant support. The authors also gratefully acknowledge the physicians who participated in this study for providing their candid and invaluable perspectives. The authors also acknowledge James C. Reynolds, M.D., Professor and Chair of the Department of Medicine, Drexel College of Medicine, Philadelphia, PA for his support of this research and Caryn Lerman, Ph.D., Deputy Director of the Abramson Cancer Center of the University of Pennsylvania for her guidance in the conceptualization of this work.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Carmen E. Guerra MD, MSCE, J. Sanford Schwartz MD, Katrina Armstrong MD, MSCE & Judy A. Shea PhD

  2. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    Carmen E. Guerra MD, MSCE, J. Sanford Schwartz MD, Katrina Armstrong MD, MSCE, Chanita Hughes Halbert PhD & Judy A. Shea PhD

  3. Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA

    Carmen E. Guerra MD, MSCE, J. Sanford Schwartz MD, Katrina Armstrong MD, MSCE & Chanita Hughes Halbert PhD

  4. Department of Health Management and Economics, Wharton School, University of Pennsylvania, Philadelphia, PA, USA

    J. Sanford Schwartz MD

  5. University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Jamin S. Brown MD & Judy A. Shea PhD

  6. Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA

    Chanita Hughes Halbert PhD

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  1. Carmen E. Guerra MD, MSCE
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  2. J. Sanford Schwartz MD
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  3. Katrina Armstrong MD, MSCE
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  6. Judy A. Shea PhD
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Corresponding author

Correspondence to Carmen E. Guerra MD, MSCE.

Additional information

Jamin S. Brown, M.D.

is currently completing his training in ophthalmology in the Department of Ophthalmology, University of Washington, Seattle, WA

Appendix

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Table 2

Table 2 In-depth Interview and Chart-stimulated Recall Protocol
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Guerra, C.E., Schwartz, J.S., Armstrong, K. et al. Barriers of and Facilitators to Physician Recommendation of Colorectal Cancer Screening. J GEN INTERN MED 22, 1681–1688 (2007). https://doi.org/10.1007/s11606-007-0396-9

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  • DOI: https://doi.org/10.1007/s11606-007-0396-9

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