Research articleColorectal Cancer Screening by Primary Care Physicians: Recommendations and Practices, 2006–2007
Introduction
Colorectal cancer (CRC) is the second leading cause of cancer death in the U.S.1 Screening for CRC is recommended by national expert groups for average-risk adults aged ≥50 years2, 3 and has been designated as a high-priority preventive service because of its substantial potential impact on disease burden and its cost effectiveness.4 Screening options recommended by the U.S. Preventive Services Task Force (USPSTF) include annual fecal occult blood testing (FOBT); sigmoidoscopy every 5 years; or colonoscopy every 10 years.3 In 2005, 50% of adults aged ≥50 years in the U.S. had been screened according to these recommendations.5 This rate is notably lower than that of other recommended adult preventive services.6, 7, 8
Most cancer screening in the U.S. occurs within routine medical practice, especially primary care. By recommending CRC screening tests, performing them, or referring patients for them, primary care physicians (hereafter, physicians) play a critical role in implementing guidelines and achieving public health targets for CRC screening. Accordingly, physician recommendation has been shown to be a strong correlate of whether or not patients undergo CRC screening.9, 10, 11 Practice-level systems to support the translation of physicians' recommendations into clinical delivery are also recognized as an important influence on the utilization of CRC screening.11, 12, 13
An earlier study14 used data from a nationally representative survey conducted in 1999–2000 to assess physicians' recommendations for and means of conducting CRC screening in their clinical practices. The study found that 98% of physicians recommended CRC screening to patients, most often with FOBT, flexible sigmoidoscopy, or both, and that many recommended screening at nonstandard starting ages or too-frequent intervals. Subsequent to that study, several major developments in national policies related to CRC screening occurred. These include the expansion of coverage by the Medicare program to include screening colonoscopy for average-risk beneficiaries in 2001,15 the addition of colonoscopy and double-contrast barium enema (DCBE) to updated guidelines by the USPSTF in 2002,16 and the adoption of CRC screening as a Health Plan Employer Data and Information Set performance measure by the National Committee for Quality Assurance17 in 2003. Physicians' CRC screening recommendations and practices may have been influenced, altered, or both, by these and other developments in the rapidly evolving CRC screening field.
To assess physicians' current knowledge, attitudes, recommendations, and practices regarding CRC and three other types of cancer screening, the National Cancer Institute (NCI)—in collaboration with the Agency for Healthcare Research and Quality and the CDC—fielded in 2006–2007 the National Survey of Primary Care Physicians' Recommendations and Practices for Breast, Cervical, Colorectal, and Lung Cancer Screening (healthservices.cancer.gov/surveys/screening_rp/). The current study uses data from the new survey to characterize U.S. physicians' CRC screening recommendations and practices. Results are compared to selected findings from the earlier, 1999–2000 survey.14 The practice-level systems that physicians report having in place to support CRC screening activities, about which there is limited information at the national level, are also described.
Section snippets
Sampling Methodology
Between September 2006 and May 2007, a nationally representative sample of physicians was surveyed. The American Medical Association's Physician Masterfile, which contains demographic and practice information on all allopathic and nearly all osteopathic physicians in the U.S., was used as the sampling frame. Eligible respondents were nonfederal, office-based family physicians, general practitioners, general internists, and obstetrician/gynecologists aged ≤75 years with patient care as their
Description of Respondents
A total of 1266 physicians responded to the survey. The absolute response rate was 69.3%. The cooperation rate, which excludes physicians lacking valid contact information, was 75%. Nearly half of the respondents were family physicians or general practitioners (Table 1). Approximately half were aged <50 years. The majority were men, non-Hispanic white, board-certified, graduates of U.S. medical schools, full or part owners of their practices, and without a medical school faculty appointment.
Discussion
This study used data from a nationally representative survey of physicians conducted in 2006–2007 and compared them to selected results from an earlier national survey14 to show that physicians' CRC screening recommendations and practices have changed substantially over a 7-year period. Colonoscopy is now the most frequently recommended test; in 1999–2000, it was FOBT. Moreover, despite national guidelines that list multiple test options for CRC screening and that promote the precept of patient
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Factors influencing colorectal cancer screening decision-making among average-risk US adults
2022, Preventive Medicine ReportsProvider-perceived barriers to patient adherence to colorectal cancer screening
2022, Preventive Medicine ReportsCitation Excerpt :These findings are concordant with patient-reported barriers in previous research (Honein-AbouHaidar et al., 2016). The persistent overreliance on colonoscopy as the preferred CRC screening method in US clinical practices is likely a major reason why patient discomfort with screening method offered was the most frequently reported patient-level barrier by providers (Klabunde et al., 2009). This barrier can be remedied through provider training and education to improve providers’ knowledge of and attitude toward alternative screening methods, as well as their skills in engaging patients in shared decision-making to align screening recommendations with patient preferences, needs, and values (Barry and Edgman-Levitan, 2012).
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