Factors associated with primary care physicians' guideline-consistent colorectal cancer screening recommendations

Background: The majority of older adults in the U.S. do not receive colorectal cancer (CRC) screening. Because primary care physicians' recommendations to their patients are central to the screening process, we evaluated whether physicians' CRC screening recommendations were consistent with major guidelines for fecal occult blood testing, flexible sigmoidoscopy, colonoscopy, and double contrast barium enema.

Methods: We used a theoretical framework and data from two nationally-representative surveys of primary care physicians in 1999-2000 (n= 1,235) and 2006-2007 (n=1,266) to 1) compare trends in guideline-consistent CRC recommendations and 2) explore factors associated with guideline- consistent CRC screening recommendations for the menu of screening modalities in 2006-2007. Analyses used descriptive statistics and polychotomous logistic regression.

Results: Across the CRC screening modalities, guideline-consistent recommendations for age at initiation and screening intervals generally improved over time, although the extent varied by modality. In both time periods, fewer than 20% of all physicians had guideline-consistent recommendations for all CRC screening modalities that they recommended, although this proportion improved over time. Physician and practice characteristics were associated with guideline-consistent screening recommendations (p<0.05).

Conclusions: Primary care physicians' recommendations for CRC screening are generally not guideline-consistent. Interventions that focus on potentially modifiable physician and practice factors and address the menu of recommended screening modalities will be important for improving screening practice.