222667 Colorectal cancer screening discussion and recommendation

Monday, November 8, 2010 : 5:10 PM - 5:30 PM

Jane Zapka, ScD , Medical University of South Carolina, Charleston, SC
Carrie Klabunde, PhD , Applied Research Program, National Cancer Institute, Bethesda, MD
Neeraj K. Arora, PhD , Applied Research Program, National Cancer Institute, Outcomes Research Branch, Rockville, MD
Primary care physician recommendation and action are pivotal to colorectal cancer (CRC) screening performance. Guidelines recommend discussion between physicians and patients about test options and their potential benefits and harms.

We analyzed data from 1266 physicians responding to the 2006-2007 National Survey of Primary Care Physicians' Recommendations and Practices for Breast, Cervical, Colorectal, and Lung Cancer Screening. Descriptive statistics were used to examine physicians' reports of discussion about and recommendations for CRC screening. Regression modeling was used to assess the relationships of discussion and recommendation practices with physician and practice characteristics and physicians' reports of the influence of patient preferences and screening barriers.

Forty-six percent of respondents usually discuss more than one testing option; the vast majority of these discuss FOBT and colonoscopy (49%) or FOBT, sigmoidoscopy and colonoscopy (32%). Very few report discussion of all options as recommended in guidelines. Of the physicians who discuss more than one option, a majority report they usually recommend one or more tests, most commonly colonoscopy alone (43%) and FOBT and colonoscopy (43%). Numerous personal (specialty), practice (proportion of uninsured), and patient characteristics (prefer MD decides), along with screening barriers (specialist availability), are independently related to discussion patterns and/or recommendations.

Most primary care physicians do not routinely discuss with their patients the full menu of CRC screening options recommended in guidelines. Given the numerous factors influencing physicians' behavior about screening decisions, multiple interventions aimed at multiple levels are essential to promote more informed discussions and recommendations.

Learning Areas:
Chronic disease management and prevention
Clinical medicine applied in public health
Provision of health care to the public

Learning Objectives:
1. Describe primary care physicians’ colorectal cancer screening discussion and recommendation patterns. 2. Identify characteristics of primary care physicians who do not present screening options to their patients. 3. Discuss interventions that might facilitate physician-patient discussions of colorectal cancer screening options.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a researcher in the area of cancer screening discussions
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3409.1: Update on Health Services Research: Impact of Changes in Cancer Screening Guidelines (organized jointly by the Cancer Forum and Medical Care)