Results from Provider and Population Surveys of Colorectal Cancer Screening in Six States

introduction: The Centers for Disease Control and Prevention funds 29 grantees to implement the Colorectal Cancer Control Program (CRCCP) to increase colorectal cancer screening rates and improve screening quality. This paper presents baseline data collected as part of an impact evaluation of the CRCCP.

methods:  In each of six states, a mailed survey was sent to a sample of primary care providers using a purchased list from the American Medical Association database, and a random-digit-dial telephone survey was conducted with adults ages 50+.  Both survey instruments measured perceptions of CRC screening; CRC screening knowledge, attitudes and behaviors; contextual factors that affect screening recommendations and test completion; and socio-demographics.

results: Provider respondents totaled 2,596 (43.5% response rate) and population respondents totaled 4,668 (34.5% response rate). Almost all population survey respondents (99%) were aware of CRC screening, but only 85% and 77% of respondents indicated having ever been screened and being up-to-date with screening, respectively. For respondents who indicated not being up-to-date, 58% reported never receiving a doctor’s recommendation for screening. Providers reported recommending multiple CRC screening modalities, including colonoscopy (98%) and stool blood tests (52% recommended guaiac-based FOBT; 41% recommended immunochemical FOBT/FIT). Although 66% of providers reported having provider reminder systems, only 43% reported having client reminder systems, and less than 30% reported receiving performance feedback reports for CRC screening. 

conclusions:  The CRCCP should focus on promoting the use of system-level strategies, such as provider and client reminders, provider assessment and feedback, and other evidence-based strategies, to improve CRC screening.