Explaining physician rates of providing flexible sigmoidoscopy

Area of Science:

• Oncology
• Preventive Medicine
• Health Services Research

Background:

• Colorectal cancer is a leading cause of cancer death, yet screening adherence is suboptimal.
• Flexible sigmoidoscopy is an effective screening tool for colorectal cancer, but its utilization by family physicians requires further investigation.

Purpose of the Study:

• To identify factors influencing family physicians' rates of recommending or performing flexible sigmoidoscopy.
• To apply a behavioral model to understand physician-level determinants of colorectal cancer screening.

Main Methods:

• A survey was administered to 60 family physicians in Washington State, guided by qualitative interviews.
• A behavioral model incorporating physician attitude, facilitating conditions, and reinforcing conditions was utilized.
• Physician sigmoidoscopy rates were measured via chart reviews; data analyzed using multiple regression.

Main Results:

• Physician attitude, facilitating conditions, and their interaction significantly predicted sigmoidoscopy rates (multiple R = 0.72).
• Specific physician beliefs (cost, time, risk, effectiveness) and facilitating conditions (training, reminders, clinic structure) correlated with screening rates.
• All three components of the behavioral model were significantly associated with flexible sigmoidoscopy provision.

Conclusions:

• A theory-based behavioral model effectively explains physician decision-making regarding flexible sigmoidoscopy.
• Targeted interventions addressing physician attitudes and improving clinic-based facilitating conditions are crucial for increasing colorectal cancer screening.
• Findings offer specific guidance for educational and motivational strategies to enhance physician-led sigmoidoscopy use.