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Colorectal cancer screening: physician attitudes and practices
Mary Lou Taylor1, Ruric Anderson
1Pain Management Center, Medical College of Wisconsin, FMLH East Clinics, 9200 West Wisconsin Ave, Milwaukee, WI 53226, USA. mltaylor@mcw.edu
Purpose:
The American Cancer Society (ACS) set a nationwide goal to increase to 75% by 2015 the proportion of people aged 50 and older who have colorectal cancer (CRC) screening consistent with ACS guidelines. Little is known about current physician screening practices and attitudes. The purpose of this study was to document current physician attitudes and practices regarding CRC screening, and to formulate appropriate interventions to meet the ACS screening goal.
Methods:
Questionnaires were sent to a random sample of 600 primary care physicians in Wisconsin. The survey measured 1) screening preferences; 2) estimates of patients screened by each method; 3) agreement to statements regarding screening guidelines and practices, patient compliance, effectiveness in reducing mortality, factors regarding colonoscopy as a screening tool; 4) use of reminder systems; 5) demographics.
Results:
Physicians prefer combining fecal occult blood testing (FOBT) with flexible sigmoidoscopy for CRC screening, while they believe patients prefer FOBT alone. Only 1.5% view colonoscopy as their preferred method of screening. There is discrepancy between physicians' beliefs that patients should be screened and estimated numbers they screen. Only 38.2% of respondents would screen a moderate-risk patient at the ACS recommended age. Physicians perceive screening compliance to be low. Cost, availability, risks, and lack of proof of effectiveness influence physician decisions. Fewer than half have any reminder system for CRC screening.
Conclusions:
CRC screening rates are currently lower than the 2015 ACS goal. Influential factors include physician attitudes and beliefs about effectiveness, familiarity with guidelines, perception of patient preferences and compliance, and lack of adequate reminder systems. Targeting interventions to these factors may increase the rate of CRC screening. Despite increased consensus from professional societies on colonoscopy as the best choice for screening, few primary care physicians would choose this option.