Colorectal Cancer Screening Practices Among Texas Nurse Practitioners and Physician Assistants

The purpose of this study was two-fold: (1) To describe and compare Texas Nurse Practitioners' and Physician Assistants' knowledge and use of current screening guidelines for individuals at varying risk for colorectal cancer and (2) to compare their recommendations for referral for genetic counseling for persons at increased risk for colorectal or endometrial cancer. The study used a descriptive correlational comparative design. A self-administered web-based survey was sent to the members of the Texas Nurse Practitioner Association and the Texas Academy of Physician Assistants. The questionnaire consisted of 44 items categorized in three domains: demographics, knowledge of national guidelines for risk-stratified colorectal cancer (CRC) screening, and referral for genetic counseling and CRC-screening practices. Data were collected from July through October 2014. More than 75% of the survey respondents reported confidence in their knowledge of the lifetime risk of colorectal cancer and the recommendations for screening in the average-risk adult. Fifty-one percent of both groups reported that they were familiar with Lynch syndrome; however, the nurse practitioners had a lower awareness of the lifetime risk of colorectal cancer associated with Lynch syndrome compared to the physician assistants. Only 34.1% of the nurse practitioners and 23.5% of the physician assistants were aware of the lifetime risk of developing endometrial cancer diagnosed before 60 years of age in women with Lynch syndrome, and only 39.6% of the physician assistants and 40% of the nurse practitioners reported performing a three-generation family history of cancer as a risk assessment. Less than 50% of the respondents would refer a patient with a personal or family history of colorectal or endometrial cancer diagnosed before the age of 60 years for genetic counseling. Nurse practitioners and physician assistants in primary care need more formal and continuing education in risk-stratified screening and referral for genetic counseling in adults at increased risk for colorectal cancer. The academic curricula of both disciplines need to include more content on genetic and genomic influences on the pathophysiology of colorectal cancer and the role of this information for screening and personalized treatment.