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Are Physicians’ Recommendations For Colorectal Cancer Screening Guideline-Consistent?

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ABSTRACT

BACKGROUND

Many older adults in the U.S. do not receive appropriate colorectal cancer (CRC) screening. Although primary care physicians’ recommendations to their patients are central to the screening process, little information is available about their recommendations in relation to guidelines for the menu of CRC screening modalities, including fecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), colonoscopy, and double contrast barium enema (DCBE). The objective of this study was to explore potentially modifiable physician and practice factors associated with guideline-consistent recommendations for the menu of CRC screening modalities.

METHODS

We examined data from a nationally representative sample of 1266 physicians in the U.S. surveyed in 2007. The survey included questions about physician and practice characteristics, perceptions about screening, and recommendations for age of initiation and screening interval for FOBT, FS, colonoscopy and DCBE in average risk adults. Physicians’ screening recommendations were classified as guideline consistent for all, some, or none of the CRC screening modalities recommended. Analyses used descriptive statistics and polytomous logit regression models.

RESULTS

Few (19.1%; 95% CI:16.9%, 21.5%) physicians made guideline-consistent recommendations across all CRC screening modalities that they recommended. In multivariate analysis, younger physician age, board certification, north central geographic region, single specialty or multi-specialty practice type, fewer patients per week, higher number of recommended modalities, use of electronic medical records, greater influence of patient preferences for screening, and published clinical evidence were associated with guideline-consistent screening recommendations (p < 0.05).

CONCLUSIONS

Physicians’ CRC screening recommendations reflect both overuse and underuse, and few made guideline-consistent CRC screening recommendations across all modalities they recommended. Interventions that focus on potentially modifiable physician and practice factors that influence overuse and underuse and address the menu of recommended screening modalities will be important for improving screening practice.

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Acknowledgement

The survey was conducted under contract with Westat. Funding support was provided by the National Cancer Institute (contract numbers N02-PC-51308), the Agency for Healthcare Research and Quality (inter-agency agreement numbers Y3-PC-5019-01 and Y3-PC-5019-02) and the Centers for Disease Control and Prevention (interagency agreement number Y3-PC-6017-01). Presented in part at the American Public Health Association meeting November 10, 2009.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA

    K. Robin Yabroff PhD, MBA, Carrie N. Klabunde PhD, Martin L. Brown PhD & Stephen Taplin MD, MPH

  2. Information Management Services, Inc., Rockville, MD, USA

    Gigi Yuan MS, Timothy S. McNeel BA & Dennis W. Buckman PhD

  3. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Dana Casciotti MPH

  4. Health Services and Economics Branch/Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Executive Plaza North, Room 4005, 6130 Executive Blvd., MSC 7344, Bethesda, MD, 20892-7344, USA

    K. Robin Yabroff PhD, MBA

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  1. K. Robin Yabroff PhD, MBA
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Correspondence to K. Robin Yabroff PhD, MBA.

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Yabroff, K.R., Klabunde, C.N., Yuan, G. et al. Are Physicians’ Recommendations For Colorectal Cancer Screening Guideline-Consistent?. J GEN INTERN MED 26, 177–184 (2011). https://doi.org/10.1007/s11606-010-1516-5

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  • DOI: https://doi.org/10.1007/s11606-010-1516-5

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