Abstract
OBJECTIVE: Successful colorectal cancer screening relies in part on physicians ordering a complete diagnostic evaluation of the colon (CDE) with colonoscopy or barium enema plus sigmoidoscopy after a positive screening fecal occult blood test (FOBT).
DESIGN: We surveyed primary care physicians about colorectal cancer screening practices, beliefs, and intentions. At least 1 physician responded in 318 of 413 (77%) primary care practices that were affiliated with a managed care organization offering a mailed FOBT program for patients aged ≥50 years. Of these 318 practices, 212 (67%) had 602 FOBT+ patients from August through November 1998. We studied 184 (87%) of these 212 practices with 490 FOBT+ patients after excluding those judged ineligible for a CDE or without demographic data. Three months after notification of the FOBT+ result, physicians were asked on audit forms if they had ordered CDEs for study patients. Patient- and physician-predictors of ordering CDEs were identified using logistic regression.
MEASUREMENTS AND MAIN RESULTS: A CDE was ordered for only 69.5% of 490 FOBT+ patients. After adjustment, women were less likely to have had CDE initiated than men (adjusted odds, 0.66; confidence interval, 0.44 to 0.97). Physician survey responses indicating intermediate or high intention to evaluate a FOBT+ patient with a CDE were associated with nearly 2-fold greater adjusted odds of actually initiating a CDE in this circumstance versus physicians with a low intention.
CONCLUSIONS: Primary care physicians often fail to order CDE for FOBT+ patients. A CDE was less likely to be ordered for women and was influenced by physician’s beliefs about CDEs.
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References
Centers for Disease Control and Prevention. CDC WONDER Compressed Mortality Database 1999. Available at: http://wonder.cdc.gov/mortSQL.shtml. Accessed April 23, 2003.
Hardcastle JD, Chamberlain JO, Robinson MH, et al. Randomized controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348:1472–7.
Kronborg O, Fenger C, Olsen J, Jorgensen OD, Sondergaard O. Randomized study of screening for colorectal cancer with fecal-occult-blood test. Lancet. 1996;348:1467–71.
Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med. 1993;328:1365–71.
Mandel JS, Church TR, Bond JH, et al. The effect of fecal occult blood screening on the incidence of colorectal cancer. N Engl J Med. 2000;343:1603–7.
Centers for Disease Control and Prevention. State- and sex-specific prevalence of selected characteristics—Behavioral Risk Factor Surveillance System, 1996 and 1997. MMWR Morb Mortal Wkly Rep. 2000;49:1–39.
Sharma VK, Vasudeva R, Howden CW. Colorectal cancer screening and surveillance practices by primary care physicians: results of a national survey. Am J Gastroenterol. 2000;95:1551–6.
U.S. Preventive Services Task Force. Guide to clinical preventive services: Report of the U.S. Preventive Services Task Force. 2nd ed. Baltimore, Md: Williams and Wilkins; 1996:89–103.
Byers T, Levin B, Rothenberger D, Dodd GD, Smith RA. American Cancer Society guidelines for screening and surveillance for early detection of colorectal polyps and cancer: update 1997. American Cancer Society Detection and Treatment Advisory Group on Colorectal Cancer. CA Cancer J Clin. 1997;47:154–60.
Myers RE, Hyslop T, Gerrity M, et al. Physician intention to recommend complete diagnostic evaluation in colorectal cancer screening. Cancer Epidemiol Biomarkers Prevent. 1999;8:587–93.
Azjen I, Fishbein M. Understanding, Attitudes, and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice-Hall; 1980.
Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall; 1986.
Myers RE, Fishbein G, Hyslop T, et al. Measuring complete diagnostic evaluation in colorectal cancer screening. Cancer Detect Prev. 2001;25:174–82.
Shields HM, Weiner MS, Henry DR, et al. Factors that influence the decision to do an adequate evaluation of a patient with a positive stool for occult blood. Am J Gastroenterol. 2001;96:196–203.
Lieberman D. Screening/early detection model for colorectal cancer. Why screen? Cancer. 1994;74:2023–7.
Mandelblatt J, Andrews H, Kao R, Wallace R, Kerner J. The late-stage diagnosis of colorectal cancer: demographic and socioeconomic factors. Am J Public Health. 1996;86:1794–7.
Donovan JM, Syngal S. Colorectal cancer in women: an under-appreciated but preventable risk. J Womens Health. 1998;7:45–8.
Erblich J, Bovbjerg DH, Norman C, Valdimarsdottir HB, Montgomery GH. It won’t happen to me: lower perception of heart disease risk among women with family histories of breast cancer. Prev Med. 2000;31:714–21.
Mandelson MT, Curry SJ, Anderson LA, et al. Colorectal cancer screening participation by older women. Am J Prev Med. 2000;19:149–54.
Richards C, Klabunde C, O’Malley M. Physicians’ recommendations for colon cancer screening in women. Too much of a good thing? Am J Prev Med. 1998;15:246–9.
Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–26.
Daly SC, Roger VL, Leibson C, et al. Cardiology services after stress testing: are there sex differences? A population-based study. J Clin Epidemiol. 2000;53:661–8.
Turner BJ, Markson LE, McKee LJ, Houchens R, Fanning T. Health care delivery, zidovudine use, and survival of women and men with AIDS. J Acquir Immune Defic Syndr. 1994;7:1250–62.
Mocroft A, Gill MJ, Davidson W, Phillips AN. Are there gender differences in starting protease inhibitors, HAART, and disease progression despite equal access to care? J Acquir Immune Defic Syndr. 2000;24:475–82.
Arfken CL, Borisova N, Klein C, di Menza S, Schuster CR. Women are less likely to be admitted to substance abuse treatment within 30 days of assessment. J Psychoactive Drugs. 2002;34:33–8.
Pignone M, Rich M, Teutsch SM, Berg AO, Lohr KN. Screening for colorectal cancer in adults at average risk: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;137:132–41.
Nikolajevic-Sarunac J, Henry DA, O’Connell DL, Robertson J. Effects of information framing on the intentions of family physicians to prescribe long-term hormone replacement therapy. J Gen Intern Med. 1999;14:591–8.
Borum ML. Cancer screening in women by internal medicine resident physicians. South Med J. 1997;90:1101–5.
Massari V, Retel O, Flahault A. How do general practitioners approach hepatitis C virus screening in France? Eur J Epidemiol. 1999;15:119–24.
Fender GR, Prentice A, Gorst T, et al. Randomised controlled trial of educational package on management of menorrhagia in primary care: the Anglia menorrhagia education study. BMJ. 1999;318:1246–50.
Block B, Branham RA. Efforts to improve the follow-up of patients with abnormal Papanicolaou test results. J Am Board Fam Pract. 1998;11:77–9.
McCarthy BD, Yood MU, Janz NK, Boohaker EA, Ward RE, Johnson CC. Evaluation of factors potentially associated with inadequate follow-up of mammographic abnormalities. Cancer. 1996;77:2070–6.
Thomson-O’Brien MA, Oxman AD, Davis DA, Haynes RB, Freemantle N, Harvey EL. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2000;2:CD000409.
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This study was supported by a grant from the National Cancer Institute.
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Turner, B., Myers, R.E., Hyslop, T. et al. Physician and patient factors associated with ordering a colon evaluation after a positive fecal occult blood test. J GEN INTERN MED 18, 357–363 (2003). https://doi.org/10.1046/j.1525-1497.2003.20525.x
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DOI: https://doi.org/10.1046/j.1525-1497.2003.20525.x