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

Yabroff, K. Robin; Klabunde, Carrie N.; Yuan, Gigi; McNeel, Timothy S.; Brown, Martin L.; Casciotti, Dana; Buckman, Dennis W.; Taplin, Stephen H.

doi:10.1007/s11606-010-1516-5

Cited by 69 publications

(56 citation statements)

References 39 publications

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“…Many endoscopists do not consistently agree with the follow-up intervals recommended in the guidelines and report preferences for shorter screening and surveillance intervals. 17 , [29][30][31] This reinforces the need to achieve endoscopists' support in addressing overuse, possibly by examining practice variation and establishing locally We found that bowel preparation was correlated with surveillance exam overuse. This variable has important limitations.…”

Section: Discussionmentioning

confidence: 60%

Overuse of Colonoscopy for Colorectal Cancer Screening and Surveillance

et al. 2014

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BACKGROUND: Ongoing efforts to increase colorectal cancer (CRC) screening rates have raised concerns that these exams may be overused, thereby subjecting patients to unnecessary risks and wasting healthcare resources. OBJECTIVE: Our aim was to measure overuse of screening and surveillance colonoscopies among average-risk adults, and to identify correlates of overuse. DESIGN, SETTING, AND PARTICIPANTS: Our approach was a retrospective cohort study using electronic health record data for patients 50-65 years old with no personal history of CRC or colorectal adenomas with an incident CRC screening colonoscopy from 2001 to 2010 within a multispecialty physician group practice. MAIN OUTCOME MEASURES: We measured time to next screening or surveillance colonoscopy and predictors of overuse (exam performed more than one year earlier than guideline recommended intervals) of colonoscopies. KEY RESULTS: We identified 1,429 adults who had an incident colonoscopy between 2001 and 2010, and they underwent an additional 871 screening or surveillance colonoscopies during a median follow-up of 6 years. Most follow-up screening colonoscopies (88 %) and many surveillance colonoscopies (49 %) repeated during the study represented overuse. Time to next colonoscopy after incident screening varied by exam findings (no polyp: median 6.9 years, interquartile range [IQR]: 5.1-10.0; hyperplastic polyp: 5.7 years, IQR: 4.9-9.7; low-risk adenoma: 5.1 years, IQR: 3.3-6.3; high-risk adenoma: 2.9 years, IQR: 2.0-3.4, p<0.001). In logistic regression models of colonoscopy overuse, an endoscopist recommendation for early follow-up was strongly associated with overuse of screening colonoscopy (OR 6.27, and surveillance colonoscopy (OR 13.47,. In a multilevel logistic regression model, variation in the overuse of screening colonoscopy was significantly associated with the endoscopist performing the previous exam. CONCLUSIONS:Overuse of screening and surveillance exams are common and should be monitored by healthcare systems. Variations in endoscopist recommendations represent targets for interventions to reduce overuse.

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Section: Discussionmentioning

confidence: 60%

Overuse of Colonoscopy for Colorectal Cancer Screening and Surveillance

et al. 2014

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“…Consistent with prior surveys regarding the cancer screening practices of primary care providers, we found evidence of Boveruse,^with providers recommending more frequent screening than that endorsed in USPSTF guidelines, as well as screening at the extremes of age. 13,22,23 Overuse of screening is expensive from societal and health system perspectives, as it may divert resources from other needed care and may result in unneeded follow-up evaluation and risk for individual patients. 24,25 A recent analysis found that full adherence to USPSTF-recommended breast cancer screening strategies would save $4.4 billion and would screen 15 % more women than in current practice.…”

Section: Discussionmentioning

confidence: 99%

Provider Attitudes and Screening Practices Following Changes in Breast and Cervical Cancer Screening Guidelines

et al. 2015

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BACKGROUND: Changes to national guidelines for breast and cervical cancer screening have created confusion and controversy for women and their primary care providers. OBJECTIVE: To characterize women's primary health care provider attitudes towards screening and changes in practice in response to recent revisions in guidelines for breast and cervical cancer screening. DESIGN, SETTING, PARTICIPANTS: In 2014, we distributed a confidential web and mail survey to 668 women's health care providers affiliated with the four clinical care networks participating in the three PROSPR (Populationbased Research Optimizing Screening through Personalized Regimens) consortium breast cancer research centers (385 respondents; response rate 57.6 %). MAIN MEASURES:We assessed self-reported attitudes toward breast and cervical cancer screening, as well as practice changes in response to the most recent revisions of the U.S. Preventive Services Task Force (USPSTF) recommendations. KEY RESULTS: The majority of providers believed that mammography screening was effective for reducing cancer mortality among women ages 40-74 years, and that Papanicolaou (Pap) testing was very effective for women ages 21-64 years. While the USPSTF breast and cervical cancer screening recommendations were widely perceived by the respondents as influential, 75.7 and 41.2 % of providers (for mammography and cervical cancer screening, respectively) reported screening practices in excess of those recommended by USPSTF. Provider-reported barriers to concordance with guideline recommendations included: patient concerns (74 and 36 % for breast and cervical, respectively), provider disagreement with the recommendations (50 and 14 %), health system measurement of a provider's screening practices that use conflicting measurement criteria (40 and 21 %), concern about malpractice risk (33 and 11 %), and lack of time to discuss the benefits and harms with their patients (17 and 8 %). CONCLUSIONS: Primary care providers do not consistently follow recent USPSTF breast and cervical cancer screening recommendations, despite noting that these guidelines are influential.KEY WORDS: breast cancer screening; cervical cancer screening; provider practice patterns; primary care; clinical practice guidelines.

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“…The need for educational intervention beyond hereditary CRC syndrome screening was indicated by a national survey conducted in 2007 of 1,266 PCPs, which reflected both general CRC screening overuse and underuse. Only 19.1% of PCPs made guideline-consistent recommendations across all CRC screening modalities [32]. …”

Section: Discussionmentioning

confidence: 99%

Impact of Academic Affiliation and Training on Knowledge of Hereditary Colorectal Cancer

Chan

Blazey²,

Tegay³

et al. 2014

Public Health Genomics

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Background: Knowledge about hereditary colorectal cancer (CRC) can aid cancer screening and prevention in high-risk patients. Genetic testing, once conducted primarily at academic centers, is now routinely performed in a variety of clinics. Nonacademic physicians may not be aware of hereditary CRC standards of care. Methods: From August to November 2012, a survey was administered to predominantly primary care physicians evaluating academic center affiliation, past training in genetics and knowledge regarding hereditary CRC. Results: One hundred forty physicians completed the survey. Knowledge of hereditary CRC was neither associated with academic affiliation nor with training during medical school or residency, but with continuing medical education (CME) training. Those with CME training were more likely to know that screening could be enhanced for patients with a hereditary cancer risk (OR = 4.49, 95% CI = 1.40-14.38) and that an individual with hereditary CRC would have different screening recommendations (OR = 7.49, 95% CI = 1.37-40.81). Residency training and CME training were associated with more frequent hereditary risk assessment. Conclusion: Genetics training may be associated with physicians' knowledge and assessment of hereditary CRC. Training at the CME level in particular may be integral to the delivery of genetic services in clinical practice.

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

Cited by 69 publications

References 39 publications

Overuse of Colonoscopy for Colorectal Cancer Screening and Surveillance

Overuse of Colonoscopy for Colorectal Cancer Screening and Surveillance

Provider Attitudes and Screening Practices Following Changes in Breast and Cervical Cancer Screening Guidelines

Impact of Academic Affiliation and Training on Knowledge of Hereditary Colorectal Cancer

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