Barriers of and Facilitators to Physician Recommendation of Colorectal Cancer Screening

Higher Physician Density is Associated with Lower Incidence of Late-stage Colorectal Cancer

“…This is further supported by the fact that after the initiation of Medicare coverage of colonoscopy for average-risk CRC, gastroenterologist density became more strongly associated with reduced late-stage CRC incidence than prior to such coverage. Physician recommendation is an important determinant of CRC screening [24][25][26] with individuals with more frequent physician contact being more likely to undergo screening 27 . Inadequate physician time with the patient is another barrier to screening 25 .…”

“…As physician recommendation is a key determinant of patients' acceptance of screening, adequate access may be an important contributor to disparity. Frequency of physician contact as well as time spent during individual visits may influence screening [24][25][26][27] . Higher physician-perpopulation ratio may improve access, decrease waiting times and increase the opportunity for contact between the patient and physician.…”

Cultural, Economic, and Psychological Predictors of Colonoscopy in a National Sample

“…While compliance with CRC screening guidelines has been evaluated in terms of receipt of any type of test, we focused specifically on colonoscopy because it would ultimately be indicated if other tests are abnormal 1 and this procedure provides a more comprehensive evaluation of the colon relative to other procedures. 3 Colonoscopy is also estimated to reduce the risk of CRC by 76% to 90% 14,15 and is the preferred screening modality among many primary care providers 16,17 because of its diagnostic and therapeutic value over other tests and its coverage by Medicare and other insurers. 18 Finally, individuals who have a negative result typically do not need to be screened again for 5-10 years and those at older ages, may not need screening again.…”

Physician use of persuasion and colorectal cancer screening

“…Of the barriers and facilitators of CRC screening that have been studied, receipt of a physician recommendation has consistently been found to be associated with screening use [2]. Yet, at the same time, overall adherence to physician-recommended CRC screening remains low [3][4][5] and a 2010 National Institutes of Health (NIH) consensus statement on CRC screening specifically highlighted the need for research on the role of physician recommendation and CRC screening adherence [2].There have now been over a dozen reports describing patient-physician communication and decisionmaking in the context of CRC screening [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Approximately half of these studies relied on patient reports to understand these processes, while the remainder utilized direct observation methods.…”

“…There have now been over a dozen reports describing patient-physician communication and decisionmaking in the context of CRC screening [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Approximately half of these studies relied on patient reports to understand these processes, while the remainder utilized direct observation methods.…”