Colorectal cancer screening and surveillance practices by primary care physicians: results of a national survey

Sharma, Virender K.; Vasudeva, Rajeev; Howden, Colin W.

doi:10.1111/j.1572-0241.2000.02093.x

Cited by 65 publications

(30 citation statements)

References 14 publications

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“…The 2002 guidelines reflect a change from the ACS 1997 recommendations (15); annual FOBT or SIG every 5 years now appear as separate screening options, whereas the two tests were previously recommended in combination. The FOBT approach currently recommended is the 3-day takehome kit method, but the digital rectal exam (DRE), a one-time, in-office test for occult blood, continues to be performed at high rates (14,16), despite the lack of evidence in support of its effectiveness (13,17).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Colorectal Cancer Screening in a Large Medical Organization

Hawley

Vernon

Levin

et al. 2004

Cancer Epidemiology, Biomarkers &Amp; Prevention

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The primary objective of this study was to determine the prevalence of colorectal cancer (CRC) screening among eligible patients in a large medical practice. A secondary objective was to compare CRC screening rates obtained from medical records with physician self-reported CRC screening recommendation. We conducted a retrospective record review of 214 patients ages > 50 years of a large multispecialty medical organization in Houston, Texas, for receipt of fecal occult blood test (FOBT), flexible sigmoidoscopy (SIG), and/or colonoscopy (COL). We estimated prevalence using two definitions: (a) FOBT in past year or SIG in past 5 years or COL in past 10 years; and (b) FOBT in past year and SIG in past 5 years or COL in past 10 years. Age, gender, race/ethnicity, family history, number of chronic conditions, and index visit were independent variables. Contingency table and logistic regression analysis were used to test for associations between outcomes and independent variables. Our study population was 48% male with a mean age of 63 years (range: 53-84 years). One-quarter of the records showed FOBT by 3-day kit (51 of 214) and 27% by digital rectal exam (57 of 214). SIG was recorded in 32% of records. Half (54%) of the records had documentation of CRC screening according to definition no. 1 and 19% according to definition no. 2. Screening rates from medical record review were lower than those derived from physician self-report. Our findings underscore the need for interventions to improve CRC screening in primary care settings. IntroductionColorectal cancer (CRC) is the fourth most common cancer and the second leading cause of cancer death in the United States.

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Section: Introductionmentioning

confidence: 99%

Prevalence of Colorectal Cancer Screening in a Large Medical Organization

Hawley

Vernon

Levin

et al. 2004

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…In a national physician survey conducted in 2000, only 52% and 7% of primary care physicians would recommend colonoscopy or flexible sigmoidoscopy and barium enema, respectively, to FOBT (+) patients in hypothetical cases, for a total CDE recommendation rate of 59% (16). Also, a recent study has shown that a substantial proportion of primary care physicians continue to practice CRC screening methods not recommended by current guidelines (e.g., single stool sample obtained by digital rectal examination) and follow up abnormal results with methods other than CDE (e.g., repeat FOBT, sigmoidoscopy only) (17).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of complete diagnostic examination in clinical practice settings

Jimbo

Meyer

Hyslop

et al. 2006

Cancer Detection and Prevention

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Background-Thorough follow-up of a positive fecal occult blood test (FOBT) result, or a complete diagnostic evaluation (CDE), is recommended as routine care on the basis of findings from colorectal cancer (CRC) screening trials. CDE involves either colonoscopy or the combination of flexible sigmoidoscopy and double contrast barium enema x-ray. However, little evidence outside clinical screening trial settings has been reported in the literature to support CDE performance. The focus of this study was to determine the impact of CDE in primary care practice settings.

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“…Thus, deciding not to perform CDE for patients with positive FOBT results unless all of their 3 cards tested positive is unsupported by the guidelines. 10 Finally, despite concerns regarding their possible effect on FOBT, dietary noncompliance or the use of contraindicated medications would not justify CDE nonperformance. [23][24][25] In determining the appropriateness of physician action for CDE nonperformance, we concluded that an inappropriate action was taken with only those patients for whom none of the reported reasons was compatible with the guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10][11][12][13][14][15][16] These data suggest that opportunities to diagnose early colorectal cancer and colorectal polyps may frequently be missed among P OSIT IV E F OB T R E SULT S patients who have positive FOBT results. Little is currently known, however, about the specifi c reasons for nonperformance of a complete evaluation.…”

Section: Introductionmentioning

confidence: 99%

Reasons Patients With a Positive Fecal Occult Blood Test Result Do Not Undergo Complete Diagnostic Evaluation

Jimbo

Myers

Meyer

et al. 2009

The Annals of Family Medicine

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PURPOSE Screening for fecal occult blood reduces colorectal cancer mortality by identifying patients with positive results for complete diagnostic evaluation (CDE). CDE rates are suboptimal, however. We sought to determine common reasons for nonperformance of a CDE as recorded by the primary care physician. METHODSWe undertook a descriptive analysis of reasons reported by physicians for nonperformance of CDE in a nested sample of patients with positive fecal occult blood test (FOBT) results from a randomized controlled trial designed to evaluate the impact of a physician intervention (CDE reminder-feedback and educational outreach) on recommendation and performance rates in primary care practices. Inspection of administrative data for 1,468 patients with positive results showed that 661 (45%) did not undergo CDE. We reviewed patient followup forms, which were completed by physicians for patients who did not have a CDE, to identify reasons for nonperformance. RESULTSNonperformance of CDE was due to physician decision for 217 patients (33%). In 123 patients (19%), reasons for nonperformance were compatible with the guidelines, and in 94 patients (14%), they were not. Reasons wholly or partially due to factors other than physician decision were noted in 212 patients (32%); physician action was considered to be appropriate in these patients. For the 232 patients (35%) without a clearly documented reason for CDE nonperformance, the appropriateness of the physicians' action could not be determined.CONCLUSIONS Decision making by primary care physicians had a major effect on nonperformance of CDE after a positive FOBT result. Colorectal cancer screening programs should include guidance for physicians about when a CDE should and should not be performed.

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Colorectal cancer screening and surveillance practices by primary care physicians: results of a national survey

Cited by 65 publications

References 14 publications

Prevalence of Colorectal Cancer Screening in a Large Medical Organization

Prevalence of Colorectal Cancer Screening in a Large Medical Organization

Effectiveness of complete diagnostic examination in clinical practice settings

Reasons Patients With a Positive Fecal Occult Blood Test Result Do Not Undergo Complete Diagnostic Evaluation

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