Colorectal cancer screening of high-risk populations: A national survey of physicians

Abstract

BackgroundThe incidence of colorectal cancer can be decreased by appropriate use of screening modalities. Patients with a family history of colon cancer and of African-American ethnicity are known to be at higher risk of developing colorectal cancer. We aimed to determine if there is a lack of physician knowledge for colorectal cancer screening guidelines based on family history and ethnicity. Between February and April 2009 an anonymous web-based survey was administered to a random sample selected from a national list of 25,000 internists, family physicians and gastroenterologists. A stratified sampling strategy was used to include practitioners from states with high as well as low CRC incidence. All data analyses were performed following data collection in 2009.ResultsThe average knowledge score was 37 ± 18% among the 512 respondents. Gastroenterologists averaged higher scores compared to internists, and family physicians, p = 0.001. Only 28% of physicians correctly identified the screening initiation point for African-Americans while only 12% of physicians correctly identified the screening initiation point and interval for a patient with a family history of CRC. The most commonly cited barriers to referring high-risk patients for CRC screening were "patient refusal" and "lack of insurance reimbursement."ConclusionsThere is a lack of knowledge amongst physicians of the screening guidelines for high-risk populations, based on family history and ethnicity. Educational programs to improve physician knowledge and to reduce perceived barriers to CRC screening are warranted to address health disparities in colorectal cancer.

Colorectal Cancer Screening in High-risk Populations: a Survey of Cognition among Medical Professionals in Jiangsu, China

“…Compared with a previous study of physician cognition and practice patterns (Schroy et al, 2002;White et al, 2012), we observed differences in cognition between different doctors, eg., oncologists, general surgeons and gastroenterologists, different title, different size of hospital, academic degree, etc. Though previous researches reported that physicians cited "a lack of time to inquire about a family history" as a barrier to screening, in our study, the main barrier is "patient refusal to colonoscopy without anesthesia for anxiety" (Schroy et al, 2002;White et al, 2012).…”

“…Though previous researches reported that physicians cited "a lack of time to inquire about a family history" as a barrier to screening, in our study, the main barrier is "patient refusal to colonoscopy without anesthesia for anxiety" (Schroy et al, 2002;White et al, 2012). Our findings are in line with prior studies that have reported "lack of a full family history and communication" and "Insufficient cognitive of current guidelines" as physician-identified barriers to CRC screening (Dulai et al, 2004;Guerra et al, 2007).…”

Low uptake of colorectal cancer screening among African Americans in an integrated Veterans Affairs health care network

“…Poor adherence to guidelines may be due to inadequate provider knowledge, failure of providers to recommend screening to African Americans, ineffective communication between providers and patients, or patient refusal of recommendations. As evidence supports guideline knowledge deficits among primary care providers and gastroenterologists, at least some of the disparities may be reversed with formal education about guidelines and quality assessment of adherence to guidelines among providers [26]. Empowering African American patients with information about their health risks and the benefits of screening is also imperative to improve screening uptake.…”

Evidence-based Guidelines for Precision Risk Stratification-Based Screening (PRSBS) for Colorectal Cancer: Lessons learned from the US Armed Forces: Consensus and Future Directions

“…The result of a recently conducted trial testing the knowledge of internists, family practitioners and gastroenterologists on the screening initiation point in CRC was alarming 111 . The trial utilized an anonymous web-based survey which was sent to 10% of American Medical Association members 111. Results of 512 responders found a dismal average knowledge score of 37 ± 18% 111.…”