Primary care physicians’ decisions to perform flexible sigmoidoscopy

Abstract

OBJECTIVE:This study was designed to identify factors that influence primary care physicians' willingness to perform flexible sigmoidoscopy. MEASUREMENTS:Using a mailed questionnaire, we surveyed all 161 primary care physicians participating in a large health care system. We obtained information on training, current practice patterns, beliefs about screening for colorectal cancer, and the influence of various factors on their decision whether or not to perform flexible sigmoidoscopy in practice. MAIN RESULTS:Of the 131 physicians included in the analysis, 68 (52%) reported training in flexible sigmoidoscopy, of whom 36 (53%) were currently performing flexible sigmoidoscopy in practice. Time required to perform flexible sigmoidoscopy, availability of adequately trained staff, and availability of flexible sigmoidoscopy services provided by other clinicians were identified most often as reasons not to perform the procedure in practice. Male physicians were more likely than female physicians to report either performing flexible sigmoidoscopy or desiring to train to perform flexible sigmoidoscopy (odds ratio 2.61; 95% confidence interval 1.10, 6.23). This observed difference appears to be mediated through different weighting of decision criteria by male and female physicians. CONCLUSIONS:Approximately half of these primary care physicians trained in flexible sigmoidoscopy chose not to perform this procedure in practice. Self-perceived inefficiency in performing office-based flexible sigmoidoscopy deterred many of these physicians from providing this service for their patients. C olorectal cancer is the third most commonly diagnosed cancer for both men and women in the United States and the second most common cause of cancerrelated deaths. 1 Several studies have suggested that screening sigmoidoscopy reduces mortality from colorectal cancer, 2-4 and numerous medical societies recommend routine screening with flexible sigmoidoscopy. 5-9 However, current estimates suggest that there are too few gastroenterologists in the United States to provide all of the recommended screening flexible sigmoidoscopies and follow-up colonoscopies. 10 As a result, primary care physicians have been identified as a source of manpower to fill this gap.Unfortunately, many primary care physicians are not trained to perform flexible sigmoidoscopy or do not perform flexible sigmoidoscopy despite being trained. Previous studies suggest that only 23% to 67% of primary care physicians routinely perform flexible sigmoidoscopy as part of their practice. 11-13 Furthermore, it is unclear how physicians choose whether or not to perform flexible sigmoidoscopy as part of their practice. The few studies addressing this issue suggest that the physicians' training, gender, and practice location influence this decision. A survey of members of the American Academy of Family Physicians demonstrated that physicians who were board certified, had more recently completed training, and practiced in smaller communities were more likely to perform flexible sigmoidosc...

Colorectal Cancer Screening by Primary Care Physicians

“…Few studies have examined physicians' specific reasons for performing or not performing this procedure. Low procedure volumes, inadequate reimbursement, and lack of time and support staff have been documented as barriers to physicians' provision of sigmoidoscopy in their practices 14,35,36…”

Colorectal Cancer Screening Practices among Obstetrician/Gynecologists and Nurse Practitioners

“…We also found that providers in practice between 5 and 10 years were more likely to report screening than other groups, which is consistent with other studies suggesting recent graduates are more likely to screen for CRC than those in practice >10 years. 27,28 In previous work, provider gender has also been shown to affect patient CRC screening adherence. Menees et al 29 demonstrated that having a female physician was associated with increased prevalence of CRC screening at the time of upper endoscopy (EGD) and increased CRC screening completion in the following 6 months.…”

Emergency Physician Perspectives on Central Venous Catheterization in the Emergency Department: A Survey‐based Study

“…Our findings are consistent with those of others, showing a sex-based difference in procedural practice. 38,39 For example, Lewis et al 37,38 found that male primary care physicians were more than two times more likely (OR = 2.61) to report performing flexible sigmoidoscopy or wishing to train to perform it. The reasons for this type of sex discrepancy are not clear.…”