Primary Care Provider Beliefs and Recommendations About Colorectal Cancer Screening in Four Healthcare Systems

Abstract

◥Primary care provider's (PCP) perceptions of colorectal cancer screening test effectiveness and their recommendations for testing intervals influence patient screening uptake. Few large studies have examined providers' perceptions and recommendations, including their alignment with evidence suggesting comparable test effectiveness and guideline recommendations for screening frequency. Providers (n ¼ 1,281) within four healthcare systems completed a survey in 2017-2018 regarding their perceptions of test effectiveness and recommended intervals for colonoscopy and fecal immunochemical testing (FIT) for patients ages 40-49, 50-74, and ≥75 years. For patients 50-74 (screening eligible), 82.9% of providers rated colonoscopy as very effective versus 59.6% for FIT, and 26.3% rated colonoscopy as more effective than FIT. Also, for this age group, 77.9% recommended colonoscopy every 10 years and 92.4% recommended FIT annually. For patients ages 40-49 and ≥75, more than onethird of providers believed the tests were somewhat or very effective, although >80% did not routinely recommend screening by either test for these age groups. Provider screening test interval recommendations generally aligned with colorectal cancer guidelines; however, 25% of providers believed colonoscopy was more effective than FIT for mortality reduction, which differs from some modeling studies that suggest comparable effectiveness. The latter finding may have implications for health systems where FIT is the dominant screening strategy. Only one-third of providers reported believing these screening tests were effective in younger and older patients (i.e., <50 and ≥75 years). Evidence addressing these beliefs may be relevant if cancer screening recommendations are modified to include older and/or younger patients.

Perceived effectiveness of cancer screening among family medicine and internal medicine physicians in the United States

“…This study provides important information about beliefs among American family medicine and internal medicine physicians regarding effectiveness of various types of cancer screening. Overall, the rates of perceived effectiveness were lower than other reports in the last decade ( Ghai et al, 2020 , Khairy et al, 2018 , Lewis et al, 2015 , Raz et al, 2018 ), perhaps related in part to the fact that the current data are more recent and from a national sample. Results suggest that a majority of physicians support colonoscopy for colorectal cancer screening, which is consistent with previous studies and recommendations ( Brown et al, 2015 ).…”

“…It is likely that perceived effectiveness is associated with, but not identical to, screening referral rates. For example, one study found that 82.9% of primary care providers rated colonoscopy as very effective ( Ghai et al, 2020 ), and 77.9% recommended colonoscopy to patients. Additionally, it is well-known that screening recommendations or referrals do not necessarily translate into actual screening completion.…”

“…Finally, primary care providers ( n = 1,281) within four healthcare systems in California, Washington, and Texas completed a survey in 2017–2018. For patients 50–74 (screening eligible), 82.9% of providers rated colonoscopy as very effective ( Ghai et al, 2020 ). These prior studies had various limitations such as older data, a relatively small sample size, limited geographic reach, and/or focus on only one screening type.…”

Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States

“…Even though this was a cross-sectional study, this difference is important and suggests that public health interventions should focus efforts to increase colorectal cancer screening in rural areas. It is important to note that while colonoscopy is reported as favored and the most recommended modality by primary care practitioners, 26 , 27 it may not be the best solution in rural communities, where travel and access barriers are pronounced for colorectal cancer screening. 28 , 29 Newer stool-based tests, like fecal immunohistochemical tests, might be more acceptable to rural residents and can address issues with respect to access barriers in rural communities.…”

Factors Associated With Clinician Recommendations for Colorectal Cancer Screening Among Average-Risk Patients: Data From a National Survey

“…CRC screening preferences appear to be misaligned between clinicians and patients: whereas clinicians tend to prefer screening colonoscopy over stool-based tests (13)(14)(15)(16), when given options, patients tend to prefer stoolbased tests over screening colonoscopy (17,18). Although research is extensive on patient, clinician, and health care system factors associated with CRC screening completion, data on clinician recommendation of guideline-endorsed CRC screening methods and factors associated with guideline-consistent screening recommendations are sparse (19,20). A 2007 survey of a nationally representative sample of primary care clinicians (PCCs) showed that less than 20% made guideline-consistent recommendations across all CRC screening methods (19).…”