Cancer prevention practices among Texas primary care physicians

Abstract

Primary care physicians are uniquely positioned to practice primary and secondary cancer prevention. However, despite a positive commitment, many physicians are pessimistic about the success of their interventions. This study describes the self-reported cancer prevention practices and perceived obstacles of 1600 Texas primary care physicians. These practices differed by primary care specialty and by length of time in practice. Time constraints were uniformly perceived as the leading obstacle to the provision of smoking cessation counseling. High cost, lack of third-party reimbursement, and poor patient compliance were cited as the leading barriers to patient referral for screening mammography. Professional education should stress to physicians that interventions need not be elaborate, expensive, or time consuming, the main purpose being to motivate and reinforce patient behavior. The special challenges of introducing health promotion activities into the clinical setting must be addressed with practical aids such as prompting systems, flowsheets, and computer-based aids for monitoring compliance rates.

Primary Care: Is There Enough Time for Prevention?

“…The most common barriers identified are lack of time during the office visit, inadequate insurance reimbursement, patient refusal to discuss or comply with recommendations, and lack of physician expertise in counseling techniques. [6][7][8][9][10] Consistent with the finding that time is a salient barrier, Zyzanski and colleagues have shown that high-volume physicians perform fewer preventive services. 11 Although a recent study showed that time spent in office visits has increased slightly in the past decade, 12 physicians continue to claim that not having enough time is a barrier to performing preventive services.…”

The Need for Health Promotion in Oral Cancer Prevention and Early Detection

“…Other studies suggest that physicians might not be fulfilling their responsibilities for cancer screening and early detection in general (67)(68)(69)(70). When asked about barriers to completing cancer screenings in surveys that did not include oral cancer, physicians listed a treatment-based orientation, time constraints, lack of financial rewards, poor patient compliance, and lack of immediate results (68-7'0).…”

“…Continuing education should be simple, valid, acceptable, and concise to enhance providers' attitudes and behaviors (69). Although educational guides for both physicians and nurses regarding early detection of oral cancer are available, their use seems limited and other approaches may be needed (68,(102)(103)(104).…”

Barriers to the Provision of Smoking Cessation Services Reported by Clinicians in Underserved Communities

“…[17][18][19] Surveys have also been administered to emergency physicians, 20 dentists, 21 and physicians caring primarily for middleclass and insured patients. [22][23][24] In addition, there is a robust foreign literature. [25][26][27][28] However, there is only 1 study of the views of African-American physicians, 29 none focusing on physicians caring for low-income patients, and none using primarily qualitative methods.…”