Colorectal Cancer Screening by Primary Care Physicians

Klabunde, Carrie N.; Lanier, David; Nadel, Marion R.; McLeod, Caroline; Yuan, Gigi; Vernon, Sally W.

doi:10.1016/j.amepre.2009.03.008

Cited by 188 publications

(189 citation statements)

References 42 publications

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“…26 Though our study suggests that primary care providers often discuss constructs related to CRC screening, discussions were often limited in scope. As in other US-based studies, [27][28][29][30] study providers demonstrated a clear preference for screening colonoscopy over flexible sigmoidoscopy or FOBT, which were discussed in a minority of visits.…”

Section: Discussionmentioning

confidence: 92%

Physician Counseling for Colorectal Cancer Screening: Impact on Patient Attitudes, Beliefs, and Behavior

Fenton

Jerant

Friederichs-Fitzwater

et al. 2011

The Journal of the American Board of Family Medicine

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Purpose: To determine how often primary care physicians address patient-level health behavioral constructs that are associated with colorectal cancer (CRC) screening and whether physician counseling addressing constructs is associated with favorable changes in patients' attitudes, beliefs, intentions, and subsequent screening.Methods: We conducted a prospective cohort study of patients eligible for CRC screening and attending routine appointments within two academic primary care clinics (50 patients, 20 primary care clinicians). Patients completed validated measures of behavioral constructs associated with CRC screening (benefits, barriers, susceptibility, self-efficacy, intention, and stage of readiness) before and after their visits. Audio-recorded discussions of CRC screening were coded for conversation addressing constructs. Bivariate and regression analyses estimated associations between discussions that did and did not address constructs and, after the visit, measures of perceived benefits, barriers, susceptibility, self-efficacy, intention, and completion of CRC screening within 6 months.Results: Physicians discussed CRC screening during 38 encounters (76%) and addressed behavioral constructs during 26 (52%). Relative to visits without CRC screening discussion, visits with discussion were associated with increased perceived susceptibility (␤ ‫؍‬ 0.39; 95% CI, 0.09 -0.68) and screening intention (␤ ‫؍‬ 0.42; 95% CI, 0.11-0.73) after the visit but no significant change in perceived benefits, barriers, or self-efficacy. Within 6 months, 17 of 38 patients (45%) who discussed screening completed screening compared with 0 of 12 patients who did not discuss screening (P ‫؍‬ .001). Associations between discussions and outcomes were similar whether or not counseling addressed behavioral constructs.Conclusions: These findings suggest that physician counseling is associated with increased patient perception of CRC susceptibility, greater screening intention, and completion of screening regardless of whether counseling addresses behavioral constructs.

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Section: Discussionmentioning

confidence: 92%

Physician Counseling for Colorectal Cancer Screening: Impact on Patient Attitudes, Beliefs, and Behavior

Fenton

Jerant

Friederichs-Fitzwater

et al. 2011

The Journal of the American Board of Family Medicine

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“…Screening colonoscopy (SC) is advocated by many professional organizations and is increasingly common in clinical practice [2][3][4][5][6] . However, there are important concerns about how age, sex, and comorbidity moderate the effectiveness of SC.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Impact of Screening Colonoscopy on Mortality in the Medicare Population

et al. 2011

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“…10 In a national survey of PCPs, Klabunde et al 11 found that 30% reported some mechanism to prompt PCPs, 15% used patient reminders, and only 12% received reports of CRCS rates for their patient panel. Investigators who analyzed practice performance data from a network of PCPs using a common electronic health record described several strategies used by high-performing practices, including prioritizing performance, progress note templates, wellness visits combined with an opportunistic approach to screening, sigmoidoscopy for self-paying patients, and patient activation through a variety of repeated screening messages.…”

mentioning

confidence: 99%

Improving Colorectal Cancer Screening in Family Medicine: An Oklahoma Physicians Resource/Research Network (OKPRN) Study

Scheid¹,

Hamm²,

Ramakrishnan³

et al. 2013

The Journal of the American Board of Family Medicine

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MPH, and the Oklahoma Physicians Resource/Research NetworkPurpose: The purpose of this study was to describe colorectal cancer screening (CRCS) practices across a variety of primary care clinics and identify the methods used by primary care physicians (PCPs) with higher rates of CRCS ("exemplars").Methods: Physician questionnaires, structured interviews, medical record abstractions, and practice observations were conducted for 48 PCPs in 25 practices within a regional practice-based research network followed by secondary in-depth interviews to further investigate the practices of PCPs in the top quartile of CRCS rates ("exemplars").Results: We abstracted 3596 medical records (mean of 75 records per PCP). Overall, exemplars had higher CRCS rates (median, 57.2% vs. 27.6%; P < .001). Patients of exemplars had higher screening rates for fecal occult blood testing (FOBT) and colonoscopy but not for flexible sigmoidoscopy or double-contrast barium enemas. Exemplars adopted few of the system-based innovations proposed by researchers to improve CRCS. Colonoscopy was promoted as the preferred CRCS method. FOBT was recommended for patients who could not afford or did not want colonoscopy. Flexible sigmoidoscopy or barium enemas were rarely recommended. Exemplars used brief CRCS promotion scripts that informally paralleled theory-driven counseling techniques.Conclusions: Experienced PCPs use brief CRCS promotion scripts including counseling techniques that improve CRCS performance. Future research should be directed toward whether these techniques can be used to create an intervention aimed at PCPs to improve CRCS. (J Am Board Fam Med 2013;26:498-507.)

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Colorectal Cancer Screening by Primary Care Physicians

Cited by 188 publications

References 42 publications

Physician Counseling for Colorectal Cancer Screening: Impact on Patient Attitudes, Beliefs, and Behavior

Physician Counseling for Colorectal Cancer Screening: Impact on Patient Attitudes, Beliefs, and Behavior

Assessing the Impact of Screening Colonoscopy on Mortality in the Medicare Population

Improving Colorectal Cancer Screening in Family Medicine: An Oklahoma Physicians Resource/Research Network (OKPRN) Study

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