Direct observation of counseling on colorectal cancer in rural primary care practices

Abstract

To better understand colorectal cancer (CRC) screening practices in primary care, medical students directly observed physician-patient encounters in 38 physician offices. CRC was discussed with 14% of patients 50 years of age; 87% of discussions were initiated by the physician. The rate of discussions varied among the practices from 0% to 41% of office visits. Discussions were more common for new patient visits, with younger patients, and in the 24% of offices that utilized flow sheets. The frequency of CRC discussions in physician offices varies widely. More widespread implementation of simple office systems, such as flow sheets, is needed to improve CRC screening rates.

Determinants of Physician Discussion Regarding Tobacco and Alcohol Abuse

“…The two previous direct observation studies (Ellerbeck et al, 2001;Jaen et al, 1998) focusing on smoking cessation activities in the primary care setting did not examine physician discussion of other health risk behaviors, and did not control for other important patient variables or assess new versus return visits . It has been demonstrated previously, that however, what takes place during the medical visit is dependent on physician-patient familiary.…”

“…Factors associated with physician screening and management of smoking and alcohol use include patient gender, age, race, education, income, the presence of a substance abuse-related chronic illness, and the length of the physicianpatient relationship (Arndt, Schultz, Turvey, & Petersen, 2002;Ellerbeck, Ahluwalia, Jolicoeur, Gladden, & Mosier, 2001;Friedmann, McCullough, Chin, & Saitz, 2000;Heywood, Firman, Sanson-Fisher, Mudge, & Ring, 1996;Jaen, Crabtree, Zyzanzki, Goodwin, & Stange, 1998;McBride, Plane, Underbakke, Brown, & Solberg, 1997;Nawaz, Adams, & Katz, 2000;Taira, Safran, Seto, Rogers, & Tarlov, 1997;Thorndike, Ferris, Stafford, & Rigotti, 1999;Volk, Steinbauer, & Cantor, 1996).…”

Attitudes and behaviours in smoking cessation among general practitioners in Finland 2001

“…However, patients have been shown to be concerned about their lifestyle and most would welcome relevant counselling by health personnel (Wallace et al 1987). Overall, the prevalence of counselling all identifi ed smokers to quit is in most countries still below 50% (Coleman & Wilson 1996;Ellerbeck et al 2001;Heywood et al 1996) and therefore, it is diffi cult to predict or to measure, how implementation of those recommendations would affect the physician-patient relationship. We still believe that benefi ts gained by counselling all smokers would overbalance possible harms of the physician-patient relationship.…”

Direct Observation of Counseling on Colorectal Cancer in Rural Primary Care Practices*

“…This subsample consisted of smokers identified during the office visit who were being surveyed for a concurrent study. 7 In the survey, we asked all patients 50 years of age if they had discussed fecal occult blood testing in the past year or a sigmoidoscopy during the past five years with their physician. The questions were derived from the Behavioral Risk Factor Surveillance System survey.…”