Physician Recommendations for Follow-Up of Positive Fecal Occult Blood Tests

Abstract

Following a positive fecal occult blood test (FOBT), physician recommendation of complete diagnostic evaluation (CDE) is an important first step to ensure identification and treatment of preinvasive or invasive colorectal cancer. Physicians may not recommend CDE, however, potentially compromising the effectiveness of colorectal cancer screening programs and the quality of care for individual patients. The authors used a theoretical model of health behavior and two national physician samples to explore factors associated with recommendations for CDE. Overall, 63 percent of the sample of physicians providing primary care and 76 percent of the gastroenterologist and general surgeon sample reported recommending CDE. Variables representing the theoretical model constructs of physician background, experience, and practice patterns; practice environment; physician psychosocial representations; and patient characteristics were significantly associated with recommendations of CDE. Development of interventions to improve recommendations of CDE is an important area for future research.

The effects of teamwork and system support on colorectal cancer screening in primary care practices

“…Most studies that examine preventive CRC screening do so aiming to find the problem -e.g., patient barriers, [25][26][27][28][29][30] physician barriers, [5][6][7]31,32] system barriers [14,23,24,33,34] -and implement targeted interventions that solely impact CRC screening. These approaches, while successful to varying degrees, may be limited in their usefulness in applied practice settings for a number of reasons.…”

“…[1] A number of recent studies [5][6][7] aimed at improving CRC screening in primary care practices directly target physicians for CRC clinical interventions examining their attitudes [6,7] and whether physicians discuss CRC screening with their patients. [5] Although, primary care physician counseling of patients has been positively associated with CRC screening, [6,8] this approach is inadequate due to multiple competing demands and priorities. [9][10][11] Increasingly traditional models of primary care practice are being criticized as too physician centric and resulting in care that is mostly reactive and often fragmented.…”

How much can current interventions reduce colorectal cancer mortality in the U.S.?

“…However, a recent study has shown that only 63% of physicians and 76% of gastroenterologists and general surgeons recommend complete diagnostic evaluation of patients who have a positive FOBT result. 73 If compliance with diagnostic follow-up and surveillance were 80% rather than 100%, then the additional benefit of screening would be reduced to 14% rather than 17%.…”

Are Physicians’ Recommendations For Colorectal Cancer Screening Guideline-Consistent?

“…We used a theoretical model of physician behavior 24,25 to guide selection of relevant physician and practice variables and inform our analysis (Fig. 1 19,23,25,[28][29][30][31] We hypothesized that these factors would also be associated with guideline-consistent recommendations.…”

“…1 19,23,25,[28][29][30][31] We hypothesized that these factors would also be associated with guideline-consistent recommendations. Less work has been conducted to assess associations between the domains of practice environment, perceptions of screening, and physician support, and guideline-consistent recommendations.…”