Screening for colorectal cancer on the front line

Lemon, Stephenie C.; Zapka, Jane G.; Estabrook, Barbara; Erban, Stephen; Luckmann, Roger
April 2003
American Journal of Gastroenterology;Apr2003, Vol. 98 Issue 4, p915
Academic Journal
: ObjectiveThe aim of this study was to assess knowledge, beliefs, and practices of primary care clinicians regarding colorectal cancer screening.: MethodsWe surveyed 77 primary care providers in six clinics in central Massachusetts to evaluate several factors related to colorectal cancer screening.: ResultsMost agreed with guidelines for fecal occult blood test (97%) and sigmoidoscopy (87%), which were reported commonly as usual practice. Although the majority (86%) recommended colonoscopy as a colorectal cancer screening test, it was infrequently reported as usual practice. Also, 36% considered barium enema a colorectal cancer screening option, and it was rarely reported as usual practice. Despite lack of evidence supporting effectiveness, digital rectal examinations and in-office fecal occult blood test were commonly reported as usual practice. However, these were usually reported in combination with a guideline-endorsed testing option. Although only 10% reported that fecal occult blood test/home was frequently refused, 60% reported sigmoidoscopy was. Frequently cited patient barriers to sigmoidoscopy compliance included fear the procedure would hurt and that patients assume symptoms occur if there is a problem. Perceptions of health systems barriers to sigmoidoscopy were less strong.: ConclusionsMost providers recommended guideline-endorsed colorectal cancer screening. However, patient refusal for sigmoidoscopy was common. Results indicate that multiple levels of intervention, including patient and provider education and systems strategies, may help increase prevalence.


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