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Association of Regional Variation in Primary Care Physicians’ Colorectal Cancer Screening Recommendations with Individual Use of Colorectal Cancer Screening  [cached]
Jennifer S. Haas, MD, MSPH,Garrett Fitzmaurice, ScD,Phyllis Brawarsky, MPH,Su-Ying Liang, PhD
Preventing Chronic Disease , 2007,
Abstract: IntroductionStudies show that the recommendations of a primary care physician for colorectal cancer screening may be one important influence on an individual’s use of screening. However, another possible influence, the effect of regional differences in physicians’ beliefs and recommendations on screening use, has not been assessed.MethodsWe linked data from the National Health Interview Survey on the use of colorectal cancer screening by respondents aged 50 years or older, by hospital-referral region, with data from the Survey of Colorectal Cancer Screening Practices on the colorectal cancer screening recommendations of primary care physicians, by region. Our principal independent variables were the proportion of physicians in a region who recommended screening at age 50 and continuing screening at the recommended frequency.Results On average, 53.3% of physicians in a region correctly recommended initiating colorectal cancer screening, and 64.8% advised screening at the recommended frequency. Of adults who lived in regions where less than 30% of physicians correctly recommended initiating screening, 47.3% had been screened, in contrast to 54.8% in areas where 70% or more of physicians made correct recommendations. Seventy-one percent of respondents living in regions where less than 30% of physicians advised screening at the recommended frequency were current on screening, in contrast to 79.9% of respondents living in regions where 70% or more of physicians made this recommendation. These differences were statistically significant after adjustment for individual characteristics.ConclusionStrategies to improve colorectal cancer screening recommendations of primary care physicians may improve the use of screening for millions of Americans.
Colorectal cancer screening awareness among physicians in Greece
Apostolos Xilomenos, Davide Mauri, Konstantinos Kamposioras, Athanasia Gkinosati, Georgios Zacharias, Varvara Sidiropoulou, Panagiotis Papadopoulos, Georgios Chatzimichalis, Vassilis Golfinopoulos, Christina Peponi, Panhellenic Association for Continual Medical Research (PACMeR)
BMC Gastroenterology , 2006, DOI: 10.1186/1471-230x-6-18
Abstract: 211 primary care physicians were surveyed by mean of a self-reported prescription-habits questionnaire. Both physicians' colorectal cancer screening behaviors and colorectal cancer screening recommendations during usual check-up visits were analyzed.Only 50% of physicians were found to recommend screening for colorectal cancer during usual check-up visits, and only 25% prescribed cost-effective procedures. The percentage of physicians recommending stool occult blood test and sigmoidoscopy was 24% and 4% respectively. Only 48% and 23% of physicians recognized a cancer screening value for stool occult blood test and sigmoidoscopy. Colorectal screening recommendations were statistically lower among physicians aged 30 or less (p = 0.012). No differences were found when gender, level and type of specialization were analyzed, even though specialists in general practice showed a trend for better prescription (p = 0.054).Contemporary recommendations for colorectal cancer screening are not followed by implementation in primary care setting. Education on presymptomatic control and screening practice monitoring are required if primary care is to make a major impact on colorectal cancer mortality.Data comparison between EUROCARE and SEER database provided evidence that colorectal cancer survival in United States of America is higher than in European countries [1]. Survival differences were maintained irrespectively of which European Nation was compared, and were much higher when Eastern European countries were considered [1]. Correction for stage at diagnosis consistently reduced survival differences and the reduction was substantially unrelated to the European geographic area analyzed [2]. The presence of a diagnostic colorectal cancer screening bias was therefore hypothesized since early diagnostic procedures might be much less available in Europe than in USA [2]. Deficiencies in European colorectal cancer screening guideline implementation, and inadequacy of screening test a
Evaluation of Educational Materials on Colorectal Cancer Screening in Appalachian Kentucky  [cached]
RaeAnne E. Davis, MSPH,Debra K. Armstrong, MSW, MPA,Mark Dignan, PhD,Gretchen R. Norling, PhD
Preventing Chronic Disease , 2006,
Abstract: Introduction Despite the availability of preventive screening for colorectal cancer, compliance with screening recommendations in Appalachian Kentucky is low. Although there are various cancer education materials available, none focus on Appalachian populations and few on low-literacy populations. The purpose of this study was to assess the type of information needed in written educational materials about colorectal cancer for Appalachian populations in Kentucky. Methods Seven focus groups were held in two Appalachian regions of Kentucky. Thirty-four members of the community participated in four focus groups held for the general public, and 15 staff members of primary care physicians’ offices participated in three focus groups. One facilitator led all seven focus groups using a moderator’s guide. Participants were asked to review and rank two fact sheets and two brochures about colorectal cancer according to perceived effectiveness. Results There was consensus between the general public focus groups and physician office staff focus groups about the ranking of materials. All groups preferred the Centers for Disease Control and Prevention’s Screen for Life: National Colorectal Cancer Action Campaign fact sheet and brochure to the other materials. They indicated that factors such as print size, inclusion of diagrams, and clear and simple presentation of the information were important and made the materials easier to use and understand. A consensus was also reached among groups on the relative importance of types of information that should be provided in the materials. Conclusion The use of educational materials to communicate messages about cancer screening is important in increasing awareness and providing valuable health information. Members of the Appalachian community and staff members of physicians’ offices preferred and recommended use of Screen for Life materials for low-literacy and Appalachian populations over other educational materials.
Results of National Colorectal Cancer Screening Program in Croatia (2007-2011)  [cached]
Miroslava Kati?i?,Nata?a Antoljak,Milan Kujund?i?,Valerija Stameni?
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i32.4300
Abstract: AIM: To study the epidemiologic indicators of uptake and characteristic colonoscopic findings in the Croatian National Colorectal Cancer Screening Program. METHODS: Colorectal cancer (CRC) was the second leading cause of cancer mortality in men (n = 1063, 49.77/100 000), as well as women (n = 803, 34.89/100 000) in Croatia in 2009. The Croatian National CRC Screening Program was established by the Ministry of Health and Social Welfare, and its implementation started in September, 2007. The coordinators were recruited in each county institute of public health with an obligation to provide fecal occult blood testing (FOBT) to the participants, followed by colonoscopy in all positive cases. The FOBT was performed by hypersensitive guaiac-based Hemognost card test (Biognost, Zagreb). The test and short questionnaire were delivered to the home addresses of all citizens aged 50-74 years consecutively during a 3-year period. Each participant was required to complete the questionnaire and send it together with the stool specimen on three test cards back to the institute for further analysis. About 4% FOBT positive cases are expected in normal risk populations. A descriptive analysis was performed. RESULTS: A total of 1 056 694 individuals (born between 1933-1945 and 1952-1957) were invited to screening by the end of September 2011. In total, 210 239 (19.9%) persons returned the envelope with a completed questionnaire, and 181 102 of them returned it with a correctly placed stool specimen on FOBT cards. Until now, 12 477 (6.9%), FOBT-positive patients have been found, which is at the upper limit of the expected values in European Guidelines for Quality Assurance in CRC Screening and Diagnosis [European Union (EU) Guidelines]. Colonoscopy was performed in 8541 cases (uptake 66%). Screening has identified CRC in 472 patients (5.5% of colonoscopied, 3.8% of FOBT-positive, and 0.26% of all screened individuals). This is also in the expected range according to EU Guidelines. Polyps were found and removed in 3329 (39% of colonoscopied) patients. The largest number of polyps were found in the left half of the colon: 64% (19%, 37% and 8% in the rectum, sigma, and descendens, respectively). The other 36% were detected in the proximal part (17% in the transverse colon and 19% in ceco-ascending colon). Small polyps in the rectum (5-10 mm in diameter), sigmoid and descending colon were histologically found to be tubular adenomas in 60% of cases, with a low degree of dysplasia, and 40% were classified as hyperplastic. Polyps of this size in the transverse or ceco-ascen
Knowledge and attitudes of primary health care physicians and nurses with regard to population screening for colorectal cancer in Balearic Islands and Barcelona
Maria Ramos, Magdalena Esteva, Jesús Almeda, Elena Cabeza, Diana Puente, Rosa Saladich, Albert Boada, Maria Llagostera
BMC Cancer , 2010, DOI: 10.1186/1471-2407-10-500
Abstract: Questionnaire-based survey of PHC physicians and nurses in the Balearic Islands and in a part of the metropolitan area of Barcelona.We collected 1,219 questionnaires. About 84% of all professionals believe that screening for colorectal cancer by fecal occult blood test (FOBT) is effective. Around 68% would recommend to their clients a colorectal cancer screening program based on FOBT and colonoscopy. About 31% are reluctant or do not know. Professionals perceive the fear of undergoing a colonoscopy as the main obstacle in getting patients to participate, and the invasive nature of this test is the main reason behind their resistance to this program. The main barriers to support the screening program among PHC professionals are lack of knowledge (nurses) and lack of time (physicians). On multivariate analysis, the factors associated with reluctance to recommend colorectal cancer screening were: believing that FOBT has poor sensitivity and is complicated; that colonoscopy is an invasive procedure; that a lack of perceived benefit could discourage client participation; that only a minority of clients would participate; thinking that clients are fed up with screening tests and being unaware if they should be offered something to ensure their participation in the programme.Two in every three PHC professionals would support a population screening program for colorectal cancer screening. Factors associated with reluctance to recommend it were related with screening tests characteristics as sensitivity and complexity of FOBT, and also invasive feature of colonoscopy. Other factors were related with patients' believes.Colorectal cancer is an important health problem in developed countries, both because of its high incidence and because it is accompanied by high mortality. In Spain, colorectal cancer ranks first among all cancers in terms of incidence and second in terms of mortality in both sexes together. Every year approximately 25,600 new cases are diagnosed [1] and in 20
Knowledge, Perceptions, and Communication about Colorectal Cancer Screening among Chinese American Primary Care Physicians
Wenchi Liang, Mei-Yuh Chen, Grace X. Ma, Jeanne S. Mandelblatt
Clinical Medicine Insights: Gastroenterology , 2012,
Abstract: Objective: To assess Chinese American primary care physicians’ knowledge, attitude, and barriers to recommending colorectal cancer (CRC) screening to their Chinese American patients. Methods: Chinese American primary care physicians serving Chinese American patients in two metropolitan areas were invited to complete a mailed survey on CRC screening knowledge, attitudes toward shared decision making and CRC screening, and CRC screening recommendation patterns. Results: About half of the 56 respondents did not know CRC incidence and mortality figures for Chinese Americans. Those aged 50 and younger, graduating from U.S. medical schools, or working in non-private settings had higher knowledge scores (p < 0.01). Physicians graduating from U.S. medical schools had more favorable attitudes toward shared decision making (p < 0.01). Lack of health insurance, inconsistent guidelines, and insufficient time were the most frequently cited barriers to recommending CRC screening. Conclusions: Most Chinese American physicians had knowledge, attitude, and communication barriers to making optimal CRC screening recommendations.
Knowledge, Perceptions, and Communication about Colorectal Cancer Screening among Chinese American Primary Care Physicians
Wenchi Liang,Mei-Yuh Chen,Grace X. Ma,Jeanne S. Mandelblatt
Clinical Medicine : Gastroenterology , 2008,
Abstract: Objective: To assess Chinese American primary care physicians’ knowledge, attitude, and barriers to recommending colorectal cancer (CRC) screening to their Chinese American patients.Methods: Chinese American primary care physicians serving Chinese American patients in two metropolitan areas were invited to complete a mailed survey on CRC screening knowledge, attitudes toward shared decision making and CRC screening, and CRC screening recommendation patterns.Results: About half of the 56 respondents did not know CRC incidence and mortality figures for Chinese Americans. Those aged 50 and younger, graduating from U.S. medical schools, or working in non-private settings had higher knowledge scores (p < 0.01). Physicians graduating from U.S. medical schools had more favorable attitudes toward shared decision making (p < 0.01). Lack of health insurance, inconsistent guidelines, and insufficient time were the most frequently cited barriers to recommending CRC screening.Conclusions: Most Chinese American physicians had knowledge, attitude, and communication barriers to making optimal CRC screening recommendations
Interactions among physicians, patients, and first-degree relatives in the familial screening of colorectal cancer in France
Isabelle Ingrand, Sarah Dujoncquoy, Virginie Migeot, Véronique Ghadi, Michel Beauchant, Pierre Ingrand
Patient Preference and Adherence , 2008, DOI: http://dx.doi.org/10.2147/PPA.S
Abstract: teractions among physicians, patients, and first-degree relatives in the familial screening of colorectal cancer in France (3213) Total Article Views Authors: Isabelle Ingrand, Sarah Dujoncquoy, Virginie Migeot, Véronique Ghadi, Michel Beauchant, Pierre Ingrand Published Date March 2008 Volume 2008:2 Pages 47 - 55 DOI: http://dx.doi.org/10.2147/PPA.S Isabelle Ingrand1, Sarah Dujoncquoy2, Virginie Migeot1, Véronique Ghadi1, Michel Beauchant3, Pierre Ingrand1 1Institut Universitaire de Santé Publique; Université de Poitiers; Centre Hospitalier Universitaire de Poitiers, Poitiers, France; 2Réseau régional de cancérologie Onco-Poitou-Charentes, Centre Hospitalier Universitaire de Poitiers, Poitiers, France; 3Service d’Hépatogastroentérologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France Aims: To characterize determining factors for compliance with colonoscopy recommendations in the familial screening of colorectal cancer through exploration of individual psychosociological factors and issues relating to patient/physician/sibling communication. Methods: A qualitative approach involving a review of the literature and interviews with general practitioners, specialists, patients, and their siblings. Results: A confrontation of the content of interviews with data from the literature made it possible to confirm the relevance of classic prevention models, the Health Belief Model and the Theory of Planned Behavior in the French cultural and healthcare environments, as well as their ability to identify the main individual factors liable to motivate or to discourage familial screening. The family network plays a decisive part in the transmission of information from the patient towards siblings. Physicians have expectations relating to communication aids and backup. This study above all highlights the difficulty in determining who is best suited to giving information to the patient, and when and how to relay this information to first-degree relatives. Conclusion: In view of the many difficulties in establishing interaction between patient, physician and siblings that is liable to lead on to efficient screening, we propose the study of the usefulness of a health-counseling intervention aimed to tailor and follow-up the delivery of screening information to the first-degree relatives.
Obesity Status and Colorectal Cancer Screening in the United States  [PDF]
Karima A. Kendall,Euni Lee,Ilene H. Zuckerman,Linda Simoni-Wastila,Marlon Daniel,Pauline M. Green,Beatrice Adderley-Kelly,Anthony K. Wutoh
Journal of Obesity , 2013, DOI: 10.1155/2013/920270
Abstract: Background. Findings from previous studies on an association between obesity and colorectal cancer (CRC) screening are inconsistent and very few studies have utilized national level databases in the United States (US). Methods. A cross-sectional study was conducted using data from the 2005 Medicare Current Beneficiary Survey to describe CRC screening rate by obesity status. Results. Of a 15,769 Medicare beneficiaries sample aged 50 years and older reflecting 39 million Medicare beneficiaries in the United States, 25% were classified as obese, consisting of 22.4% “obese” (30 ≤ body mass index (BMI) < 35) and 3.1% “morbidly obese” (BMI ≥ 35) beneficiaries. Almost 38% of the beneficiaries had a body mass index level equivalent to overweight (25 ≤ BMI < 30). Of the study population, 65.3% reported having CRC screening (fecal occult blood testing or colonoscopy). Medicare beneficiaries classified as “obese” had greater odds of CRC screening compared to “nonobese” beneficiaries after controlling for other covariates ( = 1.25; 95% CI: 1.12–1.39). Conclusions. Findings indicate that obesity was not a barrier but rather an assisting factor to CRC screening among Medicare beneficiaries. Future studies are needed to evaluate physicians’ ordering of screening tests compared to screening claims among Medicare beneficiaries to better understand patterns of patients’ and doctors’ adherence to national CRC screening guidelines. 1. Introduction According to the American Cancer Society, colorectal cancer (CRC) is the third most common cancer diagnosed and the third leading cause of cancer-related mortality in both men and women in the United States (US) [1]. While these statistics are alarming, the death rate from CRC has decreased for more than 20 years due to early detection of removable polyps by colorectal screening tests [2]. According to the US Preventive Services Task Force (USPSTF), routine screening may reduce the number of people who die of colorectal cancer [3]. Additionally, treatment for CRC has vastly improved over the last several years, and as a result, there are now more than one million survivors of CRC in the US [4]. The risk of developing colorectal cancer in a lifetime is about 1 in 19 and a number of risk factors associated with CRC have been identified [2]. Established risk factors include increased age, personal history of inflammatory bowel disease, colorectal polyps, and family history of colorectal cancer [5]. In addition, certain behavioral factors such as smoking, heavy alcohol use, and obesity, have shown to be the strongest links to an
Colorectal cancer screening: strategies to select populations with moderate risk for disease
Navarro,M.; Binefa,G.; Blanco,I.; Guardiola,J.; Rodríguez-Moranta,F.; Peris,M.; ,;
Revista Espa?ola de Enfermedades Digestivas , 2009, DOI: 10.4321/S1130-01082009001200005
Abstract: objective: to analyse the association between rectal bleeding or a family history of colorectal cancer (crc) and the results obtained in two rounds of a crc screening pilot programme performed in l'hospitalet, barcelona, spain. subjects: males and females (50-69 years) were the target population. together with the invitation letter, they received a questionnaire in which they were askaed about rectal bleeding, family history of crc and related neoplasms. the screening test was a guaiac-based faecal occult blood test (fobt), and colonoscopy for positive tests. results: 25,829 fobt were performed in 18,405 individuals. information on rectal bleeding and a family history of crc were obtained for 9,849 and 9,865 cases, respectively. male sex (or = 1.32), 60-69 years of age (or = 1.48), rectal bleeding (or = 1.84) and history of crc (or = 1.54) were independent predictors of positive fobt. with regard to colonoscopy, a greater risk of diagnosing advanced neoplasm was observed among men (or = 2.47) and subjects with a family history of crc (or = 1.98). conclusions: crc screening programmes must have instruments that make it possible to select the candidate population and the possibility of offering a study suited to the risk of individuals who are not susceptible to population screening by means of fobt.
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