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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
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.
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
Colorectal cancer screening of high-risk populations: A national survey of physicians
Pascale M White, Malini Sahu, Michael A Poles, Fritz Francois
BMC Research Notes , 2012, DOI: 10.1186/1756-0500-5-64
Abstract: The average knowledge score was 37 ± 18% among the 512 respondents. Gastroenterologists averaged higher scores compared to internists, and family physicians, p = 0.001. Only 28% of physicians correctly identified the screening initiation point for African-Americans while only 12% of physicians correctly identified the screening initiation point and interval for a patient with a family history of CRC. The most commonly cited barriers to referring high-risk patients for CRC screening were "patient refusal" and "lack of insurance reimbursement."There is a lack of knowledge amongst physicians of the screening guidelines for high-risk populations, based on family history and ethnicity. Educational programs to improve physician knowledge and to reduce perceived barriers to CRC screening are warranted to address health disparities in colorectal cancer.As the third leading cause of malignancy-related death in the United States, colorectal cancer (CRC) is expected to be responsible for over 50,000 deaths in 2011 [1,2]. While various CRC screening efforts have been implemented [3], notable disparities in screening prevalence exist among minorities, those with low incomes, lower education, as well as among individuals without health insurance [3].While some of the barriers that influence CRC screening rates include patient factors, as delineated above [4-6], there are also physician-related factors that should be considered, such as failure to recommend screening to patients [7-9]. The decision whether or not to adopt a screening strategy might be driven by both physician-perceived as well as real barriers such as patient co-morbidities, prior patient refusal of screening and lack of patient compliance, physician forgetfulness, time restrictions, and a lack of reminder systems and test tracking systems [10,11]. In addition, physician knowledge of current CRC screening guidelines may be an important contributing factor to screening referral practices.Primary care physician reco
Adherence to Physician Recommendations for Surveillance in Opportunistic Colorectal Cancer Screening: The Necessity of Organized Surveillance  [PDF]
Christian Stock, Bernd Holleczek, Michael Hoffmeister, Thomas Stolz, Christa Stegmaier, Hermann Brenner
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0082676
Abstract: Background Limited evidence exists on the utilization of surveillance colonoscopy in colorectal cancer (CRC) screening programs. We assessed adherence to physician recommendations for surveillance in opportunistic CRC screening in Germany. Methods A follow-up study of screening colonoscopy participants in 2007-2009 in Saarland, Germany, was conducted using health insurance claims data. Utilization of additional colonoscopies through to 2011 was ascertained. Adherence to surveillance intervals of 3, 6, 12 and 36 months, defined as having had colonoscopy at 2.5 to 4, 5 to 8, 10.5 to 16 and 33 to 48 months, respectively (i.e., tolerating a delay of 33% of each interval) was assessed. Potential predictors of non-adherence were investigated using logistic regression analysis. Results A total of 20,058 screening colonoscopy participants were included in the study. Of those with recommended surveillance intervals of 3, 6, 12 and 36 months, 46.5% (95%-confidence interval [CI]: 37.3-55.7%), 38.5% (95%-CI: 29.6-47.3%), 25.4% (95%-CI: 21.2-29.6%) and 28.0% (95%-CI: 25.5-30.5%), respectively, had a subsequent colonoscopy within the specified margins. Old age, longer recommended surveillance interval, not having had polypectomy at screening and negative colonoscopy were statistically significant predictors of non-adherence. Conclusion This study suggests frequent non-adherence to physician recommendations for surveillance colonoscopy in community practice. Increased efforts to improve adherence, including introduction of more elements of an organized screening program, seem necessary to assure a high-quality CRC screening process.
Improving adherence to surveillance and screening recommendations for people with colorectal cancer and their first degree relatives: a randomized controlled trial
Mariko Carey, Rob Sanson-Fisher, Finlay Macrae, David Hill, Catherine D'Este, Christine Paul, Christopher Doran
BMC Cancer , 2012, DOI: 10.1186/1471-2407-12-62
Abstract: A randomized controlled trial will be used to test the effectiveness of a print-based intervention to improve adherence to colonoscopy surveillance among people with CRC and adherence to CRC screening recommendations among their first degree relatives (FDRs). People diagnosed with CRC in the past 10 months will be recruited through a population-based cancer registry. Consenting participants will be asked if their first degree relatives might also be willing to participate in the trial. Information on family history of CRC will be obtained from patients at baseline. Patients and their families will be randomized to either minimal ethical care or the print-based intervention. The print-based intervention for FDRs will be tailored to the participant's level of risk of CRC as determined by the self-reported family history assessment. Follow up data on surveillance and screening participation will be collected from patients and their FDRs respectively at 12, 24 and 36 months' post recruitment. The primary analyses will relate to comparing levels of guideline adherence in usual care group versus print-based group in the patient sample and the FDR sample respectively.Results of this study will provide contribute to the evidence base about effective strategies to a) improve adherence to surveillance recommendation for people with CRC; and b) improve adherence to screening recommendation for FDRs of people with CRC. The use of a population-based cancer registry to access the target population may have significant advantages in increasing the reach of the intervention.This trial is registered with the Australian and New Zealand Clinical Trials Registry Registration Number (ACTRN): ACTRN12609000628246.Colorectal cancer (CRC) is among the most prevalent cancers worldwide and carries a substantial mortality and morbidity burden [1]. Five year survival ranges between 8% and 93%, depending on stage of disease [2]. Among people who have undergone surgical resection for CRC, surveil
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.
Colorectal cancer screening in Europe  [cached]
Miroslav Zavoral, Stepan Suchanek, Filip Zavada, Ladislav Dusek, Jan Muzik, Bohumil Seifert, Premysl Fric
World Journal of Gastroenterology , 2009,
Abstract: Colorectal cancer (CRC) is the second most frequent malignant disease in Europe. Every year, 412 000 people are diagnosed with this condition, and 207 000 patients die of it. In 2003, recommendations for screening programs were issued by the Council of the European Union (EU), and these currently serve as the basis for the preparation of European guidelines for CRC screening. The manner in which CRC screening is carried out varies significantly from country to country within the EU, both in terms of organization and the screening test chosen. A screening program of one sort or another has been implemented in 19 of 27 EU countries. The most frequently applied method is testing stool for occult bleeding (fecal occult blood test, FOBT). In recent years, a screening colonoscopy has been introduced, either as the only method (Poland) or the method of choice (Germany, Czech Republic).
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