March 8, 2009

Physicians Influence Rates of Colorectal Screening


Physicians Influence Rates of Colorectal Screening

Healthcare providers can greatly influence the rates at which patients undergo screening for colorectal cancer. These results were recently published in the journal Cancer.

Colorectal cancer remains the second leading cause of cancer-related deaths in the United States. When detected and treated early, prior to spread, cure rates for colorectal cancer are high. However, as the cancer advances, cure rates drop significantly. Therefore, screening for colorectal cancer is an important step in improving overall survival.

Although screening for colorectal cancer has demonstrated that it can reduce deaths, and guidelines recommend that every person begin colorectal cancer screening at the age of 50, patient compliance with screening recommendations remains low. Healthcare providers speculate that low compliance may be due in part to the invasive nature of the tests, the substantial time commitment required (particularly for a colonoscopy), and the number of patients without insurance to cover costs.

In an effort to more fully understand barriers to patient compliance with recommended screening for colorectal cancer, researchers from California recently conducted a study to ask patients directly about what they think keeps people from getting screening and about potential ways to increase participation in screening. The study included phone interviews with patients before and after an intervention to increase colorectal cancer screening rates within a large managed care health plan. In 2000, before beginning the intervention, only 38% of patients aged 50 years or older underwent screening for colorectal cancer. Following the intervention in 2003, the screening rate increased to 50%.

  • Patients whose healthcare providers had discussed screening measures for colorectal cancer had more than a twofold increased rate for screening than those whose healthcare providers had not discussed these measures.
  • Two barriers to undergoing screening-test restrictions for fecal-occult blood test and the notion that a sigmoidoscopy and colonoscopy were only necessary if a doctor recommended them-were reported by significantly fewer patients in the second phone interview (after the intervention) compared with the first phone interview.

The researchers concluded that interventions to increase colorectal cancer screening rates should be targeted both at patients and healthcare providers, as healthcare providers appear to influence increases in screening rates simply by discussing the process with their patients.

Patients who are 50 years of age or older and those with a family history of colorectal cancer may wish to speak with their physician regarding their individual risks and benefits of screening for this disease.

Reference: Farmer M, Bastani R, Kwan L, et al. Predictors of colorectal cancer screening from patients enrolled in a managed care health plan. Cancer [early online publication]. February 11, 2008. DOI: 10.1002/cncr.23290

Related News:

Rate of Colorectal Cancer Screening with Colonoscopy in First-degree Relatives Needs Improvement (08/30/2007)

Room for Improvement in Screening of Patients with Family History of Colorectal Cancer (04/03/2007)

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