Published in Cancer Detection and Prevention 2001; 25(3):291-300.

Colorectal Cancer Screening by Primary Care Physicians in Two Medical Care Organizations

Sarah Tropman Hawley, PhD,a,b Bernard Levin, MD,b and Sally W. Vernon, PhDc

aDepartment of Family and Community Medicine, Baylor College of Medicine, bDivision of Cancer Prevention, University of Texas M.D. Anderson Cancer Center, cDepartments of Epidemiology and Behavioral Science, University of Texas School of Public Health Center for Health Promotion and Prevention Research, Houston, TX.

Address all correspondence and reprint requests to: Sarah Tropman Hawley, PhD, Department of Family and Community Medicine, Baylor College of Medicine, 5615 Kirby Drive, Suite 610, Houston, TX 77005.

ABSTRACT: The objectives of this study were to (1) evaluate self-reported practices of colorectal cancer (CRC) screening among primary care physicians (PCPs) in medical organizations and (2) identify factors associated with screening performance. We surveyed a census sample of 204 PCPs from two medical organizations in Houston, TX. Outcomes were PCPs' self-reports of screening with fecal occult blood test (FOBT) and/or flexible sigmoidoscopy (FS). Independent variables included physician demographics, perception of screening efficacy, level of agreement with screening guidelines, and perceptions of screening barriers. Variables were compared using Student's t-tests, Chi-square, and Fischer's exact tests. Regression was used to examine factors associated with PCPs' reports of screening. Our response rate was 56% (n = 115). Many PCPs reported recommending or performing/ordering screening with both FOBT (82%) and FS (87%). They more often reported believing that FS was "very effective" for reducing mortality than was FOBT (76% vs. 37%). Physicians perceived that barriers to patient compliance with CRC screening were stronger than barriers to making screening recommendations. Significant test-specific differences in reported barriers to screening were found. Results revealed high awareness and self-reported practice of CRC screening in this study population. Further examination of how barriers influence CRC screening practices by PCPs in medical organizations will be important for improving population screening rates.

KEY WORDS: prevention, barriers, fecal occult blood test, flexible sigmoidoscopy.