Physician-reported reasons for limited follow-up of patients with a positive fecal occult blood test screening result

Am J Gastroenterol. 2003 Sep;98(9):2078-81. doi: 10.1111/j.1572-0241.2003.07575.x.


Objective: Fecal occult blood testing (FOBT) screening can reduce colorectal cancer (CRC) mortality when patients with an abnormal result [FOBT(+)] undergo a complete diagnostic evaluation (colonoscopy or double-contrast barium enema with or without flexible sigmoidoscopy). The aim of this study was to determine common reasons for nonperformance of a complete diagnostic evaluation.

Methods: We identified 544 FOBT(+) patients, aged 50 yr or older, who had participated in a managed care organization-sponsored CRC screening program. The performance of a complete diagnostic evaluation was determined from a patient-specific follow-up form and managed care organization claims data. Physicians were asked to report whether patients submitted to a complete diagnostic evaluation. When an evaluation was not done, the physicians were also asked to state the reasons for nonperformance.

Results: A total of 248 (46%) patients did not undergo a complete diagnostic evaluation. Physicians provided reasons for nonperformance for 50% (123/248). Factors accounting for nonperformance of a complete diagnostic evaluation were classified as follows: primary care physician decision (50%); specialist decision (28%); patient decision (17%); and other (practice-related) (5%). Many failures to complete an appropriate diagnostic evaluation were due to providers deciding to repeat the FOBT, perform a sigmoidoscopy, or not to proceed with any further testing.

Conclusion: Many patients with a positive FOBT do not receive a complete diagnostic evaluation. The reasons for nonperformance most frequently have to do with physician decision making. Many physician-related explanations do not conform to expert recommendations for appropriate follow-up.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Attitude of Health Personnel
  • Colonoscopy / standards*
  • Colonoscopy / trends
  • Colorectal Neoplasms / prevention & control*
  • Female
  • Follow-Up Studies
  • Guideline Adherence / statistics & numerical data*
  • Health Maintenance Organizations
  • Humans
  • Male
  • Mass Screening / standards*
  • Mass Screening / trends
  • Middle Aged
  • Occult Blood*
  • Physician-Patient Relations
  • Practice Patterns, Physicians'
  • Risk Assessment
  • United States