Fecal occult blood testing beliefs and practices of U.S. primary care physicians: serious deviations from evidence-based recommendations

Abstract

Background: Fecal occult blood testing (FOBT) is an important option for colorectal cancer screening that should be available in order to achieve high population screening coverage. However, results from a national survey of clinical practice in 1999-2000 indicated that many primary care physicians used inadequate methods to implement FOBT screening and follow-up.

Objective: To determine whether methods to screen for fecal occult blood have improved, including the use of newer more sensitive stool tests.

Design: Cross-sectional national survey of primary care physicians.

Participants: Participants consisted of 1,134 primary care physicians who reported ordering or performing FOBT in the 2006-2007 National Survey of Primary Care Physicians' Recommendations and Practices for Cancer Screening.

Main measures: Self-reported data on details of FOBT implementation and follow-up of positive results.

Results: Most physicians report using standard guaiac tests; higher sensitivity guaiac tests and immunochemical tests were reported by only 22.0% and 8.9%, respectively. In-office testing, that is, testing of a single specimen collected during a digital rectal examination in the office, is still widely used although inappropriate for screening: 24.9% of physicians report using only in-office tests and another 52.9% report using both in-office and home tests. Recommendations improved for follow-up after a positive test: fewer physicians recommend repeating the FOBT (17.8%) or using tests other than colonoscopy for the diagnostic work-up (6.6%). Only 44.3% of physicians who use home tests have reminder systems to ensure test completion and return.

Conclusions: Many physicians continue to use inappropriate methods to screen for fecal occult blood. Intensified efforts to inform physicians of recommended technique and promote the use of tracking systems are needed.

Figure 1

Perceived effectiveness of guaiac-based FOBT* and immunochemical FOBT*. *FOBT = fecal occult blood test. Note: Vertical lines within bars indicate 95% confidence intervals around percentages.

Figure 2

Method of conducting FOBT* for screening, by physician specialty. *FOBT = fecal occult blood test; FP = family physician; GP = general practitioner; OB/GYN = obstetrician gynecologist; IM = internist. Note: Vertical lines within bars indicate 95% confidence intervals around percentages.