Screening colonoscopy in the US: attitudes and practices of primary care physicians

Abstract

Background: Rising colorectal cancer (CRC) screening rates in the last decade are attributable almost entirely to increased colonoscopy use. Little is known about factors driving the increase, but primary care physicians (PCPs) play a central role in CRC screening delivery.

Objective: Explore PCP attitudes toward screening colonoscopy and their associations with CRC screening practice patterns.

Design: Cross-sectional analysis of data from a nationally representative survey conducted in 2006-2007.

Participants: 1,266 family physicians, general practitioners, general internists, and obstetrician-gynecologists.

Main measures: Physician-reported changes in the volume of screening tests ordered, performed or supervised in the past 3 years, attitudes toward colonoscopy, the influence of evidence and perceived norms on their recommendations, challenges to screening, and practice characteristics.

Results: The cooperation rate (excludes physicians without valid contact information) was 75%; 28% reported their volume of FOBT ordering had increased substantially or somewhat, and the majority (53%) reported their sigmoidoscopy volume decreased either substantially or somewhat. A majority (73%) reported that colonoscopy volume increased somewhat or substantially. The majority (86%) strongly agreed that colonoscopy was the best of the available CRC screening tests; 69% thought it was readily available for their patients; 59% strongly or somewhat agreed that they might be sued if they did not offer colonoscopy to their patients. All three attitudes were significantly related to substantial increases in colonoscopy ordering.

Conclusions: PCPs report greatly increased colonoscopy recommendation relative to other screening tests, and highly favorable attitudes about colonoscopy. Greater emphasis is needed on informed decision-making with patients about preferences for test options.

Figure 1.

Reported change over the past 3 years in volume of CRC screening procedures that PCPs order, perform, or supervise.

Figure 2.

PCPs’ attitudes about screening colonoscopy.

Figure 3.

Reported change over past 3 years in volume of colonoscopy ordering by strong agreement with three attitude items.