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Agency for Healthcare Research Quality

Primary Care Research

Primary care doctors should encourage colorectal cancer screening and clarify that screening is not just for those with symptoms

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Due to low CRC screening rates, only 37 percent of these cancers are detected before they spread to other parts of the body. The content of a doctor's CRC screening recommendation is a critical determinant of whether a patient follows the recommendation, concludes a new study. Primary care doctors should clarify that CRC screening is for patients without symptoms and tell patients about the benefits of screening and risks of not being screened, suggest researchers at the University of Kentucky.

The researchers asked 65 primary care doctors (via interview and questionnaire) how they typically communicate to patients their recommendation for CRC screening. Most of the physicians (77 percent) said they followed clinical guidelines for CRC screening. For example, 94 percent of doctors brought up CRC screening to patients aged 50 or older, when beginning such testing is recommended. The screening alternatives doctors most often recommended were colonoscopy and fecal occult blood testing (FOBT).

Many doctors provided some type of screening, such as stool cards (for the FOBT), digital rectal exam, or flexible sigmoidoscopy in their office. Most doctors said they would need to refer patients to a specialist to receive more invasive screening such as a colonoscopy.

Over one-fourth of physicians (28 percent) told patients that their screening recommendation was supported by authoritative groups such as the American Cancer Society. However, few physicians (12 percent) explained that a person does not have to be experiencing symptoms to undergo screening, and only 6 percent mentioned insurance coverage for screening. About half of doctors (52 percent) described the benefits of CRC screening, but only 15 percent explained the downsides of foregoing screening. Very few doctors (6 percent) assessed patients' understanding of screening or explored patients' screening preferences (1.5 percent).

The study was supported in part by the Agency for Healthcare Research and Quality (HS11845). See "Physician colorectal cancer screening recommendations: An examination based on informed decision making," by Sarah B. Wackerbarth, Ph.D., Yelena N. Tarasenko, Ph.D., Jennifer M. Joyce, M.D., and Steven A. Haist, M.D., in the April 2007 Patient Education and Counseling 66, pp. 43-50.

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