Background. Despite endorsement by a variety of professional societies
, screening sigmoidoscopy is performed on a small minority of patients
. We performed a survey of primary care physicians in Allegheny County
to examine in detail their current practice and attitude toward scree
ning sigmoidoscopy. Methods. Physicians were surveyed by mail or telep
hone. Eligible respondents were required to practice in the county and
perform direct patient care. Results. Of 732 adult primary care physi
cians in Allegheny County, 400 were randomly selected for sampling and
279, or 70%, responded. Over 88% of physicians agreed completely or p
artly with current American Cancer Society recommendations for screeni
ng sigmoidoscopy, but only 34% (95% CI 29-39%) reported they regularly
refer or schedule patients for screening. Physicians who screen were
more likely to be from internal medicine or family practice (P < 0.001
) and to be trained in (P < 0.001) or to personally perform (P < 0.001
) sigmoidoscopy. The greater the number of barriers to screening cited
by physicians, including cost, patient discomfort, equipment availabi
lity, low probability of finding a lesion, time it takes to do sigmoid
oscopy, and the risk of the procedure, the lower the screening rate (P
= 0.002). Conclusion. (a) Although primary care physicians in Alleghe
ny County report that they support screening sigmoidoscopy, only one-t
hird regularly refer or schedule patients, (b) physicians who are trai
ned in or who perform sigmoidoscopy are more likely to screen patients
, and (c) further education and training of primary care physicians in
sigmoidoscopy will be required to increase screening rates. (C) 1995
Academic Press, Inc.