FACTORS ASSOCIATED WITH THE USE OF FLEXIBLE SIGMOIDOSCOPY AS A SCREENING-TEST FOR THE DETECTION OF COLORECTAL-CARCINOMA BY PRIMARY-CARE PHYSICIANS

BACKGROUND, Despite current recommendations of flexible sigmoidoscopy as a screening test for the detection of colorectal carcinoma, relativ ely few asymptomatic patients undergo this procedure. To enhance the u se of sigmoidoscopy, differences in the use of screening, as well as b arriers to screening among specific physician groups, should be define d. METHODS. The authors surveyed 1762 practicing primary care physicia ns to determine their self-reported ability to perform sigmoidoscopy a nd perceived obstacles to either initiating or enhancing screening. RE SULTS, A total of 884 physicians (50%) responded. Ninety percent of pr imary care physicians reported that they offered sigmoidoscopic screen ing to their patients, with 46% referring patients and 44% performing the procedure themselves. Physician characteristics were not associate d with the overall use of sigmoidoscopy. In contrast, compared with ph ysicians who referred patients for the procedure, physicians who perfo rmed sigmoidoscopy themselves were more often board certified, male, a nd graduated from medical school after 1970 (P < 0.001). In a multivar iate analysis, these characteristics were also independently associate d with the ability to perform sigmoidoscopy. The barrier to sigmoidosc opy cited most often was poor patient acceptance, whether or not the p hysician performed or referred patients for sigmoidoscopic screening. Other barriers cited were lack of training, lack of equipment, and tim e required, each of which was identified most often by physicians who did not screen at all. CONCLUSIONS. Most physicians surveyed reported using sigmoidoscopic screening to some degree in their practice, altho ugh many did not perform the procedure themselves. Population-based in terventions to increase screening may benefit from targeting specific physician subgroups and attempting to improve patient acceptance of th e procedure. (C) 1998 American Cancer Society.