Physician intention to recommend complete diagnostic evaluation in colorectal cancer screening

Primary care physicians (PCPs) often do not recommend complete diagnostic e valuation (CDE; i.e., diagnostic colonoscopy or the combination of flexible sigmoidoscopy and barium enema X-ray procedures) for patients with an abno rmal screening fecal occult blood test (FOBT+) result. Information is neede d to understand why PCPs do not recommend CDE, In the spring of 1994, a tel ephone survey was carried out using a random sample of 520 PCPs in Pennsylv ania or New Jersey who had patients that were targeted for an FOBT screenin g program. Survey data were obtained from 363 (70%) PCPs on physician pract ice characteristics; personal background; perceptions concerning FOBT scree ning, CDE performance, and patient behavior; social influence related to CD E; and intention to recommend CDE for FOBT+ patients. Physician CDE intenti on scores were distributed as follows: low (22%), moderate (51%), and high (27%), Multivariate analyses demonstrate that physician board certification status, time in practice, belief in CDE efficacy, and belief that CDE is s tandard practice were positively associated with CDE intention, whereas con cern about CDE-related costs was negatively associated with CDE intention. Among physicians in larger practices, perceived FOBT screening efficacy was negatively associated with CDE intention, and belief in the benefit of CDE was positively associated with outcome. There is substantial variability i n CDE intention among PCPs, Physician perceptions about FOBT screening and follow-up are associated with CDE intention, are likely to influence CDE pe rformance, and may be amenable to educational intervention. Additional rese arch is needed to evaluate the impact of educational interventions on CDE i ntention and performance.