Explaining physician rates of providing flexible sigmoidoscopy

Colorectal cancer is the third most frequent cancer, yet screening rates fo r this cancer remain low, This study was designed to identify factors assoc iated with family physicians' rates of recommending or providing flexible s igmoidoscopy. We applied a behavioral model consisting of three components: physician attitude toward providing the test, facilitating conditions, and reinforcing conditions. Qualitative interviews identified relevant measure s of each model component and guided the design of the survey. The survey w as administered to 60 randomly selected family physicians in Washington Sta te. Chart reviews were conducted to measure physician rates of providing fl exible sigmoidoscopy, All three model components mere significantly correla ted with sigmoidoscopy rate. Multiple regression found physician attitude, facilitating conditions, and their interaction to be significant determinan ts of sigmoidoscopy rate (multiple R = 0.72). Analyses of specific items us ed to measure physician attitude found that physician beliefs about cost, t ime, income, degree of distaste, risk of complications, and screening effec tiveness were significantly correlated with sigmoidoscopy rate. Specific fa cilitating conditions found to be correlated with rate of providing the tes t included physician and staff training, availability of a reminder system, and clinic structural conditions. This study provides strong support for a pplication of a theory-based model to understand physician provision of fle xible sigmoidoscopy testing for colorectal cancer. The findings provide ver y specific information to guide development of educational and motivational efforts and modification of facilitating conditions to increase physician provision of sigmoidoscopy to control colorectal cancer.