Utilization of colorectal cancer screening tests: A 1997 survey of Massachusetts internists

Background. Physician noncompliance with screening recommendations has been a major barrier to effective colorectal cancer control. The overall object ives of this study were to assess the current attitudes and screening behav ior of primary care physicians in light of new efficacy data, revised guide lines, improved technology, and more widespread insurance coverage. Methods. Questionnaires inquiring about knowledge, beliefs, and practice pa tterns related to colorectal cancer screening were mailed in mid-1997 to 70 0 randomly selected Massachusetts internists. Results. The overall response rate was 63%. Nearly 60% of respondents repor ted an increase in screening behavior during the past 5 years. Most (80%) w ere aware of at least one set of screening guidelines and 90% reported util izing one or more recommended screening strategies. Fecal occult blood test ing (FOBT), alone (47%) or in combination with flexible sigmoidoscopy (50%) , was the preferred strategy for most respondents. Colonoscopy was rarely u tilized (5%) despite high perceived effectiveness. Concern about patient co mpliance was a significant determinant of FOBT utilization, whereas perceiv ed effectiveness, concerns about time or efficacy data, prior procedural tr aining, date of licensure, and use of instructional materials were independ ent determinants of sigmoidoscopy utilization. Conclusion. Massachusetts' internists report high rates of utilization of s elect colorectal cancer screening strategies. Future studies must validate self-reported compliance and explore barriers to screening colonoscopy. (C) 2001 American Health Foundation and Academic Press.