PRIMARY-CARE PHYSICIAN RECOMMENDATIONS FOR COLORECTAL-CANCER SCREENING - PATIENT AND PRACTITIONER FACTORS

Background: Current guidelines for colorectal cancer screening do not specify the role of age or comorbidity in patient selection. Reported screening practices may thus be influenced by patient, as well as phys ician, characteristics. Methods: A questionnaire was sent to primary c are physicians in 10 states to determine recommendations for fecal occ ult blood testing (FOBT) and sigmoidoscopy in 4 pairs of clinical vign ettes that varied by patient age (65 or 75 years) and comorbidity (non e, mild, moderate, and terminal) Results: Among the 884 respondents (5 0%), most physicians recommended FOBT in all vignettes except those wi th a terminal illness and fewer than half recommended sigmoidoscopy in any vignette. Physician recommendations were influenced by comorbidit y, but one third still recommended FOBT for terminally ill patients an d less than 50% recommended sigmoidoscopy for patients with no comorbi dity. Differences in recommended screening between vignettes that diff ered only in patient age were small. Among all subgroups of physicians , at least 30% recommended FOBT in terminally ill patients and no more than 60% recommended sigmoidoscopy in healthy patients, Conclusions: Primary care physicians were much more likely to recommend screening w ith FOBT than sigmoidoscopy, regardless of patient and practitioner fa ctors. Although physician recommendations were influenced by patient c omorbidity and age, they frequently recommended FOBT in clinically ina ppropriate settings and failed to recommend sigmoidoscopy when appropr iate. Broad-based interventions to improve appropriate screening pract ices may be needed.