scholarly journals Colorectal Cancer Screening: Physicians’ Knowledge of Risk Assessment and Guidelines, Practice, and Description of Barriers and Facilitators

2006 ◽  
Vol 20 (11) ◽  
pp. 713-718 ◽  
Author(s):  
Maida J Sewitch ◽  
Pascal Burtin ◽  
Martin Dawes ◽  
Mark Yaffe ◽  
Linda Snell ◽  
...  
Keyword(s):  
Care Delivery ◽  
Occult Blood ◽  
Fecal Occult Blood Testing ◽  
Health Care Delivery System ◽  
Fecal Occult Blood ◽  
Average Risk ◽  
Crc Screening ◽  
Barriers To Screening ◽  
Fecal Occult ◽  
Risk Patients

BACKGROUND: Physician nonadherence to colorectal cancer (CRC) screening recommendations contributes to underuse of screening.OBJECTIVE: To assess physicians’ knowledge of CRC screening guidelines for average-risk individuals, perceived barriers to screening and practice behaviours.METHODS: Between October 2004 and March 2005, staff physicians working in three university-affiliated hospitals in Montreal, Quebec, were surveyed. Self-administered questionnaires assessed knowledge of risk classification and current guidelines for average-risk individuals, as well as perceptions of barriers to screening and practice behaviours.RESULTS: All 65 invited physicians participated in the survey, including 46 (70.8%) family medicine physicians and 19 (29.2%) general internists. Most physicians knew that screening should begin at 50 years of age, all knew to screen men and women and 92% said they screened average-risk patients. Fifty-seven (87.7%) physicians correctly identified three common characteristics associated with high risk for developing CRC. Physicians who screened average-risk patients preferred fecal occult blood testing (88.3%) and colonoscopy (88.3%) to flexible sigmoidoscopy (10.0%) and double-contrast barium enema (30.0%). Most physicians knew the correct screening periodicity for fecal occult blood testing (87.6%), but only 40% or fewer could identify correct screening periodicities for the other modalities. Barriers and facilitators focused on health care delivery system improvements, better evidence on which to base recommendations and development of practical screening modalities.CONCLUSIONS: Physicians lacked knowledge of the recommended screening modalities and periodicities to appropriately screen average-risk individuals. Because CRC screening can reduce mortality, efforts to improve physician delivery should focus on physician knowledge and changes to the health care delivery system.

scholarly journals Reactions to a Targeted Intervention to Increase Fecal Occult Blood Testing among Average-Risk Adults Waiting for Screening Colonoscopy

2011 ◽  
Vol 25 (5) ◽  
pp. 248-252
Author(s):  
S Elizabeth McGregor ◽  
Paul Ritvo ◽  
Jill Tinmouth ◽  
Ashley Kornblum ◽  
Ronald Myers ◽  
...  
Keyword(s):  
Occult Blood ◽  
Fecal Occult Blood Testing ◽  
Screening Colonoscopy ◽  
Wait Times ◽  
Fecal Occult Blood ◽  
Average Risk ◽  
Wait List ◽  
Targeted Intervention ◽  
Fecal Occult ◽  
Risk Patients

BACKGROUND: Increasing demand combined with limited capacity has resulted in long wait times for average-risk adults referred for screening colonoscopy for colorectal cancer. Management of patients on these growing wait lists is an emerging clinical issue.OBJECTIVE: To inform the content and design of a mailed targeted invitation for patients to undergo annual fecal occult blood testing (FOBT) while awaiting colonoscopy.METHODS: Focus groups (FGs) with average-risk patients on a wait list for screening colonoscopy at a high-throughput academic outpatient colonoscopy facility were conducted. During each FG session, feedback regarding a range of materials under consideration for the planned intervention was elicited using a semistructured facilitator guide. The FG sessions were recorded and transcribed verbatim, and analyzed using the constant comparative method to identify key themes.RESULTS: Findings from the three FGs (n=28) suggested that average-risk patients on a wait list for screening colonoscopy would be receptive to a targeted intervention recommending they undergo FOBT while waiting. Participants indicated that the invitation to undergo FOBT was an important acknowledgement that they were on an actively managed list, and that a mechanism to ensure that they were correctly triaged while waiting was in place. Several specific suggestions to improve the design of the targeted intervention were obtained.CONCLUSIONS: Results of the present study provide useful information for developing effective strategies to manage average-risk individuals facing long wait times for screening colonoscopy.

scholarly journals Colorectal Cancer Screening in Average Risk Populations: Evidence Summary

2016 ◽  
Vol 2016 ◽  
pp. 1-18 ◽  
Author(s):  
Jill Tinmouth ◽  
Emily T. Vella ◽  
Nancy N. Baxter ◽  
Catherine Dubé ◽  
Michael Gould ◽  
...  
Keyword(s):  
Screening Program ◽  
Occult Blood ◽  
Screening Tests ◽  
Fecal Occult Blood ◽  
Average Risk ◽  
Crc Screening ◽  
Fecal Occult ◽  
Evidence Summary ◽  
Screening Intervals ◽  
Meta Analyses

Introduction. The objectives of this systematic review were to evaluate the evidence for different CRC screening tests and to determine the most appropriate ages of initiation and cessation for CRC screening and the most appropriate screening intervals for selected CRC screening tests in people at average risk for CRC.Methods. Electronic databases were searched for studies that addressed the research objectives. Meta-analyses were conducted with clinically homogenous trials. A working group reviewed the evidence to develop conclusions.Results. Thirty RCTs and 29 observational studies were included. Flexible sigmoidoscopy (FS) prevented CRC and led to the largest reduction in CRC mortality with a smaller but significant reduction in CRC mortality with the use of guaiac fecal occult blood tests (gFOBTs). There was insufficient or low quality evidence to support the use of other screening tests, including colonoscopy, as well as changing the ages of initiation and cessation for CRC screening with gFOBTs in Ontario. Either annual or biennial screening using gFOBT reduces CRC-related mortality.Conclusion. The evidentiary base supports the use of FS or FOBT (either annual or biennial) to screen patients at average risk for CRC. This work will guide the development of the provincial CRC screening program.

scholarly journals Resource Implications for a Population-Based Colorectal Cancer Screening Program in Canada: A Study of the Impact on Colonoscopy Capacity and Costs in London, Ontario

2007 ◽  
Vol 21 (6) ◽  
pp. 371-377 ◽  
Author(s):  
Agatha Lau ◽  
James C Gregor
Keyword(s):  
Screening Program ◽  
Occult Blood ◽  
Fecal Occult Blood Testing ◽  
Population Based ◽  
Fecal Occult Blood ◽  
Decision Analysis Model ◽  
Analysis Model ◽  
Crc Screening ◽  
Fecal Occult ◽  
Annual Screening

OBJECTIVE: Cancer Care Ontario has recommended a population-based colorectal cancer (CRC) screening program using fecal occult blood testing. Patients who test positive should undergo further investigation, preferably colonoscopy. So far, no studies have been performed to quantify the costs or demands on the health care system at the community level. The number of consultations, colonoscopies and polypectomies, and the corresponding direct medical costs generated by the CRC screening program, between 2006 and 2015 in London, Ontario, were estimated using a decision analysis model in comparison with the population health model.METHODS: A faxed survey study was conducted to examine the current CRC screening practice among family physicians in London. Data from the survey and randomized studies were applied to a decision analysis model, which simulated the steps involved in population-based biennial and annual CRC screening between 2006 and 2015. The number of consultations, colonoscopies and polypectomies, and their associated costs were calculated.RESULTS: For a cohort population of 140,000, between 50 and 74 years of age, in 2006 to 2015, it is estimated that an average of 412 consultations, 463 colonoscopies and 174 polypectomies will be performed per 100,000 screen eligible population per year in biennial screening, and double in annual screening, reflecting an average of 8.7% or 17.6% increase annually in outpatient colonoscopies, respectively, compared with 2003. A mean of $285,000 or $562,000 per year would be required to support the extra consultation and endoscopic procedures generated by the biennial or annual screening.CONCLUSION: Population-based fecal occult blood testing screening for CRC appears to be a manageable strategy if a modest increase in endoscopic resources is allocated.

scholarly journals Canadian Physicians’ Choices for Their Own Colon Cancer Screening

2006 ◽  
Vol 20 (4) ◽  
pp. 281-284 ◽  
Author(s):  
Mamoon Raza ◽  
Charles N Bernstein ◽  
Alexandra Ilnyckyj
Keyword(s):  
Colon Cancer ◽  
Cancer Screening ◽  
Occult Blood ◽  
Fecal Occult Blood Testing ◽  
Colon Cancer Screening ◽  
Fecal Occult Blood ◽  
Crc Screening ◽  
Personal Time ◽  
Fecal Occult ◽  
Canadian Association

INTRODUCTION: Compliance with colorectal cancer (CRC) screening in Canada is low. The aim of the present survey was to determine whether Canadian physicians older than 50 years were pursuing colon cancer screening. Specifically, physicians were asked to identify their modality of choice and identify their barriers to screening.METHODS: Surveys were mailed to members, older than 50 years, of the Canadian Association of Gastroenterology, the Society of Obstetricians and Gynaecologists of Canada, the Canadian Society of Internal Medicine, the Canadian Psychiatric Association and the Canadian Association of Radiologists.RESULTS: Of 2807 surveys, 46% were returned. Screening for CRC was reported by 53% of respondents. The Canadian Association of Radiologists members (61%) and the Canadian Association of Gastroenterology members (61%) were more likely to be screened than other specialties (P<0.01 and P<0.05, respectively). Members of the Society of Obstetricians and Gynaecologists of Canada (44%) were least likely to be screened (P<0.001). Men (P<0.001) and Ontario physicians (P<0.01) were more likely to be screened than women and Canadian physicians from other provinces, respectively. Colonoscopy (56%) was the most common screening modality used, followed by fecal occult blood testing (27%). Respondents who had not been screened cited a lack of personal time (47%) and insufficient data to warrant screening (14%).DISCUSSION: More than one-half of all respondents were screened for CRC. Colonoscopy is the most common screening modality used. Lack of time is the most common reason cited for not participating in CRC screening.

scholarly journals Screening Strategies for Colorectal Cancer: A Systematic Review of the Evidence

2001 ◽  
Vol 15 (10) ◽  
pp. 647-660 ◽  
Author(s):  
Robin S McLeod ◽  
Keyword(s):  
Colorectal Cancer ◽  
Flexible Sigmoidoscopy ◽  
Occult Blood ◽  
Fecal Occult Blood Testing ◽  
Fecal Occult Blood ◽  
Average Risk ◽  
Hereditary Nonpolyposis Colon Cancer ◽  
Fecal Occult ◽  
Hereditary Nonpolyposis ◽  
Asymptomatic Individuals

BACKGROUND: Colorectal cancer is the third most common cancer in Canada. It is well recognized that there are improved survival rates if the disease is treated in its early stages, and indeed this may be a preventable disease. This paper systematically reviews the effectiveness of specific screening techniques for colorectal cancer in asymptomatic individuals at normal or above average risk.METHODS: MEDLINE was searched for articles published between January 1966 and January 2001 by using the MESH terms 'screening' and 'colorectal neoplasia'. The reference sections of review articles published before January 2001 were checked, and content experts were surveyed. The evidence was evaluated using the standardized methodology of the Canadian Task Force on Preventive Health Care.RSULTS AND DISCUSSION: For individuals at normal risk, there is evidence to support the use of annual or biennial fecal occult blood testing and flexible sigmoidoscopy for asymptomatic individuals over age 50 years. The evidence regarding whether only one or both of fecal occult blood testing and sigmoidoscopy should be performed is unclear, as is the evidence regarding the use of colonoscopy as an initial screen. For individuals at above average risk, the evidence supports either genetic testing or flexible sigmoidoscopy of individuals at risk in familial adenomatous polyposis kindreds, and screening with colonoscopy of patients in kindreds with hereditary nonpolyposis colon cancer. The evidence regarding colonoscopy for individuals who have a family history of colorectal polyps or cancer but do not fit the criteria for hereditary nonpolyposis colon cancer is unclear. Development of better risk stratification for screening is a high research priority, and further research, including randomized, controlled trials, into the effectiveness and feasibility of other screening modalities is necessary.

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