Predictors of colorectal cancer screening from patients enrolled in a managed care health plan.

Despite the growing recognition of the importance of colorectal cancer (CRC) screening in reducing cancer mortality, national screening rates are low, indicating a critical need to understand the barriers and remedies for underutilization of CRC screening tests. Using results from independent cross-sectional telephone surveys with patients aged>or=50 years performed before (2000; n=498) and after (2003; n=482) a quality improvement intervention for CRC screening within a large managed care health plan, the trends and predictors of CRC screening with fecal occult blood test (FOBT) and/or endoscopy (flexible sigmoidoscopy/colonoscopy) were examined from a patient perspective. In 2000, patient reported screening rates within guidelines were 38% for any test, 23% for endoscopy, and 22% for FOBT. In 2003, screening rates increased to 50% for any test, 39% for endoscopy, and 24% for FOBT. Having discussed CRC with a doctor significantly increased the odds of being screened (FOBT: odds ratio [OR], 2.09 [95% confidence interval (95% CI), 1.47-2.96]; endoscopy: OR, 2.33 [95% CI, 1.67-3.26]; and any test: OR, 2.86 [95% CI, 2.06-3.96]), and reporting barriers to CRC in general decreased the odds of being screened (FOBT: OR, 0.76 [95% CI, 0.60-0.95]; endoscopy: OR, 0.74 [95% CI, 0.60-0.92]; and any test: OR, 0.66 [95% CI, 0.54-0.80]). Although screening rates increased over the 3-year period, evidence was found of ongoing underutilization of CRC screening. The 2 strongest determinants of obtaining CRC screening were provider influence and patient barriers related to CRC screening in general, pointing to the need for multilevel interventions that target both the provider and patient.

Farmer MM ，Bastani R ，Kwan L ，Belman M ，Ganz PA ... -  《CANCER》

Primary care provider perceptions of barriers to and facilitators of colorectal cancer screening in a managed care setting.

Colorectal cancer (CRC) screening tests (e.g., fecal occult blood testing [FOBT], flexible sigmoidoscopy [FS], etc.) are underused. Primary care providers (PCPs) play a critical role in screening, but barriers to and facilitators of screening as perceived by PCPs in managed care settings are poorly understood. The objectives of the current study were to describe current CRC screening practices and to explore determinants of test use by PCPs in a managed care setting. In 2000, a self-administered survey was mailed to a stratified, random sample of 1340 PCPs in a large, network model health maintenance organization in California. The survey response rate was 67%. PCPs indicated that 79% of their standard-risk patients were screened for CRC. PCP-reported median rates of recommendation for the use of specific screening tests were 90% for FOBT and 70% for FS. In logistic regression models, perceived barriers to the use of FOBT and FS included patient characteristics (e.g., education) and PCP-related barriers (e.g., failure to recall that patients were due for testing). Perceived facilitators of the use of FOBT and FS included interventions targeting certain aspects of the health care system (e.g., reimbursement) and interventions targeting certain aspects of the tests themselves (e.g., provision of evidence of a test's effectiveness). Assignment of high priority to screening, integrated medical group (as opposed to independent practice association) affiliation, and the proportion of patients receiving routine health maintenance examinations were positively associated with reported test use. CRC screening tests appear to be underused in the managed care setting examined in the current study. The perceived barriers and facilitators that were identified can be used to guide interventions aimed at increasing recommendations for, as well as actual performance of, CRC screening.

Dulai GS ，Farmer MM ，Ganz PA ，Bernaards CA ，Qi K ，Dietrich AJ ，Bastani R ，Belman MJ ，Kahn KL ... -  《CANCER》

Colorectal cancer screening behavior in women attending screening mammography: longitudinal trends and predictors.

Carlos RC ，Fendrick AM ，Abrahamse PH ，Dong Q ，Patterson SK ，Bernstein SJ ... -  《-》

Would general practitioners support a population-based colorectal cancer screening programme of faecal-occult blood testing?

Tong S ，Hughes K ，Oldenburg B ，Del Mar C ... -  《INTERNAL MEDICINE JOURNAL》

Colorectal cancer screening among Mexican Americans at a community clinic.

Yepes-Rios M ，Reimann JO ，Talavera AC ，Ruiz de Esparza A ，Talavera GA ... -  《AMERICAN JOURNAL OF PREVENTIVE MEDICINE》