The long-term goal of this research program is to improve the delivery and utilization of preventive services for colorectal cancer (CRC) as in PAR-02-042. The objective of this application is to assess current rates and modalities of CRC screening in busy, primarily rural, primary care settings and to identify physician and patient barriers/facilitators to screening. By accurately assessing patterns of preventive care for CRC in the primary care setting, this will set the stage for developing new strategies to improve CRC screening and early diagnosis, reducing untreatable CRC. The proposed multimethod study is designed to address the following Specific Aims: 1. To assess physicians' rates of delivery and patients' rates of utilization of CRC screening. 2. To ascertain patients' reasons for compliance with or lack of compliance with colorectal screening recommendations and why they opted for particular tests. 3. To ascertain physicians' reasons for screening or not screening certain patients and why specific screening modalities were chosen for these patients. Eighteen family physicians will participate along with a random sample of 30 patients/physician for a total of 540 patients. Patients will be at average risk for CRC, ages 55 to 80 years, and primarily living in rural, health professional shortage areas. Patients will complete a detailed written survey regarding their health, past CRC screening tests, discussions they have had with their physician about CRC screening, and give Informed Consent for review of their medical record for past CRC screening tests, current medications, and medical conditions. Because of clustering of patients by physician, mixed effects hierarchical models will be developed to assess both predictors of physician recommendation for screening and predictors of patient compliance with screening. We will interview physicians using qualitative methods concerning reasons for screening/not screening specific patients. We hypothesize that physicians respond to patient-specific cues that affect the likelihood of CRC screening. Previous research has focused primarily on whether physicians agree with published guidelines and their self-reported rates of CRC screening, without elucidating possible patient-specific reasons for lack of guideline adherence (e.g. co-morbid conditions, health status, patient goals for care, socioeconomic status, perceived CRC risk, medical insurance). Patient-specific information is needed to help guide future interventions. We expect this innovative approach to yield new information of importance for designing effective interventions to improve the rate of CRC screening.
| Daly, Jeanette M; Levy, Barcey T; Joshi, Mrinalini et al. (2010) Patient clock drawing and accuracy of self-report compared with chart review for colorectal cancer (CRC) screening. Arch Gerontol Geriatr 50:341-4 |
