title: Colorectal cancer screening: physicians' knowledge of risk assessment and guidelines, practice, and description of barriers and facilitators.
abstract: 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.
authors.affiliation: Department of Medicine, McGill University, Montreal, Canada. maida.sewitch@mcgill.ca
authors.forename: Maida J
authors.initials: MJ
authors.lastname: Sewitch
authors.forename: Pascal
authors.initials: P
authors.lastname: Burtin
authors.forename: Martin
authors.initials: M
authors.lastname: Dawes
authors.forename: Mark
authors.initials: M
authors.lastname: Yaffe
authors.forename: Linda
authors.initials: L
authors.lastname: Snell
authors.forename: Mark
authors.initials: M
authors.lastname: Roper
authors.forename: Patrizia
authors.initials: P
authors.lastname: Zanelli
authors.forename: Alan
authors.initials: A
authors.lastname: Pavilanis
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D011792:Quebec; D012189:Retrospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires