title: Factors associated with practice of colorectal cancer screening among primary care physicians in a Chinese population: a cross-sectional study.
abstract: OBJECTIVE
  Primary care physicians (PCPs) are influential in colorectal cancer (CRC) screening uptake in the community. This study aims to evaluate the factors associated with PCPs' practice of CRC screening among asymptomatic patients in a Chinese population.
  
  
  METHODS
  A validated postal questionnaire was sent to all practicing PCPs who were members of a community-based network in Hong Kong. Three separate rounds of reminder letters were sent to non-respondents. Binary logistic regression analysis was used with ever-referral for CRC screening in the past 12 months as the outcome variable. Predictor variables include physicians' gender, clinical experience, types of practice, and attitudes towards CRC screening.
  
  
  RESULTS
  Of 428 eligible physicians, 263 (61.4%) responded. A total of 187 physicians (71.1%) had referred patients for CRC screening in the past 1 year. Among all asymptomatic patients aged 50 years or older, physicians reported referring only 3.0% (1.0-10.0%) [median (interquartile range)] of patients. Colonoscopy (57.0%) and fecal occult blood testing (FOBT) (46.4%) were the most commonly recommended tests for these asymptomatic patients. Family history of CRC (58.6%) and patients' concern about CRC (50.2%) were major reasons for referral. PCPs in private practice (adjusted odds ratio [aOR] 2.60, 95% C.I. 1.21-5.59) and those with positive attitude towards CRC screening (aOR 2.27, 95% C.I. 1.15-4.48) were more likely to recommend CRC screening.
  
  
  CONCLUSIONS
  PCPs' attitude towards CRC screening is a significant determinant of its practice. Future studies should identify and strengthen the influencers of PCPs' attitude to enhance CRC screening rates.
authors.affiliation: School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong. wong_martin@cuhk.edu.hk
authors.forename: Martin C S
authors.initials: MC
authors.lastname: Wong
authors.forename: Augustine T
authors.initials: AT
authors.lastname: Lam
authors.forename: Donald K T
authors.initials: DK
authors.lastname: Li
authors.forename: Joseph T F
authors.initials: JT
authors.lastname: Lau
authors.forename: Sian M
authors.initials: SM
authors.lastname: Griffiths
authors.forename: Joseph J Y
authors.initials: JJ
authors.lastname: Sung
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D006723:Hong Kong; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009780:Occult Blood; D010821:Physicians, Family / Q000523:psychology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012737:Sex Factors; D011795:Surveys and Questionnaires