Physician barriers to population-based, fecal occult blood test-based colorectal cancer screening programs for average-risk patients.
BACKGROUND
Colorectal cancer (CRC) screening is an efficacious but underused means to reduce the burden of CRC. Population-based CRC screening programs are currently being implemented in Canada and physicians are key partners in increasing screening uptake. The current study identified physician attitudes and barriers that need to be addressed by provincial programs.


METHODS
A mailed survey of primary care physicians in Alberta.


RESULTS
The survey response rate was 42.4% (806 of 1903). The majority of physicians suggested CRC screening as part of a routine periodic examination; however, the approach to test selection and the type of tests recommended varied by geographical region. The majority of physicians agreed (48%) or strongly agreed (36%) that a provincewide screening program is the best approach to reducing mortality from CRC. However, there were many serious concerns identified - the most common was endoscopic capacity for follow-up of patients with a positive fecal occult blood test (FOBT), which was cited by 55% to 69% of the physicians surveyed. The barriers to three commonly available tests (FOBT, flexible sigmoidoscopy and colonoscopy) varied according to health region, and the types of barriers identified varied according to the specific test.


CONCLUSIONS
Screening for CRC is gradually being accepted among primary care physicians in Alberta. A key finding of the present descriptive study was the regional variation in practices, perceived barriers and concerns about provincial population-based screening programs based on FOBT as the primary screening test. Provincial programs will need to address the issue of endoscopic capacity and perceived barriers to FOBT to gain primary care physician acceptance of FOBT-based CRC screening programs.
McGregor
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Population Health Research, Alberta Health Services Cancer Care, Calgary, Alberta. elizabeth.mcgregor@albertahealthservices.ca
Hilsden
Robert
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Yang
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H
D000328:Adult; D000416:Alberta; D001291:Attitude of Health Personnel; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009780:Occult Blood; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012004:Rectal Neoplasms / Q000175:diagnosis*