title: A survey of Indian Health Service and tribal health providers' colorectal cancer screening knowledge, perceptions, and practices.
abstract: BACKGROUND
  Provider recommendation is critical for colorectal cancer (CRC) screening participation, yet few data exist on practices of providers serving American Indians and Alaska Natives. We examined Indian Health Service (IHS) and tribal provider practices, beliefs about screening efficacy, and perceptions of barriers.
  
  
  METHODS
  We developed a Web-based questionnaire and recruited respondents via electronic distribution lists. We generated descriptive statistics by region, provider type, and workplace setting.
  
  
  RESULTS
  Most respondents (77%) recommend starting CRC screening of average-risk patients at age 50; however, 22% recommend flexible sigmoidoscopy and 43% colonoscopy at intervals inconsistent with national guidelines. Of those recommending fecal occult blood test (FOBT), 23% use a single, in-office FOBT card as their only FOBT method. Respondents reported barriers to screening to include underutilized reminder systems and inadequate resources.
  
  
  CONCLUSIONS
  Indian Health Service/tribal providers are knowledgeable about when to begin CRC screening; however, education about the appropriate use and frequency of CRC tests is needed.
authors.affiliation: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. donald.haverkamp@ihs.gov
authors.forename: Donald
authors.initials: D
authors.lastname: Haverkamp
authors.forename: David G
authors.initials: DG
authors.lastname: Perdue
authors.forename: David
authors.initials: D
authors.lastname: Espey
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Cobb
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D015179:Colorectal Neoplasms / Q000208:ethnology* / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000523:psychology* / Q000706:statistics & numerical data; D019983:Guideline Adherence; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007198:Indians, North American; D004930:Inuit; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States; D016549:United States Indian Health Service / Q000706:statistics & numerical data*