title: Colorectal cancer screening at community health centers: A survey of clinicians' attitudes, practices, and perceived barriers.
abstract: OBJECTIVE
  Colorectal cancer (CRC) screening rates remain lower among some racial/ethnic groups and individuals with low income or educational attainment who are often cared for within community health centers (CHCs). We surveyed clinicians in a network of CHCs to understand their attitudes, practice patterns, and perceived barriers to CRC screening.
  
  
  METHODS
  A clinician survey was conducted in 2013 within the Community Health Applied Research Network (CHARN).
  
  
  RESULTS
  180 clinicians completed the survey (47.9% response rate). Participants had an average of 11.5 (SD: 9.8) years in practice, 62% were female, and 57% were physicians. The majority of respondents somewhat agreed (30.2%) or strongly agreed (57.5%) that colonoscopy was the best screening test. However, only 15.8% of respondents strongly agreed and 32.2% somewhat agreed that colonoscopy was readily available for their patients. Fecal immunochemical testing (FIT), a type of fecal occult blood test (FOBT), was viewed less favorably; 24.6% rated FIT as very effective.
  
  
  CONCLUSIONS
  Although there are no data showing that screening colonoscopy is superior to FIT, CHC clinicians believe colonoscopy is the best CRC screening test for their patients, despite the high prevalence of financial barriers to colonoscopy. These attitudes could be due to lack of knowledge about the evidence supporting long-term benefits of fecal occult blood testing (FOBT), lack of awareness about the improved test characteristics of FIT compared to older guaiac-based FOBT, or the absence of systems to ensure adherence to regular FOBT screening. Interventions to improve CRC screening at CHCs must address clinicians' negative attitudes towards FIT.
authors: Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine-Chicago, IL, United States.
authors: Tiffany
authors: T
authors: Brown
authors: Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine-Chicago, IL, United States.
authors: Ji Young
authors: JY
authors: Lee
authors: Alliance of Chicago Community Health Services-Chicago, IL, United States.
authors: Jessica
authors: J
authors: Park
authors: OCHIN, Inc.-Portland, OR, United States.
authors: Christine A
authors: CA
authors: Nelson
authors: Kaiser Permanente Northwest Center for Health Research-Portland, OR, United States.
authors: Mary Ann
authors: MA
authors: McBurnie
authors: Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine-Chicago, IL, United States.
authors: David T
authors: DT
authors: Liss
authors: Alliance of Chicago Community Health Services-Chicago, IL, United States.
authors: Erin O
authors: EO
authors: Kaleba
authors: North Country HealthCare-Flagstaff, AZ, United States.
authors: Eric
authors: E
authors: Henley
authors: Fenway Health-Boston, MA, United States.
authors: Padmini
authors: P
authors: Harigopal
authors: Chase Brexton Health Care-Baltimore, MD, United States.
authors: Laura
authors: L
authors: Grant
authors: Kaiser Permanente Northwest Center for Health Research-Portland, OR, United States.
authors: Phil
authors: P
authors: Crawford
authors: Open Door Community Health Centers-Arcata, CA, United States.
authors: Joseph E
authors: JE
authors: Carroll
authors: Chase Brexton Health Care-Baltimore, MD, United States.
authors: Kari
authors: K
authors: Alperovitz-Bichell
authors: Division of Healthcare Quality Evaluation, The Joint Commission-Oakbrook Terrace, IL, United States.
authors: David W
authors: DW
authors: Baker
keywords: Colorectal cancer screening; Community health centers; Healthcare disparities; Preventive medicine; Primary care providers