Yuan, MS6. 1VA Health Services Research & Development Center of Excellence on Implementing ... Survey of Primary Care Physicians' Recommendations and.
Variation in Primary Care Physicians’ Colorectal Cancer Screening Recommendations by Patient Age and Comorbidity David A. Haggstrom, MD, MAS1,2,3, Carrie N. Klabunde, PhD4, Judith Lee Smith, PhD5, and Gigi Yuan, MS6 1
VA Health Services Research & Development Center of Excellence on Implementing Evidence-Based Practice( Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; 2 Division of General Internal Medicine and Geriatrics, Department of Medicine( Indiana University School of Medicine, Indianapolis, IN, USA; 3 IU Center for Health Services and Outcomes Research( Regenstrief Institute, Inc., Indianapolis, IN, USA; 4 Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences( National Cancer Institute, Bethesda, MD, USA; 5 Division of Cancer Prevention and Control( Centers for Disease Control and Prevention, Atlanta, GA, USA; 6 Information Management Services, Inc., Silver Spring, MD, USA.
BACKGROUND: Screening patterns among primary care physicians (PCPs) may be influenced by patient age and comorbidity. Colorectal cancer (CRC) screening has little benefit among patients with limited life expectancy. OBJECTIVE: To characterize the extent to which PCPs modify their recommendations for CRC screening based upon patients’ increasing age and/or worsening comorbidity DESIGN: Cross-sectional, nationally representative survey. PARTICIPANTS: The study comprised primary care physicians (n=1,266) including general internal medicine, family practice, and obstetrics-gynecology physicians. MAIN MEASURES: Physician CRC screening recommendations among patients of varying age and comorbidity were measured based upon clinical vignettes. Independent variables in adjusted models included physician and practice characteristics. KEY RESULTS: For an 80-year-old patient with unresectable non-small cell lung cancer (NSCLC), 25 % of PCPs recommended CRC screening. For an 80-year-old patient with ischemic cardiomyopathy (New York Heart Association, Class II), 71 % of PCPs recommended CRC screening. PCPs were more likely to recommend fecal occult blood testing than colonoscopy as the preferred screening modality for a healthy 80-year-old, compared to healthy 50- or 65-year-old patients (19 % vs. 5 % vs. 2 % p
