Health Care Provider Characteristics Associated With Colorectal Cancer Screening Preferences and Use

Lila J Finney Rutten,Philip D Parks,Emily Weiser,Chun Fan,Debra J Jacobson,Gregory D Jenkins,Xuan Zhu,Joan M Griffin,Paul J Limburg

doi:10.1016/j.mayocp.2021.06.028

Lila J Finney Rutten, Philip D Parks + Show 7 more

Open Access

https://doi.org/10.1016/j.mayocp.2021.06.028

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Abstract

ObjectiveTo assess health care provider (HCP) preferences related to colorectal cancer (CRC) screening overall, and by HCP and patient characteristics. Participants and MethodsWe developed a survey based on the Theoretical Domains Framework to assess factors associated with CRC screening preferences in clinical practice. The survey was administered online November 6 through December 6, 2019, to a validated panel of HCPs drawn from US national databases and professional organizations. The final analysis sample included 779 primary care clinicians (PCCs) and 159 gastroenterologists (GIs). ResultsHCPs chose colonoscopy as their preferred screening method for average-risk patients (96.9% (154/159) for GIs, 75.7% (590/779) for PCCs). Among PCCs, 12.2% (95/779) preferred multi-target stool DNA (mt-sDNA), followed by fecal immunochemical test (FIT), (7.3%; 57/779) and guaiac-based fecal occult blood test (gFOBT) (4.8%; 37/779). Preference among PCCs and GIs generally shifted toward noninvasive screening options for patients who were unable to undergo invasive procedures; concerned about taking time from work; unconvinced about need for screening; and refusing other screening recommendations. Among PCCs, preference for mt-sDNA over FIT and gFOBT was less frequent in larger compared with smaller clinical practices. Additionally, preference for mt-sDNA over FIT was more likely among PCCs with more years of clinical experience, higher patient volumes (> 25/day), and practice locations in suburban and rural settings (compared to urban). ConclusionBoth PCCs and GIs preferred colonoscopy for CRC screening of average-risk patients, although PCCs did so less frequently and with approximately a quarter preferring stool-based tests (particularly mt-sDNA). PCCs’ preference varied by provider and patient characteristics. Our findings underscore the importance of informed choice and shared decision-making about CRC screening options.

Highlights

MethodsPARTICIPANTS AND METHODSSurvey Development Following the Theoretical Domains Framework, we developed a survey to assess factors associated with implementation of novel practices or technologies into clinical practice including knowledge; skills; social/ professional role and identity; beliefs about capabilities; optimism; beliefs about consequences; intentions; memory, attention, and decision processes; environmental context and resources; and social influences.[16]
Preference for multitarget stool DNA (mt-sDNA) over fecal immunochemical test (FIT) was more likely among primary care clinician (PCC) with 10 to years of experience postresidency (OR, 3.91; 95% CI, 1.22 to 12.52) and those with to 29 years of experience postresidency (OR, 4.76; 95% CI, 1.49 to 15.27) compared with those with fewer years of experience (Table 5)
Preference for mt-sDNA over FIT was more likely among PCCs who saw more than 25 patients per day (OR, 13.6; 95% CI, 2.55 to 72.63) compared with those who saw fewer patients

Summary

Methods

PARTICIPANTS AND METHODSSurvey Development Following the Theoretical Domains Framework, we developed a survey to assess factors associated with implementation of novel practices or technologies into clinical practice including knowledge; skills; social/ professional role and identity; beliefs about capabilities; optimism; beliefs about consequences; intentions; memory, attention, and decision processes; environmental context and resources; and social influences.[16].

Results

Discussion

Conclusion