Knowledge, Attitude, and Practice of Screening For Colon Cancer and Surveillance Colonoscopy for Patients With Predisposing Family History of Colon Cancer Among Primary Care Physicians and Gastroenterologists

Abstract

Introduction: Colorectal cancer (CRC) remains one of the most commonly diagnosed cancers annually within the United States and is the second leading cause of cancer deaths in both men and women. Previous reports have shown that patients with a strong family history of colon polyps and CRC are at much higher risk of developing CRC. The American College of Gastroenterology (ACG) and American Society of Gastrointestinal Endoscopy (ASGE), have developed consensus guidelines on screening and surveillance of patients with family history predisposing to development of CRC. Despite the availability of these guidelines, there continues to be disparity in physician practice with compliance of guidelines, thus leading to delayed detection of this disease. Our study aims to characterize the knowledge, attitudes, and practice patterns in regards to screening and surveillance of CRC in patients with predisposing family history, amongst primary care physicians and gastroenterologists. Methods: A brief survey was distributed to gastroenterologists, internal medicine physicians, and family medicine physicians from all levels of training (residents, fellows, faculty). The survey included seven questions regarding screening and surveillance colonoscopies in patients at high risk for CRC based on significant family history [Figure 1]. Results of the survey from each group of physicians was compared to the standard guidelines to evaluate the knowledge of, and variations in practice patterns.Figure: Percentage of physicians amongst subspecialties with accurate knowledge of screening and surveillance colonoscopy guidelines.Results: We sent the survey to 258 physicians at our center. A total of 112 physicians completed the survey (16 gastroenterologists, 82 internists, and 16 family medicine physicians). Detailed results of the survey are summarized in Figure 2. Overall, gastroenterologists performed slightly better than their counterparts. The best response was 75% from GI doctors, where our expectation was close to 100%. The mean percentage of correct answer was 59%. Conclusion: Our study suggests that despite appropriate guidelines, the knowledge regarding screening and surveillance protocols for patients with a strong family history of colon cancer remains low at 58%. Our next steps include internal medicine, family medicine and gastroenterology house staff and faculty education and increased the correct response to 80%, so these high-risk patients can be identified and their screening and surveillance colonoscopy can be scheduled in a timely manner.Table: Table. Questionnaire of Appropriate Guidelines For Screening and Surveillance Colonoscopy at High Risk for Colorectal Cancer Based on Family History