S1141 Colorectal Cancer Screening of High Risk Populations: A National Study of Physician Knowledge, Practices and Barriers

Abstract

Background and Aims: The incidence of colorectal cancer (CRC) can be decreased by appropriate screening. Given limited resources, strategies based on established guidelines may increase screening efficacy particularly by targeting high risk populations. Our aim was to assess physician knowledge of CRC screening guidelines based on family history and ethnicity, and perceived adherence barriers. Methods: Using a stratified sampling strategy of states with high and low incidence of CRC, a random sample of internists (IMs), family medicine physicians (FMPs) and gastroenterologists (GIs) was established from the American Medical Association registry. The study cohort was electronically invited to anonymously complete a web-based 19-item survey (tested for face and content validity) assessing knowledge, and adherence barriers. Responses were evaluated based on established guidelines from the US Multisociety Task Force and American College of Gastroenterology. Results: Among 25,000 invitees, 512 (2%) representing 29 states (55% from high and 45% from low CRC states) completed the survey and served as the study cohort. Reflecting the sampled cohort 38.3% were IMs, 30.1% FMPs, and 28.3% GIs. The majority (76%) had been in practice for >5 years and saw >50 patients per week. Among the participants, 49.6% were in group practice, 27% in academics, 14.6% in solo practice, and 8.8% were hospital based. The overall mean correct score for knowledge of screening guidelines was only 37± 18%. The mean score for GIs (50±19%) was higher compared to IMs (34±15%), and FMPs (31±14%); P=0.003. Private Practitioners scored higher than academicians (49±19% vs. 33±15%; P<0.001). More African American Physicians were knowledgeable about screening recommendations based on ethnicity, compared to non-African American physicians (66% vs. 28%). Among the barriers to guideline adherence reported by 43% of physicians, the two most common were patient-based factors (refusal and anxiety). However it was a physician factor reported as the third most common barrier (awareness of guidelines) that held the most significant effect on performance. Physicians unaware of screening guidelines were more likely to have low scores (p=0.002). Conclusion: This national survey reveals poor knowledge of CRC screening guidelines for high risk populations across medical specialties. Physicians identified lack of awareness as an important barrier to guideline adherence, and this was reflected by low knowledge scores. Efforts to further disseminate screening guidelines to practitioners are warranted in order to address physician knowledge as a barrier to CRC screening.