S445 Study of Compliance, Practice Patterns, and Barriers Regarding Established National Screening Programs for Barrett’s Esophagus Among Gastroenterology (GI) and Primary Care Providers (PCP): SCREEN-BE

Abstract

Introduction: Professional society guidelines recommend upper endoscopy to screen for Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC) in at-risk individuals. However, the majority of EAC cases do not have a prior BE diagnosis suggesting a failure of current screening practices. Methods: We conducted a web-based survey of GIs and PCPs at 4 academic medical centers and 2 affiliated county hospitals. Questions were adapted from validated cancer screening-related surveys that were pretested and pilot tested. Survey domains included provider and practice characteristics, screening practices, knowledge of guidelines, attitudes, and perceived barriers to implementing BE screening. Results: We obtained a GI and PCP response rate of 74.5% (120/161) and 49.2% (195/396), respectively. Most respondents were physicians (91%), with a wide distribution of numbers of years in practice, and the majority (76% GI, 92% PCP) reported seeing 2+ patients with reflux per week. GI providers were more consistently able to identify BE risk factors that would prompt screening than PCPs. Whereas half (54.17%) of GI providers order an upper endoscopy for BE screening per month, only 17.7% of PCPs reported ordering endoscopy and 25.6% reported referring patients to GI. When presented with clinical vignettes, GI providers were more likely to recommended guideline-concordant screening than PCPs [mean concordance score 6.8 (SD 1.6) vs 5.5 (SD 2.1) (Figure 1). Although over 70% of both GI providers and PCPs believe BE screening is effective for early cancer detection, few believed it reduced mortality and PCPs expressed concerns regarding cost-effectiveness. The majority of both providers agreed more data evaluating screening benefits and harms are needed, including data from randomized controlled trials (Table 1). Whereas GIs reported minimal barriers to performing BE screening, PCPs identified several barriers at the provider level (e.g., limited knowledge of guidelines) and system level (e.g. clinic time constraints and concerns about insurance coverage). Conclusion: GI providers and PCPs believe BE screening can improve EAC early detection; however there is a desire for increased data evaluating benefits and harms of BE screening. PCPs also report several barriers to BE screening. These data provide insights for the implementation of BE screening strategies in the era of BE risk-stratification models and novel, minimally invasive non-endoscopic tools. Funded by the ACG Clinical Research Award 2020.Figure 1.: GI and PCP application of guidelines to 9 clinical vignettes. Bars represent responses concordant with screening guidelines. GI responses were concordant if they recommended upper endoscopy for screening (or appropriately did not recommend endoscopy) and PCP responses were concordant if they referred to GI to discuss screening or recommended upper endoscopy (or appropriately did not recommend endoscopy).Table 1.: Gastroenterology and Primary Care Provider Attitudes and Barriers related to BE screening