Survey of Primary Care Residents to Assess Awareness of Updated 2008 ACG Guidelines for Colorectal Cancer Screening

Abstract

Purpose: To assess the awareness of updated 2008 American College of Gastroenterology (ACG) guidelines for colorectal (CRC) screening among primary care internal medicine (PCIM) residents. Methods: This study is a descriptive analysis of an anonymous, 2-minute, written survey consisting of 18 multiple-choice questions, particularly including changes from the 2000 ACG guidelines, administered simultaneously to all university-based PCIM residents. Questions focused on age to begin screening in average- & high-risk groups, available cancer prevention and cancer detection tests with their recommended intervals. Survey was collected on completion and data analyzed with respect to percentage response and compared among different levels of training. Results: 83% (40/48) residents completed the survey. Per current guidelines, screening is recommended in African Americans beginning at age 45 years; however, no resident selected this response. No resident selected younger age to begin CRC screening in smokers and obese patients which may be beneficial, though not recommended by ACG at this time. All residents correctly identified family history of CRC or adenoma at age >60 years, or small tubular adenoma as average risk factor. Regarding screening tests: 100% residents selected colonoscopy every 10 years, sigmoidoscopy every 5 years. Only 52% residents (19%, 37%, and 75% of PGY 1, 2 & 3 respectively; p<0.05) identified double barium contrast as no longer recommended. 80% residents were aware that CT colonography (CTC) is recommended every 5 years. All residents selected guiac-based fecal occult blood testing annually, though it is no longer recommended by ACG. 78% residents said fecal DNA testing is recommended annually; only 22% correctly responded as every 3 years. All residents correctly identified colonoscopy, sigmoidoscopy and CTC as cancer prevention tests but all wrongly selected these as cancer detection tests also. Almost all the residents wrongly identified fecal immunochemical test (FIT) (88%) and fecal DNA testing (100%) as cancer prevention tests. 100% residents selected colonoscopy as the preferred cancer prevention test, but all wrongly selected colonoscopy as the preferred cancer detection test. None selected FIT as preferred cancer detection test. Conclusion: Primary care residents' awareness seems in dissension with the current CRC screening guidelines. As they are mainly focused in primary care and many would be future primary care physicians, efforts should be made to improve awareness and practice of evidence-based medicine. Additional multicentric study is warranted for validation of our results, and to design intervention to increase knowledge and adherence to guidelines to improve CRC screening.