Barriers of and facilitators to physician recommendation of colorectal cancer screening

被引:114
作者
Guerra, Carmen E. [1 ]
Schwartz, J. Sanford
Armstrong, Katrina
Brown, Jamin S.
Halbert, Chanita Hughes
Shea, Judy A.
机构
[1] Univ Penn, Sch Med, Div Gen Internal Med, Philadelphia, PA 19104 USA
[2] Univ Penn, Leonard Davis Inst Hlth Econ, Philadelphia, PA 19104 USA
[3] Univ Penn, Abramson Canc Ctr, Philadelphia, PA 19104 USA
[4] Univ Penn, Wharton Sch, Dept Hlth Management & Econ, Philadelphia, PA 19104 USA
[5] Univ Penn, Sch Med, Philadelphia, PA 19104 USA
[6] Univ Penn, Dept Psychiat, Philadelphia, PA 19104 USA
关键词
physician practice patterns; colorectal cancer screening; mass screening; physician-patient relation; communication barriers;
D O I
10.1007/s11606-007-0396-9
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
BACKGROUND Colorectal cancer screening (CRCS) has been demonstrated to be effective and is consistently recommended by clinical practice guidelines. However, only slightly over half of all Americans have ever been screened. Patients cite physician recommendation as the most important motivator of screening. This study explored the barriers of and facilitators to physician recommendation of CRCS. METHODS A 3-component qualitative study to explore the barriers of and facilitators to physician recommendation of CRCS: in-depth, semistructured interviews with 29 purposively sampled, community- and academic-based primary care physicians; chart-stimulated recall, a technique that utilizes patient charts to probe physician recall and provide context about the barriers of and facilitators to physician recommendation of CRCS during actual clinic encounters; and focus groups with 18 academic primary care physicians. Grounded theory techniques of analysis were used. RESULTS All the participating physicians were aware of and recommended CRCS. The overwhelmingly preferred test was colonoscopy. Barriers of physician recommendation of CRCS included patient comorbidities, prior patient refusal of screening, physician forgetfulness, acute care visits, lack of time, and lack of reminder systems and test tracking systems. Facilitators to physician recommendation of CRCS included patient request, patient age 50-59, physician positive attitudes about CRCS, physician prioritization of screening, visits devoted to preventive health, reminders, and incentives. COCNCLUSION There are multiple physician, patient, and system barriers to recommending CRCS. Thus, interventions may need to target barriers at multiple levels to successfully increase physician recommendation of CRCS.
引用
收藏
页码:1681 / 1688
页数:8
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