Colon cancer risk counseling by health-care providers: Perceived barriers and response to an Internet-based cancer risk appraisal instrument

Background. Risk appraisal instruments may be helpful in reinforcing prevention messages, although little is known about physician acceptance of such instruments. Objective. We explored perceived barriers to colon cancer risk counseling and responses to the colon cancer component of an Internet-based risk appraisal instrument. Methods. We qualitatively assessed provider perceptions of barriers to colon cancer prevention and screening, and their responses to the Harvard Cancer Risk Index using focus groups of primary care providers. Results. Many providers commented that the risk appraisal instrument may be most helpful to reinforce messages by a health-care provider. The tool may increase awareness about modifiable risk factors for cancer and help patients prioritize changes as well as improve screening acceptance. With regard to barriers to counseling patients about colon cancer prevention and screening, providers expressed concerns that behaviors are too difficult to change. In addition, they were frustrated by limited time for prevention counseling and poor reimbursement. Conclusions. The Internet-based risk index was well accepted, although providers thought it would be most effective when used to complement provider messages about prevention. Use of an Internet-based risk index along with physician counseling could help improve cancer prevention practices and cancer screening acceptance.