A Survey of Provider Attitudes, Beliefs, and Perceived Barriers Regarding a Centralized Direct-Mail Colorectal Cancer Screening Approach at Community Health Centers

Jamie H Thompson, Jennifer L Schneider, Jennifer S Rivelli, Amanda F Petrik, William M Vollmer, Morgan J Fuoco, Gloria D Coronado, Jamie H Thompson, Jennifer L Schneider, Jennifer S Rivelli, Amanda F Petrik, William M Vollmer, Morgan J Fuoco, Gloria D Coronado

Abstract

Background: Colorectal cancer screening (CRC) rates are low, particularly among individuals with low socioeconomic status. Organized CRC screening programs have demonstrated success in increasing screening rates. Little is known about provider attitudes, beliefs, and practices related to CRC screening or how they are influenced by an organized CRC screening program. Methods: In 2014 and 2016, providers from 26 safety net clinics in Oregon and Northern California were invited to complete baseline and follow-up online surveys for the Strategies and Opportunities to Stop Colon Cancer in Priority Populations (STOP CRC) study. The provider survey link was sent electronically to primary care providers serving adult patients. Providers were sent reminders every 2 weeks via email to complete the survey, up to 3 reminders total. In this article, we describe learnings about provider attitudes, beliefs, and practices related to CRC screening after implementation of the STOP CRC program. Results: A total of 166 unique providers completed baseline and/or follow-up surveys, representing 228 responses. Main themes included (1) favorable shifts in attitude toward fecal immunochemical test (FIT) and direct-mail cancer screening programs, (2) changes in provider perception of key barriers, and (3) growing interest in centralized automated systems for identifying patients due for CRC screening and eligible for population-based outreach. Discussion: Providers are interested in improved information systems for identifying patients due for CRC screening and delivering population-based outreach (ie, to distribute FIT kits outside of the clinic visit) to help reduce health system- and patient-level barriers to screening. Trial Registration: National Clinical Trial (NCT) Identifier NCT01742065.

Keywords: colorectal cancer screening; provider survey; qualitative research.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: From September 2017 to June 2018, Dr. Coronado served as the Principal Investigator on an industry funded study awarded to Kaiser Permanente Center for Health Research to assess the clinical performance of an experimental FIT. This study was funded by Quidel Corporation. No other disclosures are reported.

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7-30.
    1. US Preventive Services Task Force; Bibbins-Domingo K, Grossman DC, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2016;315:2564-2575.
    1. American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2015-2017. Atlanta, GA: American Cancer Society; 2015.
    1. American Cancer Society. Colorectal Cancer Facts & Figures 2017-2019. Atlanta, GA: American Cancer Society; 2017.
    1. Charters TJ, Strumpf EC, Sewitch MJ. Effectiveness of an organized colorectal cancer screening program on increasing adherence in asymptomatic average-risk Canadians. BMC Health Ser Res. 2013;13:449.
    1. Coronado GD, Golovaty I, Longton G, Levy L, Jimenez R. Effectiveness of a clinic-based colorectal cancer screening promotion program for underserved Hispanics. Cancer. 2011;117:1745-1754.
    1. Coronado GD, Retecki S, Schneider J, Taplin SH, Burdick T, Green BB. Recruiting community health centers into pragmatic research: findings from STOP CRC. Clin Trials. 2016;13:214-222.
    1. Coronado GD, Burdick T, Petrik A, Kapka T, Retecki S, Green B. Using an automated data-driven, EHR-embedded program for mailing FIT kits: lessons from the STOP CRC pilot study. J Gen Pract (Los Angel). 2014;2:1000141.
    1. Coronado GD, Petrik AF, Vollmer WM, et al. Effectiveness of a mailed colorectal cancer screening outreach program in community health clinics: the STOP CRC cluster randomized clinical trial. JAMA Intern Med. 2018;178:1174-1181.
    1. Liles EG, Schneider JL, Feldstein AC, et al. Implementation challenges and successes of a population-based colorectal cancer screening program: a qualitative study of stakeholder perspectives. Implement Sci. 2015;10:41.
    1. Weiss JM, Pickhardt PJ, Schumacher JR, et al. Primary care provider perceptions of colorectal cancer screening barriers: implications for designing quality improvement interventions. Gastroenterol Res Pract. 2017;2017:1619747.
    1. Hudson SV, Ferrante JM, Ohman-Strickland P, et al. Physician recommendation and patient adherence for colorectal cancer screening. J Am Board Fam Med. 2012;25:782-791.
    1. Gilbert A, Kanarek N. Colorectal cancer screening: physician recommendation is influential advice to Marylanders. Prev Med. 2005;41:367-379.
    1. Tu SP, Young VM, Coombs LJ, et al. Practice adaptive reserve and colorectal cancer screening best practices at community health center clinics in 7 states. Cancer. 2015;121:1241-1248.
    1. Brown T, Lee JY, Park J, et al. Colorectal cancer screening at community health centers: a survey of clinicians’ attitudes, practices, and perceived barriers. Prev Med Rep. 2015;2:886-891.
    1. Zapka J, Klabunde CN, Taplin S, Yuan G, Ransohoff D, Kobrin S. Screening colonoscopy in the US: attitudes and practices of primary care physicians. J Gen Intern Med. 2012;27:1150-1158.
    1. Feeley TH, Cooper J, Foels T, Mahoney MC. Efficacy expectations for colorectal cancer screening in primary care: identifying barriers and facilitators for patients and clinicians. Health Commun. 2009;24:304-315.
    1. Guerra CE, Schwartz JS, Armstrong K, Brown JS, Halbert CH, Shea JA. Barriers of and facilitators to physician recommendation of colorectal cancer screening. J Gen Intern Med. 2007;22:1681-1688.
    1. Hawley ST, Levin B, Vernon SW. Colorectal cancer screening by primary care physicians in two medical care organizations. Cancer Detect Prev. 2001;25:309-318.
    1. Hoffman RM, Rhyne RL, Helitzer DL, et al. Barriers to colorectal cancer screening: physician and general population perspectives, New Mexico, 2006. Prev Chronic Dis. 2011;8:A35.
    1. Klabunde CN, Frame PS, Meadow A, Jones E, Nadel M, Vernon SW. A national survey of primary care physicians’ colorectal cancer screening recommendations and practices. Prev Med. 2003;36:352-362.
    1. Klabunde CN, Lanier D, Nadel MR, McLeod C, Yuan G, Vernon SW. Colorectal cancer screening by primary care physicians: recommendations and practices, 2006-2007. Am J Prev Med. 2009;37:8-16.
    1. Levy BT, Nordin T, Sinift S, Rosenbaum M, James PA. Why hasn’t this patient been screened for colon cancer? An Iowa Research Network study. J Am Board Fam Med. 2007;20:458-468.
    1. Nichols C, Holt CL, Shipp M, Eloubeidi M, Fouad MN, Britt K. Physician knowledge, perceptions of barriers, and patient colorectal cancer screening practices. Am J Med Qual. 2009;24:116-122.
    1. Davis MM, Shafer P, Renfro S, et al. Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing? BMC Health Serv Res. 2019;19:54.
    1. Gupta S, Brenner AT, Ratanawongsa N, Inadomi JM. Patient trust in physician influences colorectal cancer screening in low-income patients. Am J Prev Med. 2014;47:417-423.
    1. Singal AG, Gupta S, Tiro JA, et al. Outreach invitations for FIT and colonoscopy improve colorectal cancer screening rates: a randomized controlled trial in a safety-net health system. Cancer. 2016;122:456-463.

Source: PubMed

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