Barriers of and Facilitators to Physician Recommendation of Colorectal Cancer Screening

Colorectal cancer is the second highest cause of cancer deaths in the United States. Although colorectal cancer screening has been demonstrated to be effective and is consistently recommended by clinical practice guidelines, only 57.3 percent of adults over 50 years have been tested. There have been numerous studies investigating barriers and facilitators to screening from the patient perspective, but this is one of the few to consider the issue from the physician perspective.

The researchers carried out in-depth interviews with 29 community- and academic-based primary care physicians and held focus groups with 18 primary care physicians. The study found that all the physician participants were aware of the screening recommendation and that their preferred test was colonoscopy. Barriers to physician recommendation included dealing with other urgent medical problems, language issues, prior patient refusal of screening, physician forgetfulness, lack of time, no reminders and inadequate patient tracking systems. Motivators to physicians recommending screening included patient request, patient age between 50 and 59 years, physicians' positive attitudes toward screening, preventive health visits, reminders and incentives. These findings should help health organizations to design physician-targeted training and system interventions that will increase the number of colorectal cancer screenings.