Primary care variability in patients at higher risk for colorectal cancer: evaluation of screening and preventive care practices

Abstract

Objective: Sub-optimal colorectal cancer (CRC) evaluations have been attributed to both physician and patient factors. The primary objective of this study was to evaluate physician practice variation in patients with a higher risk of CRC. We wanted to identify the physician characteristics and the types of patients that were associated with missed screening opportunities; we also explored whether screening for CRC served as a proxy for better preventive care practices.

Methods: A total of 213 board-certified family and internal medicine physicians participated in the study, conducted between September and December 2016. We used Clinical Performance and Value (CPV^®) vignettes, simulated patients, to collect data on CRC screening. The CPV patients presented with a typical range of signs and symptoms of potential CRC. The care provided to the simulated patients was scored against explicit evidence-based criteria. The main outcome measure was rate a diagnostic CRC workup was ordered. This data quantified the clinical practice variability for CRC screening in high risk patients and other preventive and screening practices.

Results: A total of 81% of participants ordered appropriate CRC workup in patients at risk for CRC, with a majority (71%) selecting diagnostic colonoscopy over FIT/FOBT. Only 6% of physicians ordering CRC workup, however, counseled patients on their higher risk for CRC. The most commonly recognized symptoms prompting testing were unexplained weight loss or inadequate screening history, while the least recognized symptoms of CRC risk were abdominal discomfort found on review of systems.

Conclusion: This study shows that primary care physician screening of CRC varies widely. Those physicians who successfully screened for CRC were more likely to complete other prevention and screening practices.

Keywords:

• Colorectal cancer
• high risk patients
• cancer screening
• primary care
• preventive practice
• quality of care

Transparency

Declaration of funding

This study was funded by Applied Proteomics Inc., San Diego, CA, USA.

Declaration of financial/other relationships

J.P. has disclosed that he is the owner of CPV Technologies, which owns the CPV intellectual property described in this study; he is the president and a majority shareholder in QURE Healthcare. M.T. and D.P. have disclosed that they are employees of QURE Healthcare. J.-S.S. has disclosed that he has acted as a consultant/advisor for Applied Proteomics. S.F. has disclosed that he is a consultant/advisor for QURE Healthcare and is a Stock Shareholder in Pfizer and Cara Therapeutics. E.S. has disclosed that he has no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.