Exploring factors that might influence primary-care provider discussion of and recommendation for prostate and colon cancer screening

Abstract

Background

Primary-care providers may contribute to the use of low-value cancer screening.

Objective

We sought to examine circumstances under which primary-care providers would discuss and recommend two types of cancer screening services across a spectrum of net benefit and other factors known to influence screening.

Patients and methods

This was a cross sectional survey of 126 primary-care providers in 24 primary-care clinics in the US. Participants completed surveys with two hypothetical screening scenarios for prostate or colorectal cancer (CRC). Patients in the scenarios varied by age and screening-request status. For each scenario, providers indicated whether they would discuss and recommend screening. Providers also reported on their screening attitudes and the influence of other factors known to affect screening (short patient visits, worry about lawsuits, clinical reminders/performance measures, and screening guidelines). We examined associations between providers’ attitudes and their screening recommendations for hypothetical 90-year-olds (the lowest-value screening).

Results

Providers reported they would discuss cancer screening more often than they would recommend it (P<0.001). More providers would discuss and recommend screening for CRC than prostate cancer (P<0.001), for younger than older patients (P<0.001), and when the patient requested it than when not (P<0.001). For a 90-year-old patient, every point increase in cancer-specific screening attitude increased the likelihood of a screening recommendation (30% for prostate cancer and 30% for CRC).

Discussion

While most providers’ reported practice patterns aligned with net benefit, some providers would discuss and recommend low-value cancer screening, particularly when faced with a patient request.

Conclusion

More work appears to be needed to help providers to discuss and recommend screening that aligns with value.

Keywords:

• cancer screening
• older adults
• decision making
• low-value care
• colon cancer
• prostate cancer

Acknowledgments

The authors would like to thank Carol Golin and Emily Elstad for their assistance in writing this manuscript. This work was supported by the Agency for Healthcare Research and Quality grant for a Research Center for Excellence in Clinical Preventive Services P01 HS021133-01 (center principal investigator RPH and project principal investigator MV) and the Agency for Healthcare Research and Quality Mentored Career Development Program in Comparative Effectiveness Development grant K12 HS19468-01. The funding sources had no role in the study design, collection, analysis, or interpretation of data, writing the report, or the decision to submit the report for publication. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

Disclosure

The authors report no conflicts of interest in this work.