Physician and patient factors associated with ordering a colon evaluation after a positive fecal occult blood test.


Journal Article

OBJECTIVE: Successful colorectal cancer screening relies in part on physicians ordering a complete diagnostic evaluation of the colon (CDE) with colonoscopy or barium enema plus sigmoidoscopy after a positive screening fecal occult blood test (FOBT). DESIGN: We surveyed primary care physicians about colorectal cancer screening practices, beliefs, and intentions. At least 1 physician responded in 318 of 413 (77%) primary care practices that were affiliated with a managed care organization offering a mailed FOBT program for patients aged >/=50 years. Of these 318 practices, 212 (67%) had 602 FOBT+ patients from August through November 1998. We studied 184 (87%) of these 212 practices with 490 FOBT+ patients after excluding those judged ineligible for a CDE or without demographic data. Three months after notification of the FOBT+ result, physicians were asked on audit forms if they had ordered CDEs for study patients. Patient- and physician-predictors of ordering CDEs were identified using logistic regression. MEASUREMENTS AND MAIN RESULTS: A CDE was ordered for only 69.5% of 490 FOBT+ patients. After adjustment, women were less likely to have had CDE initiated than men (adjusted odds, 0.66; confidence interval, 0.44 to 0.97). Physician survey responses indicating intermediate or high intention to evaluate a FOBT+ patient with a CDE were associated with nearly 2-fold greater adjusted odds of actually initiating a CDE in this circumstance versus physicians with a low intention. CONCLUSIONS: Primary care physicians often fail to order CDE for FOBT+ patients. A CDE was less likely to be ordered for women and was influenced by physician's beliefs about CDEs.

Full Text

Cited Authors

  • Turner, B; Myers, RE; Hyslop, T; Hauck, WW; Weinberg, D; Brigham, T; Grana, J; Rothermel, T; Schlackman, N

Published Date

  • May 2003

Published In

Volume / Issue

  • 18 / 5

Start / End Page

  • 357 - 363

PubMed ID

  • 12795734

Pubmed Central ID

  • 12795734

International Standard Serial Number (ISSN)

  • 0884-8734

Digital Object Identifier (DOI)

  • 10.1046/j.1525-1497.2003.20525.x


  • eng

Conference Location

  • United States