Professor of Medicine and Chief of Gastroenterology Eastern Virginia Medical School Norfolk, VA
David A. Johnson, MD, MACG1, Kanetha Wilson, PhD2, Katie S. Lucero, MS, PhD3, Shari Dermer, PhD4, John M. Maeglin, MBA5, Doug Rex, MD, MACG6; 1Eastern Virginia Medical School, Norfolk, VA; 2Medscape, LLC, Atlanta, GA; 3Medscape Education, New York City, NY; 4Medscape Education, New York, NY; 5Medscape, LLC, Deerfield, IL; 6Indiana University Hospital, Indianapolis, IN
Introduction: Provider directed advice is important for patient acceptance in CRC screening. Recent evidence has suggested that physicians’ own screening practices might affect screening in their patients.. Methods: Medscape conducted a U.S. based web survey to determine if primary care physicians’ (PCPs) and Ob-Gyns’ (OB-GYNs) recommendations for CRC screening aligned with CRC screening choices that they would select for themselves. Email invitations were sent to 1500 members, and the survey remained open until at least 150 physicians were recruited; no reminder emails were sent. Data were collected anonymously; the study was exempt from IRB review. All participants were recruited and responded December 2 to December 5, 2019. Descriptive statistics were examined, and chi-square tests compared provider choices for patients for screening vs. choices for themselves. Results: PCPs (n=106) and OB-GYNs (n=56) responded (survey response 11%) Mean age: 47 yrs; in practice 17 yrs. 62% group practice. 88% of physicians rated effectiveness of prevention as “very important” for why they recommend the tests they do for CRC screening (Table 1). However, when asked what their first choice for screening was, only 55% chose colonoscopy, with 33% choosing to discuss the pros and cons of all options and letting the patient decide (Table 2). Surprisingly, when this group was asked what their second choice was, only 13% said colonoscopy. When comparing self-choice vs. patient choice, there was a significant difference in the number who chose colonoscopy for themselves vs. their patients as the first choice both PCPs (x2=21.975(1), p < .001) but not OB/GYNs (x2=.841(1), p =.359) (Table 3). Discussion: Despite physician high ranking for CRC prevention, only 55% picked colonoscopy- the best CRC prevention test. Significant disparity is evident for PCP selection of self testing vs patient recommendation for CRC screening. Recognition of referring provider practice should open new understanding for educational messaging towards optimizing efforts for CRC prevention. The authors recognize that this survey may represent a convenience sample.
References: Litwin O, Sontrop JM, McArthur E, et al. Uptake of colorectal cancer screening by physicians is associated with greater uptake by their patients. Gastroenterology 2020;158:906-914
Table 1. Table 1. Importance of the following for your typical recommendation to patients about CRC screening
Table 2. Comparison of first /second choice% recommendations by providers to patients Note: Percentages in each column may not sum to 100% because of rounding a 2nd choice includes those who selected “discuss pros and cons” as a first choice; for that group (n=44), order of choices: 46% FIT-fecal DNA test, 30% fecal immunochemical test, 16% colonoscopy, 7% guaiac based FOBT, 4% flexible sigmoidoscopy, 2% CT colonography
Table 3. Comparison of first choice recommendations for patients vs providers themselvesa[a] Note: Percentages in each column may not sum to 100% because of rounding [a] excludes those who selected “I discuss pros and cons of tests and let patient decide” as the first choice.
Disclosures: David Johnson: CEGX – Consultant. CRH MEDICAL – Consultant. HYGIeaCare – Consultant. ironwood – Advisory Committee/Board Member. MEDSCAPE – Advisory Committee/Board Member. Kanetha Wilson indicated no relevant financial relationships. Katie Lucero indicated no relevant financial relationships. Shari Dermer indicated no relevant financial relationships. John Maeglin indicated no relevant financial relationships. Doug Rex: Aries Pharmaceutical – Consultant. Boston Scientific – Consultant. Braintree Laboratories – Consultant. Covidian/Medtronic – Consultant. EndoAid – Grant/Research Support. Endokey – Consultant. Erbe USA Inc – Grant/Research Support. GI Supply – Consultant. Lumendi, Ltd. – Consultant. Medivators – Grant/Research Support. Medtronic – Consultant. Norgine – Consultant. Olympus Corporation – Consultant, Grant/Research Support. Satisfai Health – Stockholder/Ownership Interest (excluding diversified mutual funds).