A study of three diverse primary care practices tests the effectiveness of having doctors recommend counseling for colorectal cancer screening. Results found many patients do not follow through with the referral, but for those that do, some change their mind and have a test they might have avoided.
PLAINSBORO, N.J — Colorectal cancer is the second-leading cause of cancer among men and women in the United States, yet a recommended test that could be used each year to screen for it only gets used about half the time. Getting patients to use the fecal occult blood test (FOBT) can be difficult, and time demands of primary care physicians (PCPs) don’t help. So, a study published this month in The American Journal of Managed Care examined whether telephone counseling could fill that void with a doctor’s recommendation.
In the study, led by Roger Luckman, MD, MPH, counseling referrals were sought from three family practices with diverse demographics. An electronic system identified patients aged 50 to 79 years who were scheduled to see their PCP during the upcoming week for 14 months, and a referral form was attached to patient charts to prompt the doctor to discuss CRC screening. Doctors documented whether the patient a candidate for screening, and whether counseling was recommended.
Counseling staff made five attempts to reach patients. For those who took the call, and depending on whether symptoms were reported, candidates were referred for colonoscopy or mailed an FOTB kit.
During the recruitment period 2261 encounters were documented involving 1945 patients. Healthcare maintenance was the focus of 588 (26.0%) encounters. CRC screening was discussed at 1635 (72.3%) out of the 2261 encounters with 1613 patients.
A total of 603 patients were eligible for CRC screening and of these the providers determined that 241 (40.0%) patients were adequately informed about and motivated for CRC screening and would not benefit from counseling, and the providers recommended counseling to 362 (60.0%). Of the 362 patients recommended for counseling, 180 (49.7%) accepted a counseling referral. The overall colonoscopy rate over 6 to 9 months in the referred group (24.6%) compares favorably with the rates reported in randomized trials of telephone counseling. The study found providers willing to promote colorectal cancer (CRC) screening, which may increase its use, but many patients do not follow through with the referral. On the plus side, some patients not planning on screening change their minds after learning about CRC screening.
Nicole Beagin, Mary Caffrey
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