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Preventive Care

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Lack of physician discussion and patient refusal are two main reasons patients aren't screened for colon cancer

Even though 75 percent of colorectal cancer (CRC) cases occur in people who do not have risk factors, less than half of Americans age 50 and older have been screened as recommended. A new study of busy primary care rural doctors uncovered several reasons why many patients remain unscreened for CRC.

Researchers at the University of Iowa asked each of 15 randomly chosen Iowa family physicians to verbally describe their reasons for screening or not screening 6 randomly chosen patients aged 55 to 80 years from their practice. The researchers ascertained physicians' reasons for screening a total of 43 patients and their reasons for not screening 40 unscreened patients.Recordings were transcribed verbatim and the data was analyzed using qualitative methods.

The two main reasons patients were not up to date on CRC screening were lack of physician discussion (50 percent) and patient refusal (43 percent). The reasons doctors did not discuss screening included lack of opportunity, belief that the patient could not afford screening, distraction by the patient's other health problems/life issues, simply forgetting to bring up screening, and expecting the patient to refuse screening.

Patients typically declined CRC screening due to cost, lack of interest, autonomy, other life issues that distracted from screening, fear of screening, and lack of symptoms. Patients who were up to date on their CRC screening received diagnostic testing (for previous colon pathology or symptoms (56 percent) instead of asymptomatic screening (44 percent).

Strategies to improve CRC screening might include patient and physician education about the rationale for screening (it should be done before symptoms develop), universal coverage for health maintenance exams, and development of effective patient tracking and reminder systems. The study was supported in part by the Agency for Healthcare Research and Quality (HS13581).

See "Why hasn't this patient been screened for colon cancer? An Iowa research network study," by Barcey T. Levy, Ph.D., M.D., Terri Nordin, M.D., Suzanne Sinift, M.A., and others, in the September-October 2007 Journal of the American Board of Family Medicine 20, pp. 458-468.

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