Barriers to colorectal cancer screening: inadequate knowledge by physicians

Abstract

Background: The rate of colorectal cancer (CRC) screening remains relatively low. One potential barrier to higher rates is the lack of physician knowledge regarding CRC screening. The purpose of this study was to assess physicians' knowledge of (a) American Cancer Society (ACS) CRC screening guidelines for average-risk and high-risk patients, and (b) general colorectal cancer facts which support these guidelines.

Methods: We administered a questionnaire to internal medicine residents, internal medicine attendings and medical students who provide care to patients in a low-income, predominantly minority community, to compare their levels of knowledge regarding CRC screening. Mean knowledge scores were calculated based on the number of correct responses.

Results: Knowledge of ACS guidelines for average-risk patients was low, although it did increase directly with level of training: medical students obtained a mean score of 32%, residents 49%, and attendings 56% (p<0.001). Knowledge scores for high-risk patients were even lower, with fewer than half of the respondents offering correct answers. Mean knowledge scores of general CRC screening facts increased with level of training: medical students scored 31%, residents 38% and attendings 42% (p<0.001).

Clinical implications: Knowledge of CRC screening guidelines for both average- and high-risk patients was suboptimal among the medical students, residents and attendings studied. Lack of knowledge about CRC is one barrier to screening that may contribute to underutilization of screening for minority populations. Further educational efforts should be targeted to these health care professionals.