Klabunde Carrie N, Lanier David, Nadel Marion R, McLeod Caroline, Yuan Gigi, Vernon Sally W
Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-7344, USA.
Am J Prev Med. 2009 Jul;37(1):8-16. doi: 10.1016/j.amepre.2009.03.008. Epub 2009 May 13.
Primary care physicians (hereafter, physicians) play a critical role in the delivery of colorectal cancer (CRC) screening in the U.S. This study describes the CRC screening recommendations and practices of U.S. physicians and compares them to findings from a 1999-2000 national provider survey.
Data from 1266 physicians responding to the 2006-2007 National Survey of Primary Care Physicians' Recommendations and Practices for Breast, Cervical, Colorectal, and Lung Cancer Screening (cooperation rate=75%) were analyzed in 2008. Descriptive statistics were used to examine physicians' CRC screening recommendations and practices as well as the office systems used to support screening activities. Sample weights were applied in the analyses to obtain national estimates.
Ninety-five percent of physicians routinely recommend screening colonoscopy to asymptomatic, average-risk patients; 80% recommend fecal occult blood testing (FOBT). Only a minority recommend sigmoidoscopy, double-contrast barium enema, computed tomographic colonography, or fecal DNA testing. Fifty-six percent recommend two screening modalities; 17% recommend one. Nearly all physicians who recommend endoscopy refer their patients for the procedure. Four percent perform sigmoidoscopy, a 25-percentage-point decline from 1999-2000. Although 61% of physicians reported that their practice had guidelines for CRC screening, only 30% use provider reminders; 15% use patient reminders.
Physicians' CRC screening recommendations and practices have changed substantially since 1999-2000. Colonoscopy is now the most frequently recommended test. Most physicians do not recommend the full menu of test options prescribed in national guidelines. Few perform sigmoidoscopy. Office systems to support CRC screening are lacking in many physicians' practices. Given ongoing changes in CRC screening technologies and guidelines, the continued monitoring of physicians' CRC screening recommendations and practices is imperative.
基层医疗医生（以下简称医生）在美国结直肠癌（CRC）筛查工作中发挥着关键作用。本研究描述了美国医生的CRC筛查建议与实践，并将其与1999 - 2000年全国医疗服务提供者调查的结果进行比较。
2008年对1266名回复2006 - 2007年基层医疗医生乳腺癌、宫颈癌、结直肠癌和肺癌筛查建议与实践全国调查的医生数据进行了分析（合作率 = 75%）。采用描述性统计方法来研究医生的CRC筛查建议与实践以及用于支持筛查活动的办公系统。分析中应用了样本权重以获得全国估计值。
95%的医生常规向无症状的平均风险患者推荐结肠镜检查；80%推荐粪便潜血试验（FOBT）。只有少数医生推荐乙状结肠镜检查、双重对比钡灌肠、计算机断层结肠成像或粪便DNA检测。56%的医生推荐两种筛查方式；17%推荐一种。几乎所有推荐内镜检查的医生都会为患者安排该项检查。4%的医生进行乙状结肠镜检查，较1999 - 2000年下降了25个百分点。尽管61%的医生报告其诊所设有CRC筛查指南，但只有30%使用医疗服务提供者提醒；15%使用患者提醒。
自1999 - 2000年以来，医生的CRC筛查建议与实践发生了很大变化。结肠镜检查现在是最常被推荐的检查。大多数医生并未推荐国家指南中规定的全部检查选项。很少有医生进行乙状结肠镜检查。许多医生的诊所缺乏支持CRC筛查的办公系统。鉴于CRC筛查技术和指南不断变化，持续监测医生的CRC筛查建议与实践势在必行。
