Increasing Colorectal Cancer Screening by Primary Care Physicians Appalachia PA

Screening rates for colorectal cancer in Pennsylvania lag behind national rates, and rates for the Appalachian regions in this state are even lower. Data from the Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS) indicate that the percentage of respondents who reported use of screening tests for colorectal cancer (fecal occult blood test (FOBT), flexible sigmoidoscopy (FS) or colonoscopy) in accordance with guidelines of the U.S. Preventive Services Task Force was 53% nationwide. The figures for Pennsylvania were 49%, whereas those for Appalachian Pennsylvania were 44.4%. According to a national survey by the American Cancer Society (ACS), a reason frequently given for low screening rates is "it was not recommended by my doctor." The long-range goal of this project is to determine the feasibility of conducting a community-based full-scale dissemination trial of a physician education intervention in multiple locations and under varying practice settings. The objective of this application is to do a collaborative one-year pilot project focusing on the challenge of increasing screening for colorectal cancer in four primary care practice sites through physician education. The central hypothesis is that development and implementation of this intervention, delivered by trained staff of two networks in Appalachia Pennsylvania, ACTION Health Cancer Task Force and Penn State Ambulatory Reasearch Network (PSARN), will be a feasible way to increase colorectal cancer screening. Specific aims include: 1. Better understand current barriers to colorectal cancer screening by qualitative methodology. 2. Implement a tailored, multi-phase intervention in four clinics in the ACTION Health Cancer Task Force and PSARN, based on pre-intervention qualitative evaluation. 3. Assess the rates of colorectal cancer screening before and after intervention through medical record review. Our rationale for this research is that with better understanding of successful physician education that improves cancer screening, a full-scale implementation can be conducted. We are prepared to conduct this research because of the strong networks participating and experience of the research team. At the completion of this work. our expectation is to have better understanding of barriers to colorectal cancer screening in this population, and how this intervention had impact. These findings will be translated into improved physician education to improve screening efforts.