Family physicians' choices of and opinions on colorectal cancer screening modalities.

OBJECTIVE To determine FPs' choices of and opinions on colorectal cancer (CRC) screening options in the context of a new provincewide screening program. METHODS Mailed survey, using a modified Dillman protocol, which asked about 5 recommended CRC screening modalities. SETTING Ontario. PARTICIPANTS Computer-generated random sample of 894 eligible FPs and GPs from a commercially available physician directory. MAIN OUTCOME MEASURES Physicians' preferences for personal CRC screening; perceptions of patients' preferences for CRC screening; knowledge of screening test characteristics; and opinions on cost-effectiveness and mortality reduction of screening modalities. RESULTS Of the 894 eligible FPs and GPs who received the mailed survey, 465 physicians responded (response rate of 52%). Respondents were diverse in demographic and practice characteristics. Decennial colonoscopy and biennial fecal occult blood testing (FOBT) were the 2 most popular screening methods. There was a statistically significant difference between physicians' preferences of screening options and their perceptions about patient preferences (P<.001), with 50.8% of physicians preferring colonoscopy (vs 39.6% FOBT) but 64.1% believing the average patient prefers FOBT (vs 29.0% colonoscopy). Opinions on the cost-effectiveness and effect on mortality of screening modalities and FOBT sensitivity, but not colonoscopy wait times, significantly influenced both physician preferences and their perceptions of patient preferences. Of the respondents, 54.4% believed colonoscopy had the greatest mortality reduction, while 66.1% chose FOBT as the most cost-effective CRC screening method. CONCLUSION There was a significant difference between primary care physicians' preferences and their perceptions of patient preferences for CRC screening (P<.001). Screening choice was influenced by physicians' perceptions of FOBT sensitivity and their opinions on cost-effectiveness and mortality reduction of the screening modality. Colonoscopy wait times did not influence physicians' screening choices. As some screening programs emphasize FOBT for most people, this might result in fewer physican-patient discussions about options of other screening modalities. Further research into patient preferences for screening is warranted.