427Vol. 41, No. 6
Clinical Research and Methods
Colorectal (CRC) cancer is the second leading cause of
cancer deaths in the United States. Screening for CRC is
widely recommended because of compelling evidence
that it reduces incidence of and death from CRC.1-6 It
remains underused, however, even in populations hav-
ing insurance and access to care.
Studies investigating determinants of CRC screen-
ing have found that a physician’s recommendation for
screening is an important predictor of whether a patient
undergoes screening,7-12 especially in patients having
health insurance who have seen a physician in the last
year.9 However, relatively little is known about patient
or physician factors that are associated with whether
a physician recommends screening, especially within
diverse populations. Nor is it known whether patient-
physician gender or race congruence affects whether
a CRC screening is given. An understanding of these
factors might guide interventions to improve CRC
This study’s purpose was to identify factors influenc-
ing a physician’s recommendation for CRC screening.
Since we studied an insured population attending the
same health care system, it gave us an opportunity to
focus on patient and physician factors that influence
whether a recommendation for screening is made. We
hypothesized that patient sociodemographic factors,
health characteristics, other health behaviors, physi-
cian sociodemographic factors, and patient-physician
gender or race congruence would be associated with a
recommendation for CRC screening.
Factors Associated With a Physician’s
Recommendation for Colorectal Cancer
Screening in a Diverse Population
Navkiran K. Shokar, MD, MPH; Tracy Nguyen-Oghalai, MD; Z. Helen Wu, PhD
From the Department of Family Medicine (Dr Shokar), Department of
Internal Medicine (Dr Nguyen-Oghalai), and Department of Obstetrics and
Gynecology (Dr Wu), University of Texas Medical Branch, Galveston.
Background and Objectives: Colorectal cancer (CRC) screening is widely recommended but under-
used. A physician’s recommendation for CRC screening has been consistently associated with patients
undergoing CRC screening, but a better understanding of factors influencing a physician’s recommen-
dation for CRC screening is needed. This study’s purpose was to describe patient and physician factors
associated with a physician’s recommendation for CRC screening. Methods: A cross-sectional survey
was conducted in a primary care clinic population during 2004–2005 to determine the association
between self-reported physician recommendation for CRC testing and patients’ sociodemographic
factors, health characteristics, other health behaviors, and physician and patient-physician factors
including patient-physician gender and racial/ethnic congruence. Bivariate and multivariate logistic
regressions were performed. Results: A total of 560 patients ages 50–80 were recruited. Their mean
age was 63 years, 47.5% were male, 36% were non-Hispanic whites, 35% were African Americans,
and 29% were Hispanics. Sixty-one percent reported receiving a physician’s recommendation for
CRC testing. In multivariate testing, a physician’s recommendation for CRC testing was associated
with having a female physician, being a male patient, having gastrointestinal disease, and having
better health status. Conclusions: Female physicians are more likely to recommend CRC. Patients
are more likely to receive a CRC recommendation if they are male, have gastrointestinal disease,
and have better health status. Further studies should explore cultural influences on physician recom-
mendation for screening.
(Fam Med 2009;41(6):427-33.)
433Vol. 41, No. 6
Clinical Research and Methods
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