Changes to 4d - Clinician Post-intervention Survey

Form Approved

OMB Control No: 0920-0769

Expiration Date: 03/31/2011

Clinician Post-Intervention Survey

Clinical Care and Health Survey: Colorectal Cancer Screening

Clinician Opinion and Practice Questionnaire

Clinician Colorectal Cancer Screening

Survey

Funded by

The Centers for Disease Control and Prevention

Atlanta, GA

Battelle logo MCO logo

[MCO Research Arm Name] and Battelle Centers for Public Health Research are inviting you to participate in this study of clinicians colorectal cancer screening at [MCO Name]. The Centers for Disease Control and Prevention (CDC) is collaborating with Battelle and [MCO Research Arm Name], to study ways to improve colorectal cancer screening in primary care.

We are interested in your opinions and experiences when talking with your patients over the age of 50 about colon cancer and colon cancer screening. We know that primary care clinicians use a variety of approaches to discuss colorectal cancer screening with patients over age 50. We are interested in your training, practice approaches, and opinions about screening for colorectal cancer. We are also interested in the institutional systems you use to facilitate routine screening.

All providers in your clinic as well as several other clinics at [MCO] are being askled to complete this survey. You are being paid $50 to compensate you for your time and effort. You will be contacted one more time in the future so that we may learn more about your training, practice approaches, and opinions about screening for colorectal cancer.

Clinicians who reviewed this questionnaire estimated that it took between 15 and 45 approximately 30 minutes to complete.

We appreciate your help in improving patient care at MCO Name.

• Your answers are strictly private.

• Please do not put your name on the survey.

• Answers from other providers like you will be combined into one final summary.

• Some questions are personal, but those questions provide important information for this study.

• It is your choices to skip any questions that you do not want to answer

• Management at [MCO name] will not see your answers.

We thank you very much for taking your time to fill in this survey for us. When you are done, please mail it back to us in the enclosed envelope.

Thank you!

Clinician Questionnaire

Part I: Clinician Characteristics

This first section asks a few questions about your personal background and your current practice.

1. What is your age? _________________

2. What is your sex?

 Male  Female

3. What is your primary specialty? ___________________________________ (Please specify)

• Family/General Practice

• Internal Medicine

• Nurse Practitioner

• Physician’s Assistant

• Other: ______________________________

4. What is your secondary specialty? ___________________________________ (Please specify)

 No secondary specialty

4. Since completing your training, how long have you been practicing? _______ Years

5. How long have you practiced at ____ (name of study clinic site) _________________ your clinic?

____________ Years ____________ Months

Note: “Your clinic” = (fill with study clinic name)

Please complete remainder of survey with respect to your practice at (study clinic name)

6. On average, how many hours per week total do you spend in direct patient care in your clinic?

Average number of hours ______________

7. Approximately, how many patients are in your panel at your clinic? ______________

8. On average, how many patients do you see in a typical week in your clinic? ______________

9. On average, approximately how many patients do you see in a typical week for health maintenance visits/exams in your clinic? ______________

10. On average, approximately what percent of the patients you see in your clinic are 50 years of age or older? __________ %

Part II: Preventive Services Opinions

1. How worthwhile do you consider each of the following preventive services for asymptomatic patients, age 50 and over, during health maintenance exams a routine non-acute care visit? (Check one box for each test)

Test and interval	Not at all worthwhile	Slightly worthwhile	Somewhat worthwhile	Quite worthwhile	Very worthwhile
a. Pap smear (every 3 years)					
b. Mammogram (annual)					
c. Digital rectal exam with hemoccult (annual)					
d. Fecal occult blood test (FOBT or hemoccult) (annual)					
e. Flexible sigmoidoscopy (every 5 years)					
f. Colonoscopy (every 10 years)					
g. Cholesterol test (annual)					
h. Prostate specific antigen (annual)					
i. Digital rectal exam to check prostate (annual)					

2. How often do you discuss the following issues with patients age 50 and over during a health maintenance exam routine non-acute care visit? (Check one box for each test)

Issues Discussed	Never	Sometimes	Half the Time	Usually	Always
a. Smoking					
b. Alcohol use					
c. Exercise or physical activity					
d. Dietary practices					
e. Stress					
f. Depression					
g. Breast cancer screening					
h. Cervical cancer screening with Pap test (for women)					
i. Prostate cancer screening (for men)					
j. Colorectal cancer screening					
i. Fecal occult blood test					
ii. Flexible sigmoidoscopy					
iii. Colonoscopy					
iv. Barium enema					

3. How often do your patients (age 50 and over) bring up the following issues during a health maintenance exam routine non-acute care visit? (Check one box for each issue)

Issues brought up	Never	Sometimes		Half the Time	Usually	Always
a. Cholesterol or heart disease risk and screening						
b. High blood pressure risk and screening						
c. Diabetes risk and screening						
d. Breast cancer risk and screening (for women)						
e. Cervical cancer risk and screening (for women)						
f. Prostate cancer screening (for men)						
g. Colorectal cancer screening						

The remainder of this survey is about colorectal cancer screening. We are interested in your opinions and practices about screening your patients age 50 and over who are asymptomatic and are presenting for a health maintenance exam routine non-acute care visit.

Part III: Colorectal Cancer Screening: Your Training and Experience

The questions in this section ask about your personal training and experiences related to colorectal cancer screening.

1. In the past year, have you received specific training on any of the following topics?

	Yes	No
a. How to discuss colorectal cancer screening options with your patients		
b. Provision of fecal occult blood test (FOBT) (home test kit) to patients		
c. Recommending Flexible Sigmoidoscopy to patients		
d. Recommending Colonoscopy to patients		
e. Recommending Double contrast barium enema to patients		

1. In the past year did you attend CE/CME training offered at your clinic on how to improve the rate of colon cancer screening?

• Yes, I attended the first meeting

• Yes, I attended the second meeting

• Yes, I attended both meetings

• No, I didn’t attend any meetings at my clinic on this topic

2. In the past year, did you receive specific training on any of the following topics?

	Yes	No
a. Current colorectal cancer (CRC) screening guidelines		
b. Colorectal cancer screening rates at ABQ/Health Partners		
c. Colorectal cancer screening rates at my clinic		
a. How to discuss colorectal cancer screening options with your patients		
e. The difference between motivation and persuasion when discussing colorectal cancer screening with your patients		
f. How to modify clinic processes to increase the rate and efficiency of colorectal cancer screening		

3. Continuing Medical Education Regarding CRC Screening:
I did not attend any CME/CE about colorectal cancer screening in the past year if checked () please skip to next section	Strongly Disagree	Disagree	Neither	Agree	Strongly Agree
a. The CME/CE prepared me to use motivational interviewing techniques to encourage my patients to get CRC screening					
b. The CME/CE prepared me to use open-ended questions with my patients to hear their CRC screening issues					
c. The CME/CE prepared me to use reflective listening with my patients to hear their CRC screening issues					
d. I think other clinicians in the clinic are using the techniques we learned to motivate patients to get their CRC screening					
e. I think clinic support staff are using the techniques we learned to motivate patients to get their CRC screening					

4. In the past year, approximately how many new cases of adenomas or polyps have you detected or diagnosed among your asymptomatic patients, using each of the following screening tests?

Test	Number of Asymptomatic Cases
Fecal occult blood test (FOBT) (Hemoccult cards) (home test kit)
Flexible sigmoidoscopy
Colonoscopy
Double contrast barium enema
Other, specify _______________

5. In the past year, approximately how many new cases of colorectal cancer (including early stages) have you detected or diagnosed among your asymptomatic patients, using each of the following screening tests?

Test	Number of Asymptomatic Cases
Fecal occult blood test (FOBT) (Hemoccult cards) (home test kit)
Flexible sigmoidoscopy
Colonoscopy
Double contrast barium enema
Other, specify _______________

Part IV: Colorectal Cancer Screening Practices Information and Resources

Answer the questions in this section thinking about your patients age 50 years and over who are asymptomatic, and are presenting for a health maintenance exam.

1. For each statement below, please check how often you take each of the following actions when you see patients for health maintenance exams.

1. Information, Training and Reminders and Resources:
	Strongly Disagree	Disagree	Neither	Agree	Strongly Agree
a. I have adequate the latest information about colorectal cancer screening					
b. I have the latest information about colorectal cancer screening guidelines					
c. I have the skills I need to address colorectal cancer screening with my patients					
d. I feel prepared to answer patient questions about CRC screening					
Patients with flagged charts are more likely to receive an FOBT kit at their annual visit e. I feel prepared to discuss CR screening with patients					
f. My clinic has seen an increased volume of consulting nurse phone calls about CRC screening					

g. I feel confident that I can increase my patients’ motivation to screen for colorectal cancer					
h. My patients feel comfortable asking me questions about CRC screening					
i. I feel confident that I can help patients decide which screening test to use					
j. I can understand and address my patients’ barriers to CRC screening					

2. CRC Screening Materials:
The materials that I currently use in my practice…	Strongly Disagree	Disagree	Neither	Agree	Strongly Agree
a. are helpful tools for my practice					
b. are easy for patients to understand					
c. have been well received by patients					
d. helped me gain new skills for addressing CRC screening in my practice					
e. helped me feel more able to answer patient questions about CRC screening					

Part V: Colorectal Cancer Screening Practices

Answer the questions in this section thinking about your patients age 50 years and over who are asymptomatic, and are presenting for a health maintenance exam routine non-acute care visit.

1. For each statement below, please check how often you take each of the following actions when you see patients for health maintenance exam routine non-acute care visits.

	Never	Sometimes	Half the time	Usually	Always
a. I discuss colorectal cancer (CRC) screening when patients present with questions or concerns about colon cancer					
b. I discuss CRC screening with patients who report risk factors in a medical history					
c. I discuss CRC screening with all age-appropriate patients					
d. I have brochures on CRC screening available for all patients					
e. When discussing CRC screening with my patients:
i. I let them decide which screening method to use					
ii. I recommend a specific test they should have					
iii. I use motivational interviewing techniques with them about colon cancer screening					
iv. I ask them open-ended questions about their perceptions of colon cancer and screening					
v. I reflect back to each patient his/her own reasons for being screened					
vi. we come to a joint decision as to which screening method to use					
vii.I accept their decisions with regard to being screened					

In the questions that follow, we ask you about the recommendations you make to your patients. Even if your strategy is to encourage patients to share in decision-making, answer the questions in terms of what you would tell patients if they asked you directly what you recommend.

2. Which test or test combination do you most often recommend to your asymptomatic, average-risk patients age 50 and over, as a colorectal cancer screening strategy? (Check one box)

 I do not recommend routine colorectal cancer screening at this time

 Digital rectal exam alone

 Digital rectal exam and in-office hemoccult

 Fecal occult blood (hemoccult) test alone (patient home kit)

 Flexible sigmoidoscopy alone

 Colonoscopy alone

 Double contrast barium enema alone

 Either fecal occult blood test or flexible sigmoidoscopy

 Either fecal occult blood test or colonoscopy

 Both fecal occult blood test and flexible sigmoidoscopy

 Both fecal occult blood test and colonoscopy

 Other (describe) _____________________________________________________

3. Please complete the table below based on your recommendations for colorectal cancer

screening to asymptomatic average-risk patients, aged 50 and over. If you do not recommend a particular test for screening purposes, check the appropriate box in the first column. To complete the recommended frequency column, please answer in terms of patients ages 50 and over who do not have any abnormal findings on previous tests.

	I do not recommend	Recommended starting age	Recommended frequency of testing	Is there an age at which you no longer recommend testing?	If yes, what age?
a. Digital rectal exam without hemoccult		______yrs →	Every _____yrs →	Yes →  No	______yrs
b. Digital rectal exam in conjunction with hemoccult		______yrs →	Every _____yrs →	Yes →  No	______yrs
c. Fecal occult blood test (FOBT) (Home kit)		______yrs →	Every _____yrs →	Yes →  No	______yrs
d. Flexible sigmoidoscopy		______yrs →	Every _____yrs →	Yes →  No	______yrs
e. Colonoscopy		______yrs →	Every _____yrs →	Yes →  No	______yrs
f. Double contrast barium enema		______yrs →	Every _____yrs →	Yes →  No	______yrs

3. For the last 10 patients aged 50 and older whom you saw for a health maintenance exam routine non-acute care visit and were asymptomatic and due for routine CRC screening, please estimate how many of each of the following tests you performed or ordered for colorectal cancer screening for how many you did each of the following?

Please write “0” if you did not order the test for any of these 10 patients.

Performed digital rectal exam with hemoccult _______

Handed out fecal occult blood test (FOBT) _______

Flexible sigmoidoscopy _______

Ordered double contrast barium enema _______

Ordered colonoscopy _______

4. Among all patients aged 50 and older you saw for a health maintenance exam routine non-acute acre visit, in the past year, who were asymtoptomatic and due for routine CRC screening, for approximately what percentage did you perform or order each colorectal cancer screening test did you do each of the following?

Performed digital rectal exam with hemoccult _______ %

Handed out feccal occult blood test (FOBT) _______ %

Ordered flexible sigmoidoscopy _______ %

Double contrast barium enema _______ %

Ordered colonoscopy _______ %

Part VI: Opinions about CRC Screening

For each statement below, please check the box that best represents your opinion.

1. Discussing colorectal cancer screening with my patients aged 50 and older would:	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
a. make me feel that I am providing comprehensive care					
b. takes too much of my time and effort					
c. be is a higher priority with my male patients					
be is a low priority in my average health maintenance exam non-acute care visit caer visit					
e. reassures patients					
f. gives me an opportunity to provide reliable information and educate patients.					
g. be is a topic that patients do not want to talk about					
h. causes my patients to feel uncomfortable or embarrassed					
i. be is something that I feel prepared to discuss.					
j. distracts from other patient needs.					

2. Distributing Providing screening fecal occult blood tests (FOBT) to my patients aged 50 and older is:	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
a. is a practice standard					
b. is easy to do					
c. is a low risk test for my patients					
d. is difficult due to cultural or language barriers					
e. is an opportunity for education about CRC screening					
f. is a method to increase a patient’s role in their own health care					
g. is cost effective					
h. is difficult due to time constraints					
i. is something I feel prepared to do					
j. other, (specify)_________________					

3. Having my asymptomatic patients aged 50 and older complete screening fecal occult blood test (FOBT) kits at home would:	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
k. be is convenient for patients					
l. be is effective in finding CRC at an early stage					
m. be is effective in decreasing mortality					
n. result s in patients doing it wrong					
o results in patients not returning cards					
p be is distasteful for patients					
q. worry my patients because of false positive results					
r. be is difficult for patients					
s. produce inaccurate results					
j. other, (specify)_________________					

3. Having Encouraging my asymptomatic patients aged 50 and older complete a screening flexible sigmoidoscopy would:	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
a. find most colorectal cancer at early stage					
b. be cost-effective					
c. reassure patients					
d. take too much of my time and effort to discuss and refer					
e. take too much time for patients					
f. miss a large part of the colon					
g. be effective in decreasing mortality					
h. be difficult/unpleasant for patients to prepare for					
i. be inconvenient for patients					
j. expose patients to significant risk of complications					
k. be something that patients would refuse to do					
l. be something that I feel prepared to discuss					
m. result in a long wait time for an appointment					
n. other, (specify)_________________					

3. Encouraging my asymptomatic patients aged 50 and older complete a screening colonoscopy would :	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
a. be is appropriate only for high risk patients					
b. be is appropriate only as follow-up to other tests					
c. is easy to do					
d. would .find colorectal cancer at an early stage					
e. reassures patients					
f. is an opportunity to educate patients about CRC screening					
g. be is preferred by most patients					
h. be is the best test we can provide					
i. allows a view the entire colon					
j. be is effective in decreasing mortality					
k. takes too much time for patients					
l. be is unpleasant for patients to prepare for					
m. be is inconvenient for patients					
n. exposes patients to significant risk of complications					
o. be is expensive for the patient					
p. be is cost-effective					
q. takes too much of my time and effort to discuss and refer					
r. be is something that patients would refuse to do					
s. be is something that I feel prepared to discuss					
t. results in a long wait time for an appointment					

Part VII. Facilitators and Barriers to CRC Screening

We are interested in how various factors affect the ease or difficult of colorectal cancer (CRC) screening.

1. Do you use any of the following systems at your clinic to remind you or your patients when they are due to be screened for colorectal cancer? (Check one box for each item)

	Yes	No
a. Flow charts, “tickler files,” or prompts to remind me or my staff if patients are due for a CRC screening via an FOBT		
b. Flow charts, “tickler files,” or prompts to remind me or my staff if patients are due for a CRC screening via a flexible sigmoidoscopy		
c. Flow charts, “tickler files,” or prompts to remind me or my staff if patients are due for a CRC screening via a colonoscopy		
d. Computerized printouts of my patients’ status on screening tests		
e. Reminder phone calls to patient		
f. Reminder cards by mail to patient		
g. Materials (e.g., handouts) or programs to educate patients		
h. Other (Please specify) _______________________		

2. On average, how long do you think it takes for an asypmtomatic, average risk patient, aged 50 years or older, in your health care system to get a Colonoscopy appointment?:

Get lab results to an Fecal occult blood test (FOBT) ____________________________

Get a Flexible sigmoidoscopy appointment ___________________________

Get a Colonoscopy appointment ____________________________

Get a Double contrast barium enema appointment ____________________________days

3. How adequate do you find each of the following at your facility to support CRC screening? Using the scales below, please mark your opinion.

	Not available	Not at all adequate				Very adequate
a. A summary record of the patient’s screening tests (e.g., stable events summary)						
b. A computer-generated prompt or flag to remind you when a patient is due for a screening test						
c. A medical assistant generated prompt or flag to remind you when a patient is due for a screening test						
d. Tracking system to follow-up patients after referral to a colonoscopy appointment						
e. A patient reminder or recall system						
f. Materials (e.g., handouts) to educate patients about CRC screening						
g. Materials about CRC screening in languages other than English						
h. Staff trained to do patient education about FOBT (hemoccult) cards						
i. Availability of FOBT kits (Hemoccult cards)						
j. Staff/system to remind patients to return FOBT cards						
k. A convenient ordering, appointment, or referral system for colonoscopy						
l. Staff to make patient appointments for flexible colonoscopy						
m. Reminder system for patient appointments for colonoscopy						
n. Staff trained to do patient education about colonoscopy preparation						
o. Facilities to perform colonoscopy in your health system						
p. Availability of timely colonoscopy appointments						

Part VIII. Support for CRC Screening

My discussing colorectal cancer screening options and methods with asymptomatic patients over 50 years of age who see me for a general health maintenance exam routine health maintenance exam is something that:
	Strongly Encourage	Encourage	Neither Encourage nor Discourage	Discourage	Strongly Discourage
a. Patients generally					
b. My colleagues generally					
c. My primary professional medical organizations (specify) ________					
c. Governmental health organizations (e.g., CDC, NIH, State and Local Health Departments)					
e. Voluntary and non-profit health organizations (e.g., ACS)					
d. US Preventive Services Task Force, and other independent working groups					
g. Health insurance policies					
h. Medicare coverage policies					
i. The popular media (TV, radio, magazines)					
j. My group practice policies					
e. Clinicians in my clinic generally					

Please let us know if you have any additional comments:

Thank you very much for completing your survey

Please place it in the enclosed, stamped, envelope and drop it in the mail for us!

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