Survey of Primary Care Providers

Form Approved:

OMB No.: 0920-XXXX

Expiration Date: XX/XX/XXXX

Public reporting burden of this collection of information is estimated to average 12 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX)

Section A. Colorectal Cancer Screening
Knowledge and Beliefs

1. How effective do you believe the following screening procedures are in reducing colorectal cancer mortality in asymptomatic, average-risk patients aged 50 years and older?

How effective is… (CHECK ONE BOX ON EACH LINE)	Very Effective	Somewhat Effective	Not Effective	Don’t Know
Guaiac-based FOBT1	1	2	3	97
Immunochemical FOBT or FIT2	1	2	3	97
Flexible sigmoidoscopy	1	2	3	97
Colonoscopy	1	2	3	97
Double-contrast barium enema	1	2	3	97
Virtual colonoscopy (e.g., CT colonography)	1	2	3	97
Fecal DNA testing	1	2	3	97

2. Please indicate whether you agree or disagree with the following statements about colorectal cancer screening tests.

(CHECK ONE BOX ON EACH LINE)	Agree	Neutral	Disagree	Don’t Know
Guidelines recommend the digital rectal exam as a colorectal cancer screening test	1	2	3	97
If a stool blood test kit is returned and only one window is positive, the test should be repeated	1	2	3	97
A positive stool blood test should not be repeated with another stool blood test	1	2	3	97
Guidelines recommend that providers do a stool blood test in the office to make sure that at least one colorectal cancer screening test is completed	1	2	3	97
Patients referred for a screening colonoscopy who undergo a biopsy or polypectomy during the procedure may be required to pay a co-pay	1	2	3	97

¹FOBT: Fecal Occult Blood Test

²FIT: Fecal Immunochemical Test

3. Please indicate whether, in your opinion, the following barriers have affected your efforts to provide colorectal cancer screening for your patients.

(CHECK ONE BOX ON EACH LINE)	Major Barrier	Minor Barrier	Not a Barrier	Don’t Know
My patients do not follow through to complete colorectal cancer screening tests	1	2	3	97
My patients are reluctant or refuse to address colorectal cancer screening	1	2	3	97
My patients are unaware of colorectal cancer screening	1	2	3	97
My patients do not perceive colorectal cancer as a serious health threat	1	2	3	97
My patients have difficulty understanding the colorectal cancer screening information I give them	1	2	3	97
My patients’ other health concerns have a higher priority than colorectal cancer screening	1	2	3	97
I don’t have enough time to discuss colorectal cancer screening with my patients	1	2	3	97
Resources for providing timely follow-up to positive FOBT/FIT screening tests are limited (e.g., lack of personnel, time)	1	2	3	97
Resources for providing screening colonoscopy or flexible sigmoidoscopy are limited (e.g., lack of qualified personnel, equipment, facilities)	1	2	3	97
My practice setting lacks an adequate reminder system for colorectal cancer screening	1	2	3	97
My practice setting lacks an adequate tracking system for colorectal cancer screening	1	2	3	97
Experts disagree about appropriate colorectal cancer screening and/or diagnostic modalities	1	2	3	97
Provider reimbursement for conducting colorectal cancer screening is inadequate	1	2	3	97
My patients cannot afford or lack adequate insurance coverage for colorectal cancer screening	1	2	3	97

Section B. Colorectal Cancer Screening Recommendations

4. Which one of the following factors has the greatest influence on your recommendations for colorectal cancer screening? (CHECK ONE BOX)

₁ Guidelines or recommendations of any health plan with which you are affiliated

₂ Clinical evidence in the published literature

₃ Guidelines from national organizations (e.g., ACS/USMSTF, USPSTF, NCCN)*

₄ Day-to-day practice experiences

₅ Other (specify): __________________________

₆ None of these

* ACS/USMSTF: Joint American Cancer Society/U.S. Multi-Society Task Force on Colorectal Cancer; USPSTF: Guidelines of the U.S. Preventive Services Task Force; NCCN: National Comprehensive Cancer Network Guidelines on Colon and Rectal Cancers

5. Please complete the table below based on your colorectal cancer screening recommendations to asymptomatic, average-risk patients (in good health for their age). If you do not routinely recommend a particular test, check “no” and go to the next row.

Do you routinely recommend… (CHECK ONE BOX ON EACH LINE)	Your Recommended Starting Age	Your Recommended Frequency of Testing
Guaiac-based FOBT 1 Yes 2 No	Y ___ ___ ears	Every _________ Years
Immunochemical FOBT or FIT 1 Yes 2 No	Y ___ ___ ears	Every _________ Years
Colonoscopy 1 Yes 2 No	Y ___ ___ ears	Every _________ Years
Flexible sigmoidoscopy 1 Yes 2 No	Y ___ ___ ears	Every _________ Years
Double-contrast barium enema 1 Yes 2 No	Y ___ ___ ears	Every _________ Years
Virtual colonoscopy (e.g., CT colonography) 1 Yes 2 No	Y ___ ___ ears	Every _________ Years
Fecal DNA testing 1 Yes 2 No	Y ___ ___ ears	Every _________ Years
Digital rectal exam 1 Yes 2 No	Y ___ ___ ears	Every _________ Years
Other (specify): _______________________	Y ___ ___ ears	Every _________ Years

6. Why DON’T you routinely recommend guaiac-based FOBT? (CHECK ALL THAT APPLY)

1 Preparation requirements for the patient 2 Lack of patient compliance 3 Patient fear or anxiety 4 Unpleasantness of the procedure for the patient

5 Lack of or unknown test effectiveness 6 High cost or lack of insurance coverage for the patient 7 Poor provider reimbursement 8 Other (specify):___________________

7. Why DON’T you routinely recommend immunochemical FOBT or FIT? (CHECK ALL THAT APPLY)

1 Preparation requirements for the patient 2 Lack of patient compliance 3 Patient fear or anxiety 4 Unpleasantness of the procedure for the patient

5 Lack of or unknown test effectiveness 6 High cost or lack of insurance coverage for the patient 7 Poor provider reimbursement 8 Other (specify):___________________

8. Why DON’T you routinely recommend colonoscopy? (CHECK ALL THAT APPLY)

1 Preparation requirements for the patient 2 Lack of patient compliance 3 Patient fear or anxiety 4 Unpleasantness of the procedure for the patient 5 Lack of or unknown test effectiveness 6 High cost or lack of insurance coverage for the patient

7 Poor provider reimbursement 8 Requirement of anesthesia 9 Difficulties obtaining precertification 10 Poor endoscopic capacity in your area 11 Too many risks to the patient 12 Other (specify):___________________

Section C. Colorectal Cancer Screening Modalities: Fecal Occult Blood Testing or Fecal Immunochemical Testing

If you do not order or perform FOBT/FIT in your practice, SKIP TO SECTION D on page 6.

9. Please complete the table below based on your experiences in providing colorectal cancer screening with FOBT/FIT for your asymptomatic, average-risk patients.

During a typical month, how many times do you order or perform this screening test?

(CHECK ONE BOX ON EACH LINE)	0	1–10	11–20	21–40	More Than 40	Don’t Know
Office-based FOBT/FIT (e.g., via a digital rectal exam)	0	1	2	3	4	97
FOBT/FIT with home test kits	0	1	2	3	4	97

9A. Do you have a reminder system to ensure that patients who are given or mailed home FOBT/FIT kits complete and return the FOBT/FIT?

₁ Yes  GO TO QUESTION 9B

₂ No  SKIP TO QUESTION 10

₉₇ Don’t know  SKIP TO QUESTION 10

9B. What kinds of reminder systems do you use? (CHECK ALL THAT APPLY)

₁ Patient reminder telephone call

₂ Mailed patient reminder

₃ E-mailed patient reminder

₄ Chart reminder to return kit at next visit

₅ Other (specify): _______________________________

10. Which of the following do you usually recommend to a healthy, average-risk patient as an initial follow-up step to a positive FOBT/FIT? (CHECK ALL THAT APPLY)

₁

10A. Do you stop the workup if the second FOBT/FIT is negative?

₁ Yes

₂ No

Repeat FOBT/FIT

₂ Flexible sigmoidoscopy

₃ Colonoscopy

₄ Double-contrast barium enema

₅ Virtual colonoscopy (e.g., CT colonography)

₆ Other (specify): ____________________________

11. Do you have a mechanism (such as reminder calls or mailings, case management, or a tracking system) to ensure that patients with positive FOBT/FIT results complete follow-up testing?

₁ Yes  GO TO QUESTION 11A

₂ No  SKIP TO QUESTION 12

₉₇ Don’t know  SKIP TO QUESTION 12

11A. What is the mechanism? (CHECK ALL THAT APPLY)

₁ Patient reminder telephone call

₂ Mailed patient reminder

₃ E-mailed patient reminder

₄ Case management or patient navigation

₅ Tracking system or log

₆ Scheduling system

₇ Other (specify): _______________________

12. What percentage of FOBT/FIT with home test kits are completed by your patients?
    (Your best guess is fine.)

________ % ₉₇ Don’t know

Section D. Screening With Endoscopy and Other Colorectal Cancer Screening Tests

13. Complete the table below based on your experiences in referring and/or providing colorectal cancer screening for your asymptomatic, average-risk patients.

During a typical month, how many times do you… (CHECK ONE BOX ON EACH LINE)	0	1–5	6–10	11–20	More Than 20	Don’t Know
Refer patients to another provider for screening:
Colonoscopy	0	1	2	3	4	97
Sigmoidoscopy	0	1	2	3	4	97
Double-contrast barium enema	0	1	2	3	4	97
Virtual colonoscopy (e.g., CT colonography)	0	1	2	3	4	97
Personally perform or supervise screening:
Colonoscopy	0	1	2	3	4	97
Sigmoidoscopy	0	1	2	3	4	97

14. Do you counsel patients about fees they may be required to pay if a biopsy or polypectomy is performed during a screening colonoscopy?

₁ Yes

₂ No

₉₇ Don’t know

15. Do you have a procedure or system that helps patients who have been referred for colorectal cancer screening complete the endoscopy (e.g., flexible sigmoidoscopy, colonoscopy)?

₁ Yes  GO TO QUESTION 15A

₂ No  SKIP TO QUESTION 16

₉₇ Don’t know  SKIP TO QUESTION 16

15A. What is the procedure or system? (CHECK ALL THAT APPLY)

₁ Use a tracking system that reminds staff to follow up with patients

₂ Get office staff to schedule screening appointment for patients

₃ Send reminder letters to patients

₄ Contact patients by phone to remind them

₅ Contact patients by e-mail to remind them

₆ Confirm completion through receipt of endoscopy report

₇ Offer patients case managers or navigators

₈ Other (specify): _______________________

16. Over the past 2 years, has the volume of colorectal cancer screening tests you order, perform, or supervise:

(CHECK ONE BOX ON EACH LINE)	Increased Substantially	Increased Somewhat	Stayed About the Same	Decreased Somewhat	Decreased Substantially	Don’t Know	I Do Not Order or Perform This Test
Guaiac-based FOBT	1	2	3	4	5	97	6
Immunochemical FOBT or FIT	1	2	3	4	5	97	6
Screening sigmoidoscopy	1	2	3	4	5	97	6
Screening colonoscopy	1	2	3	4	5	97	6

Section E. Primary Care Practice Systems

Some primary care physicians work in more than one location. Please answer the following questions as they relate to your main primary care practice location (i.e., the setting in which you spend the most hours per week).

17. How many nurse practitioners, physician assistants, or other staff at your main primary care practice are involved in colorectal cancer screening activities (e.g., education, referral, tracking, patient navigation, and test distribution)?

________ ₉₇ Don’t know

18. Has your main primary care practice implemented guidelines (e.g., practice protocols, policies, algorithms) for colorectal cancer screening?

₁ Yes

₂ No

₉₇ Don’t know

19. What type of medical record system does your main primary care practice use?
    (CHECK ALL THAT APPLY)

₁ Paper charts

₂ Partial electronic medical records (e.g., lab results available electronically, but patient history on paper)

₃ In transition from paper to full electronic medical records

₄ Full electronic medical records

20. Does your main primary care practice use a procedure or system to remind you or other members of the care team that a patient is due for colorectal cancer screening?

₁ Yes  GO TO QUESTION 20A

₂ No  SKIP TO QUESTION 21

₉₇ Don’t know  SKIP TO QUESTION 21

20A. What is the procedure or system? (CHECK ALL THAT APPLY)

₁ Special notation or flag in patient’s chart

₂ Computer prompt or computer-generated flow sheet

₃ I routinely look it up in the medical record at the time of a visit

₄ The practice regularly gives me a list of patients who are not up-to-date

₅ Other (specify): _______________________

21. Does your main primary care practice use a procedure or system to remind your patients that they are due for colorectal cancer screening?

₁ Yes  GO TO QUESTION 21A

₂ No  SKIP TO QUESTION 22

₉₇ Don’t know  SKIP TO QUESTION 22

21A. What is the procedure or system? (CHECK ALL THAT APPLY)

₁ Verbal prompt from you or a member of the care team during an office visit

₂ Patient reminder telephone call

₃ Mailed patient reminder

₄ E-mailed patient reminder

₅ Personalized Web page

₆ Other (specify): _______________________

22. During the past 12 months, did you receive feedback reports from any source regarding rates of colorectal cancer screening for your patients?

₁ Yes  GO TO QUESTION 22A

₂ No  SKIP TO QUESTION 23

₉₇ Don’t know  SKIP TO QUESTION 23

22A. Did these reports allow you to compare your own performance with your own patients to the performance of other practitioners and their patients?

₁ Yes

₂ No

₉₇ Don’t know

22B. During the past 12 months, were your payments adjusted based on your own performance, as reflected in these colorectal cancer screening reports?

₁ Yes

₂ No

₉₇ Don’t know

23. Does your main primary care practice monitor the percentage of patients, aged 50 years and older, that are up-to-date with colorectal cancer screening?

₁ Yes  GO TO QUESTION 23A

₂ No  SKIP TO QUESTION 24

₉₇ Don’t know  SKIP TO QUESTION 24

23A. What is the percentage of patients at your main primary care practice who are up-to-date with colorectal cancer screening? (Your best guess is fine.)

________ % ₉₇ Don’t know

24. When it comes to educating patients about colorectal cancer screening, which of the following have been used by your main primary care practice in the past 6 months? (CHECK ALL THAT APPLY)

₁ Direct consultation during office visits

₂ Nursing staff/PA/MA interactions

₃ Office handouts (pamphlets, brochures, etc.)

₄ Mailed information (pamphlets, brochures, etc.)

₅ Referral to Web-based resources

₆ DVDs

₇ Other (specify): ________________________

₉₇ Don’t know

25. During the past 12 months, have you participated in any meetings, seminars, or Webinars that offer CMEs on colorectal cancer screening?

₁ Yes

₂ No

₉₇ Don’t know

26. During the past 12 months, have there been any activities in your community to encourage people to get screened for colorectal cancer?

₁ Yes  GO TO QUESTION 26A

₂ No  SKIP TO QUESTION 27

₉₇ Don’t know  SKIP TO QUESTION 27

26A. Please briefly describe these activities.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Section F. Practice and Other Characteristics

27. How many hours per week do you spend in direct patient care?

________ ₉₇ Don’t know

28. Including yourself, about how many physicians work in your main primary care practice location?

₁ 1

₂ 2–5

₃ 6–15

₄ 16–49

₅ 50–99

₆ 100+

29. During a typical week, approximately how many patients do you see in your main primary care practice location?

₁ 25 or fewer

₂ 26–50

₃ 51–75

₄ 76–100

₅ 101–125

₆ 126 or more

30. Approximately what percentage of your patients in your main primary care practice is aged 50 years and older? (Your best guess is fine.)

________ % ₉₇ Don’t know

31. Approximately what percentage of your patients in your main primary care practice location is uninsured? (Your best guess is fine.)

________ % ₉₇ Don’t know

32. Approximately what percentage of your patients in your main primary care practice location is insured by Medicaid? (Your best guess is fine.)

________ % ₉₇ Don’t know

33. Approximately what percentage of your patients in your main primary care practice is of a racial or ethnic minority? (Your best guess is fine.)

________ % ₉₇ Don’t know

Section G. Personal Characteristics

34. What is your sex?

₁ Male

₂ Female

35. Are you Hispanic or Latino?

₁ Yes

₂ No

36. What is your race?
    (CHECK ALL THAT APPLY)

₁ White

₂ Black or African American

₃ Asian

₄ Native Hawaiian or Other Pacific Islander

₅ Native American or Alaska Native

₆

37. What year did you graduate from medical school? ___ ___ ___ ___

38. In which country did you complete your residency? ________________________________

39. What is your primary clinical specialty?

₁ Family practice

₂ General practice

₃ Internal medicine

₄ Obstetrics/Gynecology

₅ Other (specify): __________________

40. The CDC is using data from this survey and other efforts to shape its colorectal cancer screening promotional efforts. Information from practicing doctors is especially important to CDC. We would like to contact you again in approximately 18 months. May we have your permission to contact you again?

₁ Yes

₂ No

41. Is there anything else you would like to tell us about colorectal cancer screening in your practice or in general?

_

Thank you very much for completing this survey. Please return it in the envelope provided to:

ICF Macro
Attn: Naomi Freedner
126 College Street
Burlington, VT 05401

You can also fax your completed survey to the attention of Naomi Freedner at: 1-866-777-8356.

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