Physician Characteristics and Colorectal Cancer Stage

描述（由申请人提供）：结直肠癌是美国第四大常见癌症和第二大癌症死亡原因。生存很大程度上取决于诊断时的分期，但只有大约40%的新病例在局部阶段被诊断出来。现有有效的筛查方法可导致早期发现并降低该病的死亡率，但这些方法仍未得到充分利用。我们认为，影响人群中结直肠癌筛查率的因素决定了该人群中结直肠癌的诊断阶段。我们建议进行一项基于人群的病例对照研究，以确定与高风险、服务不足人群中结直肠癌诊断阶段相关的因素。特别是，我们将研究医生特征、实践类型、专业培训、筛查指南知识、对筛查的态度、实际筛查实践、患者教育和沟通方法以及与结直肠癌诊断阶段相关的筛查障碍之间的关系。该研究将比较大约533例局部侵袭性结直肠癌患者（病例）和1242例更晚期疾病患者（对照），这些患者来自基于人群的癌症登记处。在控制混杂因素的同时，逻辑回归将用于评估癌症分期与医生特征和行为之间的关系。这项研究将增加社区医生筛查实践的知识基础，以及这些实践如何影响诊断阶段和最终结直肠癌的结局。更好地了解目前可用的筛查程序的使用和对筛查的态度将有助于阐明在美国观察到的结直肠癌筛查低流行率和结直肠癌高死亡率的原因。公共卫生相关性：结直肠癌筛查利用不足导致检测延误，导致患者被诊断为较大（更晚期）肿瘤。我们将进行一项研究，检查医生因素（培训、关于筛查的信念、筛查实践）与结直肠癌诊断阶段之间的关系。这些特征可用于确定可能从旨在增加结直肠癌筛查的教育努力中受益的从业人员。

DESCRIPTION (provided by applicant): Colorectal cancer is the fourth most common cancer and the second leading cause of cancer death in the United States. Survival is strongly determined by stage at the time of diagnosis but only approximately 40% of all new cases are diagnosed at local stage. Effective screening methods are available which can lead to early detection and reduced mortality from this disease, but these remain underutilized. We believe the factors that influence colorectal cancer screening rates in a population determine the stage at diagnosis of colorectal cancer in that population. We propose to conduct a population based case: control study to identify factors associated with stage at diagnosis of colorectal cancer in a high-risk, underserved population. In particular, we will study the relationship between physician characteristics, type of practice, specialty training, knowledge of screening guidelines, attitudes regarding screening, actual screening practices, approaches to patient education and communication, and perceived barriers to screening in relation to stage at colorectal cancer diagnosis. The study will compare approximately 533 patients with incident local stage invasive colorectal cancer (cases) and 1242 patients with more advanced stage disease (controls) identified from a population-based cancer registry. Logistic regression will be used to assess the relationship between cancer stage and physician characteristics and behaviors while controlling for confounding. This research will increase the knowledge base regarding screening practices of community-based physicians and how these practices affect stage at diagnosis and ultimately colorectal cancer outcome. A better understanding of the utilization of currently available screening procedures and attitudes toward screening will help illuminate the reasons for the low prevalence of colorectal screening and high colorectal mortality observed in the United States. Public Health Relevance: Underutilization of colorectal cancer screening contributes to delays in detection causing patients to be diagnosed with larger (more advanced stage) tumors. We will conduct a study examining the relation between physician factors (training, beliefs about screening, screening practices) and stage at diagnosis of colorectal cancer. These characteristics can be used to identify practitioners likely to benefit from educational efforts designed to increase colorectal cancer screening.