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Cancer Screening: Provider Assessment and Feedback – Colorectal Cancer by Colonoscopy or Flexible Sigmoidoscopy

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What the CPSTF Found

About The Systematic Review

The Task Force finding is based on evidence from a Community Guide systematic review published in 2008 (Sabatino, et al., search period through September 2004) combined with more recent evidence (search period 2004 - October 2008). The systematic review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to cancer prevention and control. This finding updates and replaces the 2008 Task Force finding on Cancer Screening: Provider Assessment and Feedback – Colorectal Cancer by Colonoscopy or Flexible Sigmoidoscopy [PDF - 233 kB].

The effectiveness of provider-directed interventions was determined by considering evidence across all three cancer screening sites combined, as long as there were not differences in effectiveness by screening test. This was done because provider behavior was thought to be less influenced than client behavior by the nature of screening tests.

Context

There is no information for this section.

Summary of Results

The review included nine studies that assessed intervention effectiveness for breast, cervical, and colorectal cancers.

  • Screening for breast, cervical or colorectal cancer: median increase of 13.0 percentage points (interquartile interval: 5.5 to 21.8 percentage points; 13 study arms).
  • The single effect measure for flexible sigmoidoscopy indicated no substantial change.

 

Summary of Economic Evidence

The updated search for evidence included studies about breast, cervical, or colorectal cancer screening. Only one study about colorectal cancer screening qualified for the review. Monetary values are presented in 2009 U.S dollars.

  • The estimated cost of increasing screening for colorectal cancer among military veterans was $1,074 per additional screening.

Applicability

Applicability of this intervention across different settings and populations was not assessed because the Task Force did not have enough information to determine if the intervention works.

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

The following outlines evidence gaps for provider assessment and feedback to increase breast, cervical, or colorectal cancer screening.

  • Can a single assessment and feedback program targeting all three cancer sites increase screening use for each site?
  • Are some approaches more effective than others (e.g., group versus individual feedback)?
  • Does the magnitude of effect differ for (1) physicians in training versus trained physicians and (2) providers other than physicians?
  • What is required to facilitate dissemination and implementation of provider assessment and feedback to healthcare system settings across the United States?
  • How are the costs and cost effectiveness of these interventions related to the structural characteristics of the settings of interventions? In particular, can HMOs address logistical problems (e.g., contacting providers and reducing administrative time) more readily than fee-for-service practices, thereby lowering costs and improving cost effectiveness?
  • What is the impact of interventions on non–cancer related healthcare delivery? For example, does the effect of these interventions spill over into improved delivery of other clinical services?
  • What are the incremental effects of adding intervention components to other interventions?
  • What influence do newer methods of communication (e.g., the Internet, e-mail, social media, automated interactive voice response, texting) have on intervention effectiveness?
  • What is the influence of health system factors on intervention effectiveness?
  • Are interventions effective for promoting colorectal cancer screening with methods other than FOBT?
  • Are interventions to promote colorectal cancer screening equally effective when specific to one type of test as they are when addressing colorectal cancer screening more generally?

Study Characteristics

  • Completed screening outcomes were ascertained through medical record review
  • Assessment of provider screening performance was conducted via chart review by researchers or others.
  • Feedback was provided concerning group provider performance at regular intervals.
  • Studies were conducted in the U.S.

Publications