Purpose: This study seeks to understand leading GI specialists' opinions of screening colonoscopy (SC) as a function of their perception of the evidence base and perceived barriers to implementation.

Method: Thirty-six GI specialists attending a VHA GI leadership meeting at the Digestive Disease Week 2004 conference participated in the study. 38.9% were GI staff physicians, 58.3% were chiefs of GI service and 1 participant was a chief of medicine. Participants were given remote response keypads and viewed questions projected on the auditorium screen. We asked 56 questions covering screening practices, perceived benefits and consequences of SC; attitudes toward screening modalities, the evidence base and perceived barriers to implementation of SC. Questions used a ten point response scale.

Results: Three items assessed attitude toward the SC evidence base: perceived adequacy of evidence for effectiveness, safety and cost-effectiveness. The scale had high internal consistency (alpha =.92). 40% of participants had attitude scores of 6 or more, indicating perceived insufficiency of SC evidence. Perceived insufficiency is significantly correlated with: belief that screening modality must be individualized to the patient (.59), less favorable attitude toward offering screening colonoscopy in the VA (-.40), perceived cost-effectiveness (-.70), anticipated impact on screening rates, colorectal cancer prevention, early detection and mortality (-.41, -.44, -.49, -.49), concerns over safety (.49), perceived benefit of a 10 year rescreening interval (-.46), perceived benefit of the ability to conduct polypectomy during colonoscopy (-.43). Regardless of attitude toward the evidence base, participants agreed that implementation of SC within the VA, under current resource constraints, would have negative consequences for adverse outcomes, wait times for other procedures, the ability to conduct surveillance colonoscopy and screen high risk individuals, and the overall cost of colorectal cancer screening.

Conclusions: Using colonoscopy to screen asymptomatic, average risk persons for colorectal cancer is becoming the standard of care in many communities, despite weaknesses in the evidence base (US Preventive Services Task Force). This study indicates that providers who acknowledge this weakness are more likely to support multiple screening choices for patients and express concern about safety. Providers who believe the evidence base is sufficient are more likely to believe one screening modality is best for all patients, and stress practical clinical benefits such as rescreening interval, polypectomy, and expected impact on patient outcomes.