For a study published in JAMA Network Open, Steven J. Atlas, MD, MPH, and colleagues examined primary care physicians’ perceptions about the process for patient follow-up after abnormal cancer screening tests. Physician’s Weekly spoke with Dr. Atlas about the study group’s findings.
What prompted your research?
In the United States, preventative screening for cancer is viewed favorably. However, the full benefits of screening require follow-up if there are abnormal results, and we don’t have good systems in place to do that. As part of a National Cancer Institute-funded study to improve follow-up for abnormal results, we surveyed physicians about their perceptions of their systems for this process.
We had hypotheses about the source of the problem, and the survey results supported our views. Most screenings are done in a primary care setting, but once the test is completed, it may be assessed by a variety of healthcare professionals who do the follow-up. For example, if you get a mammogram, it’s read by a radiologist. If you get a colonoscopy, it’s performed by agastroenterologist. We’ve created these different silos for follow-up after abnormal results.
While many different healthcare professionals may be involved in following up after abnormal results, or reporting the results of those tests, ultimately it comes down to the PCP to manage it. The PCPs we surveyed agreed that we don’t have a good system in place for follow-up.
What were your key findings?
We surveyed 275 PCPs about screening for the most common cancers—breast, cervical, lung, and colorectal. Across the board, most PCPs—including both nurse practitioners and general internists—said that “No matter who does the test, ultimately, I am responsible for it.”
In the US, the follow-up for abnormal results is often left to the radiologist who may interpret the result or the gastroenterologist who
performs the colonoscopy. Ultimately, however, the PCP views that they’re responsible for when things fall through the cracks. The good news is that we performed a randomized controlled trial to help improve this situation.
We designed a fail-safe, IT-based system to identify overdue abnormal results and a PCP-based system to provide feedback. The goal is to cut across healthcare silos so that when a doctor is tracking their patients for cancer screening tests, results can be found in a single place.
