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Cancer > Cancer Screening > Provider Assessment and Feedback
Provider-oriented Cancer Screening Interventions:
Provider Assessment and Feedback
On behalf of the Task Force on Community Preventive Services, a team of subject matter specialists and other scientists conducted a systematic review of published studies evaluating the effectiveness of provider assessment and feedback in increasing screening for breast, cervical and colorectal cancer.
The Task Force recommends interventions that include provider assessment and feedback based on evidence of their effectiveness in increasing: -
breast cancer screening by mammography
- cervical cancer screening by Pap test, and
- colorectal cancer screening by fecal occult blood test (FOBT).
The Task Force concluded there was insufficient evidence to determine the effectiveness of using provider assessment and feedback to increase:
- colorectal cancer screening by flexible sigmoidoscopy, colonoscopy, or double contrast barium enema.
- The goal of provider-directed interventions is to increase delivery of appropriate cancer screening services.
- Provider assessment and feedback interventions both:
- evaluate provider performance in frequency of delivery or offerings of a screening service to clients (assessment), and
- present providers with information about their performance in providing screening services (feedback).
- Feedback may describe the performance of a group of providers (e.g., mean performance for a practice) or an individual provider, and may be compared with a goal or standard.
Findings from the Systematic Review
- Twelve effect estimates were available for completed screening outcomes: four for mammography, four for Pap tests, three for FOBTs, and one for flexible sigmoidoscopy.
- All effects on mammography, Pap test, and FOBT completion were in the positive direction, with a 13 percentage point median increase across these tests.
- There was a median increase of 14 percentage points in the proportion of study participants who completed mammography.
- There was a median increase of 9 percentage points in the proportion of study participants who completed Pap tests.
- There was a median increase of 13 percentage points in the proportion of study participants who completed FOBTs.
- The single effect measure for flexible sigmoidoscopy indicated no substantial change and it is not clear whether findings for other screening tests will generalize to these more invasive tests.
Prior to and during the literature review and data analysis, the review team and the Task Force on Community Preventive Services attempt to address the key questions of what interventions work, for whom, under what conditions, and at what cost. Lack of sufficient information often leaves one or more of these questions unanswered. The Community Guide refers to these as “research gaps". Research gaps are pulled together in the form of a basic set of questions to inform a research agenda for those in the field. Each completed Community Guide review includes a section on research gaps (or issues) and this is included in final evidence review publications.
Cancer is a major public health problem in the United States. For more information on the scope of this problem, visit
Background on Screening for Breast, Cervical and Colorectal Cancers.
Evidence Review:
Sabatino SA, Habarta N, Baron RC. Interventions to increase recommendation and delivery of screening for breast, cervical, and colorectal cancers by healthcare providers: systematic reviews of provider assessment and feedback and provider incentives. Am J Prev Med 2008;35(1S):67-74.
Recommendations:
Task Force on Community Preventive Services. Recommendations for client- and provider-directed interventions to increase breast, cervical, and colorectal cancer screening Am J Prev Med 2008;35(1S):21-5.
The findings and conclusions in this report are those of the authors and the Task Force on Community Preventive Services and do not necessarily represent the official position of the CDC.
The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Provider-oriented cancer screening interventions: provider assessment and feedback.
www.thecommunityguide.org/cancer/screening/provider-assessment.htm.
Last Updated: MM/DD/YYYY.
Review completed: July 2008
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