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Cancer Screening: Provider Assessment and Feedback – Colorectal Cancer


What the CPSTF Found

About The Systematic Review

The CPSTF findings are 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 CPSTF 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 CPSTF finding on Cancer Screening: Provider Assessment and Feedback – Colorectal Cancer by FOBT pdf icon [PDF - 233 KB] and Cancer Screening: Provider Assessment and Feedback – Colorectal Cancer by Colonoscopy or Flexible Sigmoidoscopy pdf icon [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.

Summary of Results

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 229 KB].

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).
  • Completed colorectal screening by fecal occult blood test (FOBT): estimated effects ranged from a 12.3 to 23.0 percentage point increase (3 study arms).
  • The single effect measure for flexible sigmoidoscopy indicated no substantial change

Summary of Economic Evidence

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 229 KB].

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.


Based on results of provider assessment and feedback interventions to increase colorectal cancer screening by FOBT, findings should be applicable across settings and populations described, with the caveat that provider training status may be related to magnitude of effect.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are 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 assessed by medical record review.
  • Provider screening performance was assessed by providers auditing charts of another provider’s patients, via computer search, or chart review by researchers.
  • Feedback was provided at regular intervals concerning individual provider performance, group performance, or both.
  • Studies of completed screening were conducted in urban settings in the U.S. and included trainee physicians.