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Cited by 54Colorectal Cancer Screening and DetectionHealth Policy Implementation ScienceBehavioral Health and Interventions

Factors influencing variation in physician adenoma detection rates: a theory-based approach for performance improvement

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Atkins, Louise, Hunkeler, Enid M., Jensen, Christopher D., Michie, Susan, Lee, Jeffrey K., Doubeni, Chyke A., Zauber, Ann G., Levin, Theodore R. +2 more·2016·Gastrointestinal Endoscopy
DOI 10.1016/j.gie.2015.08.075PMC PMC4762744
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Abstract

Background and aims Interventions to improve physician adenoma detection rates for colonoscopy have generally not been successful, and there are little data on the factors contributing to variation that may be appropriate targets for intervention. We sought to identify factors that may influence variation in detection rates by using theory-based tools for understanding behavior. Methods We separately studied gastroenterologists and endoscopy nurses at 3 Kaiser Permanente Northern California medical centers to identify potentially modifiable factors relevant to physician adenoma detection rate variability by using structured group interviews (focus groups) and theory-based tools for understanding behavior and eliciting behavior change: the Capability, Opportunity, and Motivation behavior model; the Theoretical Domains Framework; and the Behavior Change Wheel. Results Nine factors potentially associated with adenoma detection rate variability were identified, including 6 related to capability (uncertainty about which types of polyps to remove, style of endoscopy team leadership, compromised ability to focus during an examination due to distractions, examination technique during withdrawal, difficulty detecting certain types of adenomas, and examiner fatigue and pain), 2 related to opportunity (perceived pressure due to the number of examinations expected per shift and social pressure to finish examinations before scheduled breaks or the end of a shift), and 1 related to motivation (valuing a meticulous examination as the top priority). Examples of potential intervention strategies are provided. Conclusions By using theory-based tools, this study identified several novel and potentially modifiable factors relating to capability, opportunity, and motivation that may contribute to adenoma detection rate variability and be appropriate targets for future intervention trials.

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Authors
Atkins, L., Hunkeler, E. M., Jensen, C. D., Michie, S., Lee, J. K., Doubeni, C. A., Zauber, A. G., Levin, T. R., Quinn, V. P., & Corley, D. A.
Affiliations
  • Kaiser Permanente (US)
  • University College London (GB)
  • University of Pennsylvania (US)
  • Memorial Sloan Kettering Cancer Center (US)
Corresponding author
Jensen, Christopher D.
ORCID
Venue
Gastrointestinal Endoscopy
Publisher
Elsevier BV
Published
2016-03
Volume
83
Issue
3
Pages
617-626.e2
ISSN
0016-5107 (ISSN-L)
DOI
10.1016/j.gie.2015.08.075
PMC
PMC4762744
OpenAlex
W1661176515
Cited by
54
References
12
Citations by year
2026: 3 · 2025: 5 · 2024: 2 · 2023: 4 · 2022: 12 · 2021: 8 · 2020: 4 · 2019: 5 · 2018: 4 · 2017: 3 · 2016: 4
FWCI
1.60
Type
journal article
Language
en
Open access
Licence
Locations
  • Gastrointestinal Endoscopy (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
National Cancer Institute (U54 CA163262)
Topics
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords
colonoscopy, adenoma detection rate, endoscopy nurses, gastroenterologists, Theoretical Domains Framework, Behaviour Change Wheel, performance improvement, behaviour change interventions, colonoscopy quality
MeSH terms
Gastroenterologists, Adenoma, Attention, Clinical Competence, Colonoscopy, Fatigue, Humans, Motivation, Nurses, Psychological Theory, Social Environment, Colorectal Neoplasms, Workload, Focus Groups, Quality Improvement

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