It is estimated that over 50% could be prevented if we applied what is known about cancer. By virtue of their role, physicians are strategically placed to be key delivers of preventative care. Despite majority endorsement of the benefits of preventive care, less than 50% of physicians regularly deliver such care. Commonly reported barriers to delivery included perceived lack of time, knowledge, counseling skills, and self-efficacy. Though a starting point for intervention development, reported barriers may not be generalizable across communities. Therefore, this study proposes a step-wise strategy to identify and surmount the barriers that deter the delivery of preventive care services by primary care physicians in Western New York (WNY). First, a semi- directed Opinion Leader discussion will provide qualitative ascertainment of physician and patient attitudes about and barriers to cancer prevention and how these factors impact WNY preventive care delivery rates. Second, the findings will be applied to the development of surveys for baseline assessment of preventive care, barriers, and level of existing preventive care office systems. Surveys will be mailed to a stratified random sample of 325 WNY primary care physicians with sub-specialties in family practice, general practice, OB/GYN, or internal medicine, other staff (200) identified by the physicians as key deliverers of preventive care and consenting patients (300) from the given practices will also be sent surveys. Third, results from steps 1&2, extensive literature review, and expert panel conclusions will be used to develop a web based health risk assessment tool for use as an office system tool to enhance delivery of care. Risk algorithms and tailored messages based on regional input and data will provided the proposed web based HRA relative advantage over other HRA via increased relevancy gained by inherent recognition of the regional reality. Four of the findings of tool field testing in primary care practices and process evaluate will be used to revised and ready the tool to test by randomized controlled trial the hypothesis that office system integration of a web based regionally-oriented HRA with tailored feedback will increase the regional rate of cancer preventive care delivery as defined by the Healthy People 2010 Objectives.
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