Psychological and behavioral factors associated with colorectal cancer screening among Ashkenazim

Provincial variation in colorectal cancer screening adherence in Canada; evidence from the Canadian Partnership for Tomorrow's Health

Introduction

Although colorectal cancer (CRC) screening program is proven to reduce CRC incidence and mortality, understanding patterns and predictors of suboptimal adherence in screening program requires further investigation in Canada.

Methods

We used self-reported data from five regional cohorts of the Canadian Partnership for Tomorrow's Health (CanPath), namely the BC Generations Project (BCGP), Alberta's Tomorrow Project (ATP), the Ontario Health Study (OHS), Quebec's CARTaGENE, and the Atlantic Partnership for Tomorrow's Health Study (Atlantic PATH). We stratified participants into the following four risk categories: 1) age 50-74 years, 2) family history in a first-degree relative, 3) personal history of chronic inflammatory bowel disease and/or polyps, and 4) co-existence of personal risk and family history. Multivariable logistic regression was used to identify predictors of adherence to the screening guidelines.

Results

Adherence to CRC screening varied considerably between regions, ranging from 16.6% in CARTaGENE to 47.7% in OHS. Compared to the largest cohort OHS, the likelihood of non-adherence to CRC screening was significantly higher in BCGP (OR 1.15, 95% CI 1.11-1.19), the Atlantic PATH (OR 1.90, 95% CI 1.82-1.99) and CARTaGENE (OR 5.10, 95% CI 4.85-5.36). Low physical activity, current smoking, presence of personal risk, family history of CRC significantly reduced the likelihood of adherence to screening recommendations.

Discussion/conclusion

Compared to the national target of ≥ 60% for participation in CRC screening, adherence to regular CRC screening was suboptimal in this cohort of Canadians and varied by region. Further efforts are needed to identify the specific barriers to screening adherence in different provinces and across risk categories.

Advantages of Anticipated Emotions over Anticipatory Emotions and Cognitions in Health Decisions: A Meta-Analysis

Recent persuasion theories and some empirical studies indicate that emotional responses can be more persuasive than cognitive evaluations under certain circumstances. The aim of this meta-analysis was to compare the effects of emotions and perceived risk on health-related intentions and behavior. Ten studies which examined anticipated emotions (AdE) and 19 studies which examined anticipatory emotions (AyE) were included. AdE was moderately associated with health intention (r = 0.38, 95% CI 0.24-0.51) and behavior (r = 0.48, 95% CI 0.43-0.53). The average correlations with AyE were small (with intention r = 0.25, 95% CI 0.18-0.31; with behavior r = 0.18, 95% CI 0.11-0.23). AdE was significantly more likely to lead to ideal intentions and behavior than perceived risk, and was more likely to promote desired behaviors than AyE. AdE had a stronger effect on intentions to prevent disease compared to detect disease. Other moderators were discussed. Theoretical and practical implications are provided.

Understanding Cancer Worry Among Patients in a Community Clinic-Based Colorectal Cancer Screening Intervention Study

BACKGROUND

To reduce colorectal cancer (CRC) screening disparities, it is important to understand correlates of different types of cancer worry among ethnically diverse individuals.

OBJECTIVES

The current study examined the prevalence of three types of cancer worry (i.e., general cancer worry, CRC-specific worry, and worry about CRC test results) as well as sociodemographic and health-related predictors for each type of cancer worry.

METHODS

Participants were aged 50-75, at average CRC risk, nonadherent to CRC screening guidelines, and enrolled in a randomized controlled trial to increase CRC screening. Participants completed a baseline questionnaire assessing sociodemographics, health beliefs, healthcare experiences, and three cancer worry measures. Associations between study variables were examined with separate univariate and multivariable logistic regression models.

RESULTS

Responses from a total of 416 participants were used. Of these, 47% reported experiencing moderate-to-high levels of general cancer worry. Predictors of general cancer worry were salience and coherence (aOR = 1.1, 95% CI [1.0, 1.3]), perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3), and social influence (aOR = 1.1, 95% CI [1.0, 0.1]). Fewer (23%) reported moderate-to-high levels of CRC-specific worry or CRC test worry (35%). Predictors of CRC worry were perceived susceptibility (aOR = 1.4, 95% CI [1.3, 1.6]) and social influence (aOR = 1.1, 95% CI [1.0, 1.2]); predictors of CRC test result worry were perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3) and marital status (aOR = 2.0, 95% CI [1.1, 3.7] for married/partnered vs. single and aOR = 2.3, 95% CI [1.3, 4.1] for divorced/widowed vs. single).

DISCUSSION

Perceived susceptibility consistently predicted the three types of cancer worry, whereas other predictors varied between cancer worry types and in magnitude of association. The three types of cancer worry were generally predicted by health beliefs, suggesting potential malleability. Future research should include multiple measures of cancer worry and clear definitions of how cancer worry is measured.

Health information seeking and scanning among US adults aged 50–75 years: Testing a key postulate of the information overload model

Past research has found that older US adults (aged 50–75 years) exhibit high levels of cancer information overload and cancer worry; however, no study to date has examined whether these perceptions are related to information seeking/scanning. To explore this relationship, older adults ( N = 209, Mage = 55.56, SD = 4.24) were recruited to complete a survey measuring seeking, scanning, cancer information overload, and cancer worry. Most participants were high-scan/seekers (40.2%) followed by low-scan/seekers (21.1%), high-scan/no seekers (19.6%), and low-scan/no seekers (19.1%). Low-scan/no seekers had significantly higher cancer information overload compared to all other groups, consistent with the postulate that overload and seeking/scanning are negatively related. Low-scan/no seekers and high-scan/seekers both exhibited higher cancer worry severity, consistent with past research suggesting that cancer worry explains high levels of activity/inactivity.

Does colorectal cancer risk perception predict screening behavior? A systematic review and meta-analysis

Although health behavior theories postulate that risk perception should motivate colorectal cancer (CRC) screening, this relationship is unclear. This meta-analysis aims to examine the relationship between CRC risk perception and screening behavior, while considering potential moderators and study quality. A search of six databases yielded 58 studies (63 effect sizes) that quantitatively assessed the relationship between CRC risk perception and screening behavior. Most included effect sizes (75 %) reported a positive association between CRC risk perception and screening behavior. A random effects meta-analysis yielded an overall effect size of z = 0.13 (95 % CI 0.10-0.16), which was heterogeneous (I (2) = 99 %, τ(2) = 0.01). Effect sizes from high-quality studies were significantly lower than those from lower quality studies (z = 0.02 vs. 0.16). We found a small, positive relationship between CRC risk perception and reported screening behavior, with important identified heterogeneity across moderators. Future studies should focus on high quality study design.

Intention to undergo colonoscopy screening among relatives of colorectal cancer cases: a theory-based model

BACKGROUND

It is recommended that persons having familial risk of colorectal cancer begin regular colonoscopy screening at an earlier age than those in the general population. However, many individuals at increased risk do not adhere to these screening recommendations.

PURPOSE

The goal of this study was to examine cognitive, affective, social, and behavioral motivators of colonoscopy intention among individuals at increased risk of familial colorectal cancer.

METHODS

Relatives of colorectal cancer cases (N = 481) eligible for colonoscopy screening completed a survey assessing constructs from several theoretical frameworks including fear appeal theories.

RESULTS

Structural equation modeling indicated that perceived colorectal cancer risk, past colonoscopy, fear of colorectal cancer, support from family and friends, and health-care provider recommendation were determinants of colonoscopy intention.

CONCLUSIONS

Future interventions to promote colonoscopy in this increased risk population should target the factors we identified as motivators. (ClinicalTrials.gov number NCT01274143).

Colorectal cancer screening among Asian Americans

OBJECTIVES

Colorectal cancer (CRC) is the most commonly diagnosed cancer for all US populations including Asian Americans. CRC screening has considerable benefits to prevent CRC and reduce mortality. The purpose of this article was to review the published literature on rates of colorectal cancer screening and factors associated with colorectal cancer screening practice among Asian Americans.

METHODS

Through searching electronic reference databases from 2000 to 2013, 30 articles were found on Chinese, Filipino, Japanese, Korean, and Vietnamese Americans.

FINDINGS

Asian Americans had significantly low rates for CRC screening; Korean Americans reported the lowest rates, while higher screening rates were found among Japanese Americans. Older age, longer length of stay in the US, and having a physician's recommendation were the most common facilitators to receiving screening. The common inhibiting factors were financial issues, employment status, and worries/fears about the procedure.

CONCLUSIONS

Despite a number of Asian Americans being vulnerable to CRC, individual Asian subgroups were underserved with CRC screening and intervention. Further studies should focus on each individual Asian subgroup and culturally proficient CRC screening intervention programs should be developed for each.

Colon cancer screening in women

Colorectal cancer is the third leading cause of cancer-related deaths in women. Colorectal cancer is a preventable disease with accepted screening modalities that have been proven to save lives. As women are more likely than men to develop right-sided colon cancers, colonoscopy is the preferred screening test in women. Currently, women are less likely to undergo colorectal cancer screening than men. Frank discussions addressing the fear or embarrassment of endoscopic screening are important in helping women overcome these barriers. Enhanced education of both practitioners and patients targeted to improve colorectal cancer screening adherence will improve early diagnosis and patient survival.

Individual-level factors in colorectal cancer screening: a review of the literature on the relation of individual-level health behavior constructs and screening behavior

OBJECTIVE

Compliance with colorectal cancer screening recommendations requires considerable conscious effort on the part of the individual patient, making an individual's decisions about engagement in screening an important contributor to compliance or noncompliance. The objective of this paper was to examine the effectiveness of individual-level behavior theories and their associated constructs in accounting for engagement in colorectal cancer screening behavior.

METHODS

We reviewed the literature examining constructs from formal models of individual-level health behavior as factors associated with compliance with screening for colorectal cancer. All published studies examining one or more constructs from the health belief model, theory of planned behavior, transtheoretical model, or social cognitive theory and their relation to screening behavior or behavioral intentions were included in the analysis.

RESULTS

By and large, results of studies supported the theory-based predictions for the influence of constructs on cancer screening behavior. However, the evidence base for many of these relations, especially for models other than the health belief model, is quite limited.

CONCLUSIONS

Suggestions are made for future research on individual-level determinants of colorectal cancer screening.

Risk perception among Brazilian individuals with high risk for colorectal cancer and colonoscopy

Background

Risk perception is considered a motivating factor for adopting preventive behaviors. This study aimed to verify the demographic characteristics and cancer family history that are predictors of risk perception and to verify if risk perception is a predictor of colonoscopy adherence.

Methods

Individuals with a family colorectal cancer history as indicated by a proband with cancer were interviewed by telephone. They responded to a questionnaire covering demographic characteristics, colonoscopy history and four questions on risk perception. Tests of multiple linear regression and logistic regression were used to identify associations between dependent and independent variables.

Results

The 117 participants belonged to 62 families and had a mean age of 45.2 years. The majority of these individuals were female (74.4%) and from families who met the Amsterdam Criteria (54.7%). The average risk perception was 47.6%, with a median of 50%. The average population perception of individual risk was 55.4%, with a median of 50%. Variables associated with a higher risk perception were age, gender, religion, school level, income, and death of a family member. The variable predicting colonoscopy was receiving medical information regarding risk (odds ratio OR 8.40).

Conclusions

We found that family cancer history characteristics (number of relatives with cancer, risk classification) are associated with adequate risk perception. Risk perception does not predict colonoscopy in this sample. The only variable that predicted colonoscopy was receiving medical information recommending screening.

Family communication, genetic testing and colonoscopy screening in hereditary non-polyposis colon cancer: a qualitative study

OBJECTIVE

Genetic testing and colonoscopy is recommended for people with a strong history of colorectal cancer (CRC). However, families must communicate so that all members are aware of the risk. The study aimed to explore the factors influencing family communication about genetic risk and colonoscopy among people with a strong family history of CRC who attended a genetic clinic with a view to having a genetic test for hereditary non-polyposis colon cancer (HNPCC).

METHODS

Interviews were held with 30 people with a high familial risk of colon cancer. The transcripts were transcribed verbatim and analysed using Interpretative Phenomenological Analysis.

RESULTS

The family context, family history and perceptions about family duties and responsibilities were important motivators for communication about risk, genetic testing and colonoscopy and influenced participation in genetic testing and screening programmes. Participants reported usually communicating openly with their relatives about genetic risk and colonoscopy. Individuals felt a duty towards affected relatives and to their own children. The influence of the spouse and other relatives, particularly those affected by CRC, was also important. Colonoscopy was perceived to be embarrassing, unpleasant and sometimes painful. While there was sometimes anxiety about the result of the colonoscopy the results were usually reassuring.

CONCLUSIONS

The family context and the experience of the family history can have an impact on communication, genetic testing and screening in HNPCC and this should be explored during counselling. Some individuals might benefit from support in communicating with relatives about genetic risk. Ways of improving the individual's experience of colonoscopy should also be examined.

Using the transtheoretical model to stage screening behavior for colorectal cancer

This study sought to describe the colorectal cancer (CRC)-screening behavior of a population of two lower income communities near Pittsburgh, Pennsylvania. The transtheoretical model was used to characterize individuals according to their stage of readiness to engage in one of two recommended CRC screening tests--the Fecal Occult Blood Test (FOBT) or Flexible Sigmoidoscopy (FSG) test. A telephone survey was conducted of 50- to 79-year-old men and women in Aliquippa and Clairton in the spring of 1999. Analyses based on 414 survey respondents showed associations between FOBT or FSG behavioral stage and factors including gender, age, recent doctor checkup, chronic need for prescription medications, history of cervical Pap smear testing, history of prostate-specific antigen blood testing, and prior doctor recommendation in favor of FOBT or FSG testing. This study appears to be one of the first applications of this theory to understanding CRC screening behavior in a community intervention.

Provider recommendation for colorectal cancer screening: examining the role of patients' socioeconomic status and health insurance

BACKGROUND

Provider recommendation for colorectal cancer (CRC) screening test has been shown as a strong predictor of patients' decision to be screened. Evidence of factors associated with provider recommendation remains limited and inconsistent. The present study sought to examine the association between provider recommendation for colorectal cancer screening and patients' socioeconomic status (SES) and insurance status using national survey data for 2005.

METHODS

Analyses were based on 2948 adult aged 50 and older who participated in the 2005 Health Information National Trend Survey (HINTS). Multivariate logistic regression models were used to determine whether the indicators of SES (income and educational level) and insurance status have any impact on provider recommendation.

RESULTS

Our study found a strong association between recall of health care provider recommendation and reported recent screening testing after controlling for other patient characteristics. When all the study population were included in the analysis, those who had lower than high school education and high school graduates were less likely to have received provider recommendation than those with higher than high school education (OR=0.49; 95%CI=0.32-0.73 and OR=0.60; 95%CI=0.47-0.78 respectively). Income and insurance were not significant predictors. Education remained significantly associated with provider recommendation when only those who had made one or more medical visits in the past year were included in the analyses.

CONCLUSIONS

Patient's educational level--but not income or insurance status--was related to provider recommendation for CRC screening. To increase awareness of colorectal cancer risks and the benefit of screening, health care providers need to make a concerted effort to recommend colorectal cancer screening to all relevant patients, regardless of socioeconomic status and other personal characteristics.

Colorectal cancer screening among underserved minority population: discrepancy between physicians' recommended, scheduled, and completed tests

OBJECTIVE

This study examines the correlates of: (1) health care provider recommendation of CRC testing; (2) provider scheduling for recommended CRC testing using sigmoidoscopy, colonoscopy, or double-contrast barium enema; and (3) adherence to CRC scheduling among underserved minority populations.

METHODS

Medical record and schedule logbook reviews and interviewer-administered surveys.

SETTING

Large urban safety-net, outpatient primary care setting in Los Angeles County.

PARTICIPANTS

306 African-American and Latino patients aged 50 years and older.

RESULTS

A vast majority of minority patients do not receive standard CRC testing in urban safety-net primary care settings. Of those patients who were actually scheduled for sigmoidoscopy or colonoscopy, almost half completed the procedure. Completing CRC testing was associated with marital status, co-morbid chronic physical conditions, number of risk factors for colorectal cancer, and lower perceived barriers to CRC testing.

CONCLUSION

Effective interventions to reduce CRC mortality among underserved minority populations require an integrated approach that engages patients, providers, and health care systems.

PRACTICE IMPLICATIONS

Designing interventions that (1) increase physician-patient communications for removing patients' perceived barriers for CRC testing and (2) promote a non-physician-based navigator system that reinforces physicians' recommendation are strongly recommended.

Sexual orientation and intentions to obtain breast cancer screening

AIMS

This longitudinal study examined predictors of intentions to obtain breast cancer screening in two samples, one comprising self-identified lesbian/bisexual women (n = 150) and the other comprising heterosexual women (n = 400). We hypothesized that beliefs about mammography, cancer vulnerability, and attitudes toward the medical provider would mediate the relationship between sexual orientation and plans to obtain breast cancer screening.

METHODS

Women in this study participated in one of two larger clinical trials of breast cancer risk counseling methods. All participants completed questionnaires about breast cancer screening attitudes at baseline and at a 6-month follow-up.

RESULTS

Logistic regression analyses, controlling for age, education, and race, revealed that baseline negative beliefs about mammography, lower levels of provider trust, and less perceived risk of breast cancer significantly mediated the relationship between sexual orientation and 6-month intentions to obtain a clinical breast examination (CBE) and mammography.

CONCLUSIONS

These findings suggest that attitudes and beliefs about breast cancer, breast cancer screening, and medical providers impact lesbian/bisexual women's willingness to plan for CBE and mammography.

Ethnic differences in colorectal cancer screening

The present study was designed to assess ethnic disparities in CRC screening rates in a low-income population and to examine factors that could account for those differences. Participants were randomly selected and asked to complete a questionnaire about CRC screening. After controlling for gender, age, education, income, health insurance, and family history of CRC, differences in screening rates as a function of ethnicity remained. Physicians' recommendations and perceived efficacy of screening were also strong predictors of CRC screening. Psychological factors accounted in part for differences in screening rates between European Americans and Mexican Americans.

Adherence to colorectal cancer screening guidelines in Canada

BACKGROUND

To identify correlates of adherence to colorectal cancer (CRC) screening guidelines in average-risk Canadians.

METHODS

2003 Canadian Community Health Survey Cycle 2.1 respondents who were at least 50 years old, without past or present CRC and living in Ontario, Newfoundland, Saskatchewan, and British Columbia were included. Outcomes, defined according to current CRC screening guidelines, included adherence to: i) fecal occult blood test (FOBT) (in prior 2 years), ii) endoscopy (colonoscopy/sigmoidoscopy) (prior 10 years), and iii) adherence to CRC screening guidelines, defined as either (i) or (ii). Generalized estimating equations regression was employed to identify correlates of the study outcomes.

RESULTS

Of the 17,498 respondents, 70% were non-adherent CRC screening to guidelines. Specifically, 85% and 79% were non-adherent to FOBT and endoscopy, respectively. Correlates for all outcomes were: having a regular physician (OR = (i) 2.68; (ii) 1.91; (iii) 2.39), getting a flu shot (OR = (i) 1.59; (ii) 1.51; (iii) 1.55), and having a chronic condition (OR = (i) 1.32; (ii) 1.48; (iii) 1.43). Greater physical activity, higher consumption of fruits and vegetables and smoking cessation were each associated with at least 1 outcome. Self-perceived stress was modestly associated with increased odds of adherence to endoscopy and to CRC screening guidelines (OR = (ii) 1.07; (iii) 1.06, respectively).

CONCLUSION

Healthy lifestyle behaviors and factors that motivate people to seek health care were associated with adherence, implying that invitations for CRC screening should come from sources that are independent of physicians, such as the government, in order to reduce disparities in CRC screening.

Colorectal cancer screening in 3 racial groups

OBJECTIVES

To understand predictors of colorectal cancer (CRC) screening in African Americans, European Americans, and Native Americans as these groups differ in CRC incidence and mortality.

METHODS

Participants were surveyed for knowledge, beliefs, and behaviors related to CRC.

RESULTS

Predictive regression modeling found, after adjusting for race, CRC risk, and CRC worry, the odds of screening within guidelines were increased for men, those receiving doctor's recommendation, those with polyp/tumor history, those under 70, those with more knowledge about CRC, and those with fewer barriers to screening. CRC screening rates did not differ by race.

CONCLUSIONS

These results reiterate the importance of knowledge, barriers, and physician recommendation for CRC screening in all racial groups.

Correlates and predictors of colorectal cancer screening among male automotive workers

BACKGROUND

Most studies examining factors associated with colorectal cancer (CRC) screening (CRCS) are cross-sectional and thus temporal relationships cannot be determined. Furthermore, less attention has been paid to psychosocial predictors of CRCS. We examined both cross-sectional correlates of prior CRCS and predictors of prospective CRCS initiation and maintenance during The Next Step Trial, a 2-year worksite behavioral intervention to promote regular CRCS and dietary change.

METHOD

The sample included 2,693 White male automotive workers at increased occupational risk for, but no history of, CRC who completed a baseline survey. Stratified analyses were conducted for three dependent variables (prior CRCS, CRCS initiation, and CRCS maintenance). We also assessed prior CRCS as a moderator in prospective analyses. Multivariable logistic regression analyses with generalized linear mixed models were used to adjust for cluster sampling.

RESULTS

Except for education, cross-sectional correlates of prior CRCS including older age, family history of CRC or polyps, personal history of polyps, self-efficacy, family support, and intention were also significant prospective predictors of increased CRCS during the trial. Despite differences in the patterns of association for CRCS initiation and maintenance in stratified analyses, the only associations with prospective CRCS that were significantly moderated by prior CRCS were family history and CRCS availability.

CONCLUSIONS

Correlates of prior CRCS that also were prospective predictors of CRCS may be suitable targets for intervention. Additionally, intervention messages addressing psychosocial constructs may be relevant for both CRCS initiation and maintenance. However, studies with more diverse samples are needed to replicate the results reported here.

Provision of breast cancer risk information to women at the lower end of the familial risk spectrum

BACKGROUND

Breast cancer family clinics provide risk information as one of their key functions. Many referrals to these clinics are 'low-risk' women.

OBJECTIVE

It was the aim of this study to report on the generic risk status letters and printed materials (in the form of leaflets) provided to this category of counselees by UK cancer genetics centres.

METHODS

A postal survey was conducted requesting information materials from genetic centres.

RESULTS

Personalized risk letters and/or printed materials were received from 16 of 22 familial cancer centres in the UK. Personalized risk letters and printed materials currently provided to these counselees display inconsistencies and over-simplification that may lead to misunderstanding.

CONCLUSION

There is a need for collaboration among cancer genetics centres to design more helpful and consistent literature.

Familial testicular cancer: interest in genetic testing among high-risk family members

PURPOSE

This study is part of an ongoing National Cancer Institute multidisciplinary, etiologically-focused, cross-sectional study of Familial Testicular Cancer (FTC). The current report targets interest in clinical genetic testing for susceptibility to FTC.

METHODS

Demographics, knowledge, health beliefs, and psychological and social factors were evaluated as covariates related to interest in genetic testing.

RESULTS

The majority (66%) of 229 participants (64 affected men, 66 unaffected men, and 99 women) from 47 multiple-case FTC families expressed interest in having a genetic test within 6 months, should such a test become available. Interest was similar among the three subgroups mentioned above. Worries about insurance discrimination based on genetic test results were associated with a significantly lower interest in testing. Alternatively, participants were more likely to be interested in genetic testing if they were younger and had higher levels of family support, a physician's recommendation supporting testing, cancer distress, and a need for information to inform the health care of their children.

CONCLUSIONS

This study reveals social and relationship factors that FTC survivors and their relatives considered important when contemplating the use of new genetic technologies. This is the first study describing hypothetical interest in genetic testing for familial testicular cancer.

Colorectal cancer screening: physicians' knowledge of risk assessment and guidelines, practice, and description of barriers and facilitators

BACKGROUND

Physician nonadherence to colorectal cancer (CRC) screening recommendations contributes to underuse of screening.

OBJECTIVE

To assess physicians' knowledge of CRC screening guidelines for average-risk individuals, perceived barriers to screening and practice behaviours.

METHODS

Between October 2004 and March 2005, staff physicians working in three university-affiliated hospitals in Montreal, Quebec, were surveyed. Self-administered questionnaires assessed knowledge of risk classification and current guidelines for average-risk individuals, as well as perceptions of barriers to screening and practice behaviours.

RESULTS

All 65 invited physicians participated in the survey, including 46 (70.8%) family medicine physicians and 19 (29.2%) general internists. Most physicians knew that screening should begin at 50 years of age, all knew to screen men and women and 92% said they screened average-risk patients. Fifty-seven (87.7%) physicians correctly identified three common characteristics associated with high risk for developing CRC. Physicians who screened average-risk patients preferred fecal occult blood testing (88.3%) and colonoscopy (88.3%) to flexible sigmoidoscopy (10.0%) and double-contrast barium enema (30.0%). Most physicians knew the correct screening periodicity for fecal occult blood testing (87.6%), but only 40% or fewer could identify correct screening periodicities for the other modalities. Barriers and facilitators focused on health care delivery system improvements, better evidence on which to base recommendations and development of practical screening modalities.

CONCLUSIONS

Physicians lacked knowledge of the recommended screening modalities and periodicities to appropriately screen average-risk individuals. Because CRC screening can reduce mortality, efforts to improve physician delivery should focus on physician knowledge and changes to the health care delivery system.

Psychosocial factors associated with the adherence to a colorectal cancer screening program

BACKGROUND

Although colorectal cancer (CRC) is one of the most commonly diagnosed cancers and a major cause of cancer related mortality, very little is known about why screening adherence rates are low. First-degree relatives of CRC patients are the largest group of individuals at increased risk of CRC. Psychosocial factors related to CRC screening adherence were examined in a sample of siblings of individuals diagnosed with CRC.

METHOD

To identify psychosocial factors related with participation in cancer screening examinations, 90 siblings of CRC patients were recruited. Adherence to screening by fecal occult blood test, flexible sigmoidoscopy and colonoscopy was the relevant factor. Sociodemographic variables, health locus of control (HLOC), perceived social support, knowledge about CRC and coping strategies were independent measures.

RESULTS

Significant differences were found in age, gender, retirement status, knowledge of sibling's illness, HLOC-powerful others, coping strategies (positive thinking, blaming others, seeking social support), perceived social support types (listening, affective, material) and social support sources (friends, work colleagues and health staff). Using stepwise logistic regression, the strongest predictor of adherence was knowledge of sibling's illness.

CONCLUSIONS

The findings suggest that effective strategies to increase participation in CRC screening may include efforts to improve knowledge of sibling's illness, material social support and advice from health staff.

Medical and psychosocial predictors of delay in seeking medical consultation for breast symptoms in women in a public sector setting

We examined demographic, medical and psychosocial factors related to delay in seeking medical consultation for breast symptoms. In this cross-sectional survey, 124 women with breast symptoms attending an outpatient breast surgery clinic in a county general hospital completed questionnaires measuring demographic, medical and psychosocial variables. Our outcome variable was delay in seeking medical consultation. Younger age (p <or= 0.05), less education (p <or= 0.01), absence of a lump (p <or= 0.05), lower perceived risk (p <or= 0.001), less spirituality (p <or= 0.01), cost (p <or= 0.001) and not wanting to think about breast symptom(s) (p <or= 0.05) were related to delay. Multivariate analyses showed absence of a breast lump by education interaction (p <or= 0.05), risk perception (p <or= 0.001), spirituality (p <or= 0.01) and cost (p <or= 0.001) collectively accounted for 38.4% of the variance in delay. Health promotion programs targeting low-income populations should emphasize the importance of breast symptoms other than lumps, especially to younger and less educated women.

Gastroenterologists utilize the referral for EGD to enhance colon cancer screening more effectively than primary care physicians

BACKGROUND

Colorectal cancer screening rates among patients with upper gastrointestinal symptoms undergoing oesophagogastroduodenoscopy have not been previously established. We hypothesize that gastroenterologists seize this opportunity more frequently than primary care providers.

AIMS

To assess colorectal cancer screening rates at the time of direct access oesophagogastroduodenoscopy and gastrointestinal clinic evaluation for upper gastrointestinal symptoms. To compare rates in the 6 months following the oesophagogastroduodenoscopy in both cohorts of patients.

METHODS

Retrospective review. primary care physician group: direct access oesophagogastroduodenoscopy (n = 247) vs. gastrointestinal group (n = 278). Multivariable regression analysis utilized to assess predictors of screening outcome.

RESULTS

Colorectal cancer screening at the time of referral was 54%. Among the 243 unscreened patients, an additional 29% in the primary care physician group vs. 59% in the gastrointestinal group completed colorectal cancer screening in 6 months of follow-up. Nearly 60% patients evaluated in gastrointestinal clinic for upper symptoms had documented discussion, and 99% of those patients underwent colonoscopy (P < 0.001). Gastrointestinal consultation increased the probability of colorectal cancer screening completion eightfold (95% CI 3.69-18.96).

CONCLUSIONS

At the time of evaluation for upper symptoms, half of patients were not current with colorectal cancer screening recommendations. Referrals for the direct access oesophagogastroduodenoscopy and, more importantly, the gastroenterology consult represent key opportunities for colorectal cancer screening education and improved compliance.

Factorial validity and invariance of a survey measuring psychosocial correlates of colorectal cancer screening among African Americans and Caucasians

BACKGROUND

Psychosocial constructs are widely used to predict colorectal cancer screening and are targeted as intermediate outcomes in behavioral intervention studies. Reliable and valid instruments for measuring general colorectal cancer screening psychosocial constructs are needed; yet, few studies have conducted psychometric analyses. This study replicated a five-factor structure for 16 theory-based, general colorectal cancer screening items measuring salience and coherence, cancer worries, perceived susceptibility, response efficacy, and social influence. In addition, we examined factorial invariance across race and sex.

METHODS

African American and Caucasian patients (n = 1,413) attending an urban, primary care clinic were included in this study. These individuals completed a baseline survey as part of a colorectal cancer screening intervention trial. Single and multigroup confirmatory factor analyses using maximum-likelihood estimation were done.

RESULTS

The five-factor general colorectal cancer screening model provided excellent fit and was invariant across race-sex subgroups.

CONCLUSIONS

The findings of invariance across sex and race subgroups support the use of these scales to measure group differences.

A model of disease-specific worry in heritable disease: the influence of family history, perceived risk and worry about other illnesses

Disease-related worry is associated with family history and perceived risk of that disease; however, the influences of general risk perceptions and tendencies to worry about diseases have been neglected in the literature. This study investigates a model of disease-specific worry which includes family history, disease-specific perceived risk, and perceived risk for and worry about other diseases. Participants completed a survey assessing these variables in relation to several heritable diseases. Structural equation modeling found that family history predicted disease-specific perceived risk but not perceived risk for other diseases. Disease-specific perceived risk predicted disease-specific worry and worry about other diseases. Perceived risk for other diseases predicted worry about other diseases and disease-specific perceived risk but not disease-specific worry. Disease-specific worry predicted worry about other diseases. This model was supported across several diseases and indicates that disease-specific and general considerations of risk influence worry about a disease and should be considered in interventions.

Survey of primary physicians' knowledge of colorectal cancer screening

OBJECTIVE

Colorectal cancer (CRC) is the most common of the gastrointestinal cancers in Israel. The low rate of patient compliance to a recent CRC screening program of Clalit Health Services, a major health management organization in Israel, prompted the present survey of primary care physicians' knowledge and practices regarding CRC screening.

METHODS

A 23-item questionnaire, formulated according to the policy of the Israel Ministry of Health and the recommendations of the American Gastroenterological Association, was distributed to 150 primary physicians of Clalit Health Services. The relative ratio of correct to incorrect answers was calculated for every question and by professional group.

RESULTS

The response rate was 89%. Total score (out of a maximum 23) was 20.68 for family physicians (experts in family medicine), 17.79 for experts in other fields, and 17.82 for general practitioners (average, 0.90, 0.77, and 0.77, respectively). The score for the family physicians was significantly higher than for the other two groups (P=0.0070). Clustering items by specific issues yielded significantly better scores for the family physicians in four areas: screening (P=0.0164), appropriate test for high-risk population in Israel (P=0.0012), definition of average-risk population (P=0.0012), and CRC symptoms (P=0.0108). A low level of knowledge on the definition of the high-risk population was noted in all three groups.

CONCLUSIONS

Experts in family medicine in Israel have significantly greater knowledge of most issues of CRC than primary care experts in other fields and general practitioners, although all three groups lack knowledge on the definition of the high-risk population. Continuing physician education should focus on these areas.

The role of cancer worry in cancer screening: a theoretical and empirical review of the literature

This paper reviews findings regarding the influence of cancer worry on cancer screening behaviors. The role of cancer worry in motivating cancer screening has been pursued for over 30 years. Recent concerns that high levels of cancer worry may impede the screening behavior of high-risk individuals have further prioritized this area of research. Despite heavy attention in the literature, there is currently no theoretical or empirical consensus concerning whether cancer worry motivates or inhibits cancer screening behaviors. We focus the review on four questions: (1) What is cancer worry? (2) To what extent are people worried about cancer? (3) What are the predominant theoretical approaches to understanding the role of cancer worry in cancer screening behaviors? (4) What is the empirical evidence for the role of cancer worry in cancer screening behaviors? We identify factors that have hampered theoretical and empirical advancement, including divergent definitions and measurement strategies for cancer worry, low to moderate levels of cancer worry even among those at high risk, and a reliance on cross-sectional research designs. The review clarifies the current state of this literature, and proposes future research strategies, including an expanded emphasis on cancer worry and cancer screening among men and diverse racial/ethnic groups.

Survey of surgeons' and internists' knowledge of colorectal cancer screening

BACKGROUND

Colorectal cancer (CRC) is the most common of the gastrointestinal cancers in Israel, with an incidence of 50 cases per 100,000 for men and 45 per 100,000 for women in 2000.

AIM

The low rate of patient compliance noted in CRC screening program conducted in our center, prompted the present survey of the knowledge and practices regarding CRC screening recommendations.

METHODS

A 23-item questionnaire formulated according to the Israeli Ministry of Health policy and recommendation of the American Gastroenterological Association was distributed among the physicians of the six departments of internal medicine, and the department of surgery of the Rabin Medical Center. The relative ratio of correct answers was calculated for every question and by subgroups: internists and surgeons, experts and residents in internal medicine and in surgery.

RESULTS

Fifty-five of 80 physicians (69%) completed the questionnaire. The total score for all participants was 15.82 (average 0.68), significantly lower than the optimal correct score of 23 (average 1.00). The internists had a similar total score to the surgeons, 15.61 and 15.28. When the questions were clustered according to specific issues and only the correct answers for each cluster scored, the success rate decreased with a range of 19-69%. Only 22% of responders did not advise fecal occult blood test (FOBT) for the high-risk population; 57% thought the screening age range was 40-65 years, and only 37% knew that the high-risk criteria include a family history of ovarian cancer.

CONCLUSION

Both internists and surgeons' knowledge about screening recommendations of CRC can be improved. Health authorities should invest greater efforts in continuing physician education. We believe that this strategy will increase the participation rate in CRC preventive programs.

Screening behavior of individuals at high risk for colorectal cancer

BACKGROUND AND AIMS

Periodic colonoscopy is an effective means of reducing the incidence and mortality of colorectal cancer in individuals with a family history of the disease. The aims of this study were to determine the degree of compliance and to identify the factors related significantly to noncompliance with periodic screening in this high-risk population.

METHODS

A total of 178 individuals who had undergone genetic counseling for colorectal cancer between 1986 and 1998 and who had been advised to undergo periodic screening because of familial colorectal cancer (FCRC) or hereditary nonpolyposis colorectal cancer (HNPCC) were invited to complete a self-report questionnaire on psychosocial issues and screening experiences. Compliance data were derived from medical records and via self-report.

RESULTS

A total of 149 individuals (84%) participated in the study. Noncompliance with screening advice was rare (in 3% of cases), but significant delays (more than 1 year) in undergoing screening were observed in approximately 25% of the cases. The number of perceived barriers to screening (eg, discomfort, embarrassment) was the only variable related significantly to noncompliance/screening delay (odds ratio, 1.2; 95% confidence interval, 1.1-1.3). Use of sedatives during the procedure and receipt of a reminder letter seemed to facilitate better compliance.

CONCLUSIONS

Although few high-risk individuals abstain from screening entirely, approximately one in 4 deviates significantly from the recommended frequency of screening. Increased compliance may be achieved by reducing the discomfort and embarrassment associated with the procedure and by the use of reminder letters.

Comprehensive Cancer Screening in a Primary Care Population

There is a great deal to be learned about how factors within the context of primary care influence the provision of comprehensive preventive services. This study assessed the prevalence of cancer screening among a primary care population of men and women and examined the association of characteristics of the patient-physician relationship, the healthcare facility, and type of health insurance. Findings suggest that prevalence of comprehensive cancer screening is low, particularly among men. Characteristics of the patient-physician relationship are an important predictor of screening among women but not men. Among men, however, greater contact with the medical care system is important.

Factors associated with colorectal cancer screening among the US urban Japanese population

OBJECTIVES

The author examined the prevalence and predictors of colorectal cancer screening among the urban Japanese population of the United States.

METHODS

A sample of Japanese residents of major US metropolitan areas completed a self-administered mailed survey.

RESULTS

Physician recommendation, acculturation, and perceived psychological costs were consistent predictors of screening for colorectal cancer. Gender and marital status were related to screening via fecal occult blood testing; age, susceptibility, and health insurance were related to sigmoidoscopy/colonoscopy screening.

CONCLUSIONS

Colorectal cancer screening among the urban Japanese population could be increased with interventions seeking to promote physician recommendations for screening, alleviate perceived psychological costs among patients, and improve physician-patient communication.

Adherence to colorectal cancer screening in mammography-adherent older women

Colorectal cancer (CRC) is the third leading cause of cancer mortality among women. Screening can prevent the development of CRC or diagnose early disease when it can effectively be cured, however existing screening methods are underutilized. In this study, we examined the utility of an updated Health Belief Model to explain CRC screening adherence. The present study included 280 older women seeking routine mammography at a large, urban breast diagnostic facility. Overall, 50% of women were adherent to CRC screening guidelines. Multiple regression indicated that self-efficacy, physician recommendation, perceived benefits of and perceived barriers to screening accounted for 40% of variance in CRC screening adherence. However, there was no evidence for two mediational models with perceived benefits and perceived barriers as the primary mechanisms driving adherence to CRC screening. These findings may inform both future theoretical investigations as well as clinical interventions designed to increase CRC screening behavior.

Current Research Promises and Challenges in Behavioral Oncology

The Behavioral Oncology Interest Group of the American Society of Preventive Oncology held a Roundtable session on March 10, 2002, at the American Society of Preventive Oncology annual meeting in Bethesda, Maryland, to discuss the current state-of-the-science in behavioral approaches to cancer prevention and control and to delineate priorities for additional research. Four key areas were considered: (a) behavioral approaches to cancer genetic risk assessment and testing; (b) biological mechanisms of psychosocial effects on cancer; (c) the role of risk perceptions in cancer screening adherence; and (d) the impact of tailored and targeted interventions on cancer prevention and control research. The evidence reviewed indicates that behavioral approaches have made significant contributions to cancer prevention and control research. At the same time, there is a need to more closely link future investigations to the underlying base of behavioral science principles and paradigms that guide them. To successfully bridge the gap between the availability of effective new cancer prevention and control technologies and the participants they are meant to serve will require the development of more integrative conceptual models, the incorporation of more rigorous methodological designs, and more precise identification of the individual and group characteristics of the groups under study.

Psychosocial and medical predictors of colorectal cancer screening among low-income medical outpatients

BACKGROUND

Identification of factors related to colorectal cancer screening (CRC) and intent to obtain fecal occult blood tests (FOBTs) among low-income persons are important because CRC incidence and mortality are higher among socioeconomically disadvantaged populations.

METHOD

Participants were 193 individuals 50 years of age and older. CRC screening and intent to obtain FOBTs were dependent measures. Demographic variables, objective risk factors, and health beliefs were independent measures.

RESULTS

Digital rectal examinations and FOBTs were obtained by 41% and 22%, respectively, during the previous year. Flexible sigmoidoscopies were obtained by only 19% of those 55 years of age and older during the previous five years. Multivariate analyses showed that family history of CRC, personal history of polyps, and physician recommendation were the strongest predictors of CRC screening. Family history of CRC and self-efficacy were related to intent to obtain FOBTs.

CONCLUSIONS

Results suggest the importance of physician assessment of personal and family CRC risk factors, as well as recommendation of CRC screening, to all patients as part of routine medical care.

Relatives of colorectal cancer patients: factors associated with screening behavior

BACKGROUND

The purpose of this study was to identify whether decisions regarding colorectal cancer (CRC) screening by relatives of CRC patients are influenced by social interactions with family members, friends, and physicians or by public awareness campaigns.

METHODS

Screened (n=236) and nonscreened (n=132) relatives of CRC patients were interviewed in 2001. A socioecologic model was used as the framework for the interview variables, which included interactions with relatives, medical professionals, and social groups, as well as perceived benefits and barriers to screening and perceived susceptibility.

RESULTS

Physician encouragement, fewer barriers to screening, strong CRC family history, encouragement from relatives, advice from a surgeon, and discussion of CRC screening with social groups were all associated with ever having been screened. Having been encouraged by a physician was the strongest correlate of screening behavior. Perceived susceptibility to CRC, advice from family members, and exposure to public awareness information were not associated with screening.

CONCLUSIONS

The socioecologic framework is a good explanatory model of CRC screening in increased-risk relatives, as variables from each level were associated with screening. These findings can guide interventions aimed at increasing screening uptake, particularly those involving physicians.

Colorectal cancer screening and familial risk: a survey of internal medicine residents' knowledge and practice patterns

OBJECTIVE

Risk stratification is essential to the appropriate use of colorectal cancer screening recommendations. The principal objective of this study was to assess the knowledge and screening behavior of internal medicine (IM) residents regarding familial colorectal cancer.

METHODS

We conducted a survey of IM residents in their second and third year of postgraduate training from two university-based programs (n = 127). The survey instrument assessed physician knowledge of screening recommendations and current practices for individuals with a family history of colorectal cancer, adenomatous polyps, familial adenomatous polyposis, and hereditary nonpolyposis colorectal cancer. The instrument also elicited data regarding familial risk assessment, documentation, and notification of at-risk family members.

RESULTS

Eighty-one IM eligible residents (81%) completed the survey. Most respondents identified a family history of colorectal cancer as an important factor in assessing colorectal cancer risk and appropriately implemented relevant screening recommendations. However, for patients with a family history of adenomatous polyps diagnosed before age 60 yr, knowledge and adherence to recommendations advocating screening at age 40 was relatively poor. More importantly, for patients with familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, respondents lacked the necessary risk assessment skills and knowledge to appropriately implement current recommendations. There were no consistent differences in knowledge or screening behavior when stratified on the basis of program site or postgraduate year status.

CONCLUSION

Many IM residents are deficient in their knowledge, risk assessment skills, and screening practices for patients at familial risk of colorectal cancer. Effective educational strategies that promote awareness regarding familial risk, risk assessment skills, and appropriate use of relevant screening guidelines are needed.

Correlates of colorectal cancer testing in Massachusetts men and women

BACKGROUND

Colorectal cancer (CRC) is a leading cause of cancer-related death. Although CRC screening can reduce CRC mortality, it is underutilized. We examined the association between personal and health care characteristics and CRC testing, defined as being current on any test that meets CRC screening guidelines.

METHODS

The current investigation relies on questionnaire data from the 1999 Massachusetts Behavioral Risk Factor Surveillance System and a CRC call-back survey of 869 Behavioral Risk Factor Surveillance System participants age 50 and older. Multivariate logistic regression was used to identify predictors of CRC testing. All analyses were stratified by gender.

RESULTS

Men were more likely than women to be currently tested for CRC. Physician recommendation for testing was strongly associated with testing among men and women, but among those with a recommendation, men were more likely to be tested than women. Older age, usually having an annual check-up, and HMO membership were associated with CRC testing among men and women. Perceived high risk of CRC was more strongly associated with testing among men, while other cancer screening was more strongly associated with testing among women.

CONCLUSIONS

There are important gender differences in the prevalence of CRC testing and in factors associated with testing. Research into understanding gender differences related to compliance with physician recommendations is warranted.

Increasing attendance at colorectal cancer screening: testing the efficacy of a mailed, psychoeducational intervention in a community sample of older adults

This article describes a trial of a psychoeducational intervention designed to modify negative attitudes toward flexible sigmoidoscopy screening and thereby increase screening attendance. The intervention materials addressed the multiple barriers shown to be associated with participation in earlier studies. Adults ages 55-64 (N = 2,966), in a "harder-to-reach" group were randomized either to receive an intervention brochure or to a standard invitation group. Attitudes and expectations were assessed by questionnaire, and attendance at the clinic was recorded. Compared with controls, the intervention group had less negative attitudes, anticipated a more positive experience, and had a 3.6% higher level of attendance. These results indicate that psychoeducational interventions can provide an effective means of modifying attitudes and increasing rates of screening attendance.

Barriers to preventive intervention

A spectrum of colorectal cancer screening studies identified barriers to screening adherence, although definitive and comprehensive conclusions cannot be drawn. Barriers can be intrinsic (demographic, medical, psychological, and knowledge/attitudes/beliefs) or extrinsic (access to health care, health care provider knowledge and motivation, and lifestyle issues). Certain consistent patterns are emerging. Lower adherence is generally seen in persons who have less knowledge and lower perceived risk of colorectal cancer, as well as when health care providers do not recommend screening. Remedies that reduce intrinsic and extrinsic barriers to screening adherence are needed.

Primary care physicians' awareness and implementation of screening guidelines for colorectal cancer

OBJECTIVE

The objective was to determine primary care physicians' (PCPs) familiarity and implementation of screening guidelines for colorectal cancer (CRC) in central Israel.

METHODS

Fifty PCPs were interviewed and 1000 charts of their asymptomatic patients ages 50-70 were examined. All CRC patients treated at the regional Oncology Institute in 1980-1984 and in 1993-1997 were then compared, with emphasis on the event leading to diagnosis and tumor stage.

RESULTS

Almost all PCPs endorsed screening. Fecal occult blood testing (FOBT) was appropriately recommended by 40% (annually), and the use of flexible sigmoidoscopy (FS) was appropriately recommended by 12% of physicians (every 3-5 years). Only four (8%) were correct in the use of both techniques. Most PCPs estimated that >25% of their patients had been screened for CRC. In fact, 92/1,000 had FOBT (9.2%), 14/1,000 had screening FS (1.4%), and 3 patients only had both tests. Only 1.2% of CRC diagnoses in the 1980s (n = 175) and 2.6% in the 1990s (n = 343) were established as a result of screening (P > 0.25, NS). Tumor stage distribution at diagnosis was similar.

CONCLUSIONS

PCPs studied endorse CRC screening but they are not familiar with accepted guidelines and do very little about implementing them, and this has not changed much over the past decade. CRC screening has a potential to markedly decrease mortality, yet the best screening strategy is worthless without physician education and compliance.

Family history and colorectal cancer screening: a survey of physician knowledge and practice patterns

OBJECTIVES

Risk stratification is essential to effective implementation of colorectal cancer (CRC) screening strategies. The objectives of this study were to assess and compare the current knowledge and practice patterns of gastroenterologists and primary care physicians regarding familial risk of CRC.

METHODS

We conducted a survey of regional gastroenterologists and a sample of university- and community-based primary care physicians. The survey instrument assessed physician knowledge of screening recommendations and current practices for individuals with family histories of CRC, adenomatous polyps (APs), familial adenomatous polyposis (FAP), and hereditary nonpolyposis cancer (HNPCC). The instrument also elicited data about familial risk assessment, documentation, and notification of at-risk family members.

RESULTS

Thirty-five gastroenterologists (65%) and 58 primary care physicians (92%) completed the survey. Most gastroenterologists and primary care physicians (85% vs 72%) chose age 40 as the appropriate age to begin screening for a family history of CRC, but relatively few (37% vs 36%) recommended screening at age 40 for a family history of APs. Gastroenterologists were significantly more likely to recommend screening for FAP at puberty (80% vs 27%, p < 0.001) and for HNPCC at age 25 (73% vs 50%, p = 0.04). Colonoscopy was the preferred screening strategy by both groups for family histories of CRC (97%), HNPCC (97%), and APs (77%); primary care physicians also preferred colonoscopy for family histories of CRC (72%) and HNPCC (76%) but flexible sigmoidoscopy plus fecal occult blood testing for a family history of APs (38%). Gastroenterologists were more likely to recommend genetic testing for persons at risk of FAP (91% vs 71%, p = 0.03) and HNPCC (72% vs 57%, p = 0.18), routinely inquire about a family history of CRC or APs (93% vs 63%, p < 0.001), and recommend notification of at-risk first-degree relatives with family histories of CRC (94% vs 55%, p < 0.001) or AP (53% v.s 6%, p < 0.001).

CONCLUSION

Although gastroenterologists are more likely than primary care physicians to elicit a family history of colorectal neoplasia and implement appropriate screening strategies, overall compliance with recommended guidelines and notification of at-risk relatives are suboptimal. Novel approaches for improving awareness of the available screening guidelines are needed.

Risk and reluctance: understanding impediments to colorectal cancer screening

PURPOSE

Screening to detect and prevent colorectal cancer (CRC) is well below optimal, contributing to needless CRC-related morbidity and mortality. Little detailed information exists explaining why screening technologies are underutilized and why screening adherence rates are low. Prior to the design of an intervention study, we assessed knowledge about CRC among adult women and men with access to health care. We also investigated patterns of perceived risk for CRC, barriers and facilitators to screening, and experience and intentions with regard to both fecal occult blood testing and flexible sigmoidoscopy.

METHODS

We analyzed data from semistructured focus group interviews with a small, nonrepresentative sample (n = 39) of community-dwelling adult men and women ages 50 to 64 and 65 plus.

RESULTS

CRC-related knowledge is low, and misperceptions are common. Provider practices reinforce low levels of perceived risk. Multiple barriers to screening exist, of which many are remediable.

CONCLUSIONS

We are at an early stage in the diffusion of information about CRC. Screening utilization may be improved through development of appropriate public health awareness campaigns and by addressing service factors. Recommendations are provided.