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Ghebrial M, Aktary ML, Wang Q, Spinelli JJ, Shack L, Robson PJ, Kopciuk KA. Predictors of CRC Stage at Diagnosis among Male and Female Adults Participating in a Prospective Cohort Study: Findings from Alberta's Tomorrow Project. Curr Oncol 2021; 28:4938-4952. [PMID: 34898587 PMCID: PMC8628758 DOI: 10.3390/curroncol28060414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 11/22/2022] Open
Abstract
Colorectal cancer (CRC) is a leading cause of morbidity and mortality in Canada. CRC screening and other factors associated with early-stage disease can improve CRC treatment efficacy and survival. This study examined factors associated with CRC stage at diagnosis among male and female adults using data from a large prospective cohort study in Alberta, Canada. Baseline data were obtained from healthy adults aged 35–69 years participating in Alberta’s Tomorrow Project. Factors associated with CRC stage at diagnosis were evaluated using Partial Proportional Odds models. Analyses were stratified to examine sex-specific associations. A total of 267 participants (128 males and 139 females) developed CRC over the study period. Among participants, 43.0% of males and 43.2% of females were diagnosed with late-stage CRC. Social support, having children, and caffeine intake were predictors of CRC stage at diagnosis among males, while family history of CRC, pregnancy, hysterectomy, menopausal hormone therapy, lifetime number of Pap tests, and household physical activity were predictive of CRC stage at diagnosis among females. These findings highlight the importance of sex differences in susceptibility to advanced CRC diagnosis and can help inform targets for cancer prevention programs to effectively reduce advanced CRC and thus improve survival.
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Affiliation(s)
- Monica Ghebrial
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
| | - Michelle L. Aktary
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Qinggang Wang
- Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada;
| | - John J. Spinelli
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
- Population Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Lorraine Shack
- Cancer Surveillance and Reporting, Alberta Health Services, Calgary, AB T2S 3C3, Canada;
| | - Paula J. Robson
- Department of Agricultural, Food and Nutritional Science and School of Public Health, University of Alberta, Edmonton, AB T6G 2P5, Canada;
- Cancer Care Alberta and Cancer Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3H1, Canada
| | - Karen A. Kopciuk
- Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada;
- Departments of Oncology, Community Health Sciences and Mathematics and Statistics, University of Calgary, Calgary, AB T2N 4N2, Canada
- Correspondence:
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Validity and Reliability of the Instruments to Measure Colorectal Cancer Screening Benefits and Barriers-Turkish Version. Cancer Nurs 2020; 45:E364-E373. [PMID: 33399288 DOI: 10.1097/ncc.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Perceptions of benefits and barriers are important determinants in understanding colorectal cancer screening (CRCS) behaviors. There is a need for standardized Turkish tools that measure the benefits and barriers of fecal occult blood test (FOBT) and colonoscopy (COL). OBJECTIVE The aim of this study was to assess the validity and reliability of the Turkish version of the "Instruments to Measure CRCS Benefits and Barriers." METHODS This methodological study was carried out in 2 stages in primary care and in 394 adults between the ages of 50 and 70 years. In the first stage, some items of the scales demonstrated low/unacceptable corrected item-total and factor loadings, and in the second stage, it was decided to add emoji-based facial scales, which include emoji expressions. RESULTS Results with the emoji-based facial scales included internal consistency coefficients of 0.85 for FOBT benefits, 0.79 for FOBT barriers, 0.84 for COL benefits, and 0.86 for COL barriers; the item-total correlations of FOBT varied between 0.39 and 0.73, whereas those of COL varied between 0.38 and 0.76. The factor loadings of all items were higher than 0.40. CONCLUSIONS The emoji-based facial scale for CRC Screening Benefits and Barriers is a valid and reliable tool for measuring the benefits and barriers perceptions of 50- to 70-year-old Turkish adults. IMPLICATIONS FOR PRACTICE The Instruments to Measure CRCS Benefits and Barriers-Turkish version can provide insights for nurses and healthcare professionals to understand individuals' perceived FOBT and COL benefits and barriers and to develop effective interventions to increase CRCS rates.
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Implementing a multilevel intervention to accelerate colorectal cancer screening and follow-up in federally qualified health centers using a stepped wedge design: a study protocol. Implement Sci 2020; 15:96. [PMID: 33121536 PMCID: PMC7599111 DOI: 10.1186/s13012-020-01045-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 12/31/2022] Open
Abstract
Background Screening for colorectal cancer (CRC) not only detects disease early when treatment is more effective but also prevents cancer by finding and removing precancerous polyps. Because many of our nation’s most disadvantaged and vulnerable individuals obtain health care at federally qualified health centers, these centers play a significant role in increasing CRC screening among the most vulnerable populations. Furthermore, the full benefits of cancer screenings must include timely and appropriate follow-up of abnormal results. Thus, the purpose of this study is to implement a multilevel intervention to increase rates of CRC screening, follow-up, and referral-to-care in federally qualified health centers, as well as simultaneously to observe and to gather information on the implementation process to improve the adoption, implementation, and sustainment of the intervention. The multilevel intervention will target three different levels of influences: organization, provider, and individual. It will have multiple components, including provider and staff education, provider reminder, provider assessment and feedback, patient reminder, and patient navigation. Methods This study is a multilevel, three-phase, stepped wedge cluster randomized trial with four clusters of clinics from four different FQHC systems. In the first phase, there will be a 3-month waiting period during which no intervention components will be implemented. After the 3-month waiting period, we will randomize two clusters to cross from the control to the intervention and the remaining two clusters to follow 3 months later. All clusters will stay at the same phase for 9 months, followed by a 3-month transition period, and then cross over to the next phase. Discussion There is a pressing need to reduce disparities in CRC outcomes, especially among racial/ethnic minority populations and among populations who live in poverty. Single-level interventions are often insufficient to lead to sustainable changes. Multilevel interventions, which target two or more levels of changes, are needed to address multilevel contextual influences simultaneously. Multilevel interventions with multiple components will affect not only the desired outcomes but also each other. How to take advantage of multilevel interventions and how to implement such interventions and evaluate their effectiveness are the ultimate goals of this study. Trial registration This protocol is registered at clinicaltrials.gov (NCT04514341) on 14 August 2020.
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Travis E, Ashley L, Pownall M, O'Connor DB. Barriers to flexible sigmoidoscopy colorectal cancer screening in low uptake socio-demographic groups: A systematic review. Psychooncology 2020; 29:1237-1247. [PMID: 32539187 DOI: 10.1002/pon.5443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To synthesise qualitative evidence related to barriers and facilitators of flexible sigmoidoscopy screening (FSS) intention and uptake, particularly within low socio-demographic uptake groups. FSS uptake is lower amongst women, lower socio-economic status (SES), and Asian ethnic groups within the United Kingdom (UK) and United States of America. METHODS A total of 12 168 articles were identified from searches of four databases: EMBASE, MEDLINE, PsycINFO and Web of Science. Eligibility criteria included: individuals eligible to attend FSS and empirical peer-reviewed studies that analysed qualitative data. The Critical Appraisal Skills Program tool evaluated the methodological quality of included studies, and thematic synthesis was used to analyse the data. RESULTS Ten qualitative studies met the inclusion criteria. Key barriers to FSS intention and uptake centred upon procedural anxieties. Women, including UK Asian women, reported shame and embarrassment, anticipated pain, perforation risk, and test preparation difficulties to elevate anxiety levels. Religious and cultural-influenced health beliefs amongst UK Asian groups were reported to inhibit FSS intention and uptake. Competing priorities, such as caring commitments, particularly impeded women's ability to attend certain FSS appointments. The review identified a knowledge gap concerning factors especially associated with FSS participation amongst lower SES groups. CONCLUSIONS Studies mostly focussed on barriers and facilitators of intention to participate in FSS, particularly within UK Asian groups. To determine the barriers associated with FSS uptake, and further understand how screening intention translates to behaviour, it is important that future qualitative research is equally directed towards factors associated with screening behaviour.
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Affiliation(s)
| | - Laura Ashley
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
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5
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Shen MJ, Lafata JE, D’Agostino TA, Bylund CL. Lower Adherence: A Description of Colorectal Cancer Screening Barrier Talk. JOURNAL OF HEALTH COMMUNICATION 2019; 25:43-53. [PMID: 31795843 PMCID: PMC6981046 DOI: 10.1080/10810730.2019.1697909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Understanding how patients and physicians discuss screening barriers may illuminate reasons for non-adherence to recommended colorectal cancer (CRC) screening. The goal of the present study was to describe patients' reporting of and physicians' responses to CRC screening barriers and examine their associations with patients' CRC screening behaviors. Audio-recorded primary care consultations (N = 413) with patients due for CRC screening were used to identify CRC screening-related barrier talk and physician responses. Presence of barrier talk was associated with less patient adherence to CRC screening (OR = 0.568, p = 0.007). Neither CRC screening talk (n = 413) nor physician responses (n = 151) were associated with patients' CRC screening. Among the consultations in which barrier talk occurred (n = 151), patients most often reported test-related (28.9%) and psychological (26.1%) barriers. Barriers were most often reported in the context of CRC screening discussions (45.7%) or in direct response to a physician's question about CRC screening (48.6%). Results indicated that patients rarely raised CRC screening barriers unprompted and that presence of barrier talk was predictive of CRC screening behavior. These findings may help improve future clinical practice by highlighting that patients may benefit from physicians initiating and facilitating discussions of CRC screening barriers and directly helping patients overcome known barriers to CRC screening.
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Affiliation(s)
| | - Jennifer Elston Lafata
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Henry Ford Health System, Detroit, MI
| | | | - Carma L. Bylund
- Memorial Sloan Kettering Cancer Center; New York, NY, USA
- University of Florida; Gainesville, FL
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Tong ST, Sopory P. Does integral affect influence intentions to use artificial intelligence for skin cancer screening? A test of the affect heuristic. Psychol Health 2019; 34:828-849. [PMID: 30822146 DOI: 10.1080/08870446.2019.1579330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: This study investigated how affect influences people's processing of messages about risks and benefits of using autonomous artificial intelligence (AI) technology to screen for skin cancer. We examined integral affect (emotion derived during decision making) separately from incidental affect (extraneous mood states). Design: Using the affect heuristic framework, we randomly assigned 273 participants to conditions featuring risk (high, low, uncertain) or benefit (high, low, uncertain) messages about AI. Following 'affect-as-spotlight', we also explored whether people's integral affect towards skin cancer moderated the relationship between risk/benefit messages and AI screening intentions. Outcomes: Perceived risk, perceived benefit, positive and negative affect toward AI, intention to use AI screening. Results: After controlling for incidental affect and risk perceptions, we found that compared to low risk messages, uncertain risk messages increased participants' negative affect toward AI, decreased positive affect toward AI, increased AI risk evaluations and reduced AI benefit evaluations. Perceptual variables significantly mediated participants' intentions to use AI for risk messages but not benefit messages. No moderation effects were found. Conclusions: Results suggest extending the affect heuristic framework to include uncertain risk conditions. Integral AI affect influenced people's interpretation of messages, which then impacted likelihood to use AI technology for health.
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Affiliation(s)
- Stephanie Tom Tong
- a Department of Communication , Wayne State University , Detroit , Michigan , USA
| | - Pradeep Sopory
- a Department of Communication , Wayne State University , Detroit , Michigan , USA
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7
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Rapid review of factors associated with flexible sigmoidoscopy screening use. Prev Med 2019; 120:8-18. [PMID: 30597228 DOI: 10.1016/j.ypmed.2018.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/04/2018] [Accepted: 12/24/2018] [Indexed: 01/19/2023]
Abstract
Flexible sigmoidoscopy (FS) screening has been shown to reduce colorectal cancer (CRC) incidence and mortality among screened adults. The aim of this review was to identify patient-related factors associated with the screening test's use. We searched PubMed for studies that examined the association between FS screening use and one or more factors. To determine the eligibility of studies, we first reviewed titles, then abstracts, and finally the full paper. We started with a narrow search, which we expanded successively (by adding 'OR' terms) until the number of new publications eligible after abstract review was <1% of the total number of publications. We then abstracted factors from eligible papers and reported the number of times each was found to be positively or negatively associated with FS screening use. We identified 42 papers, most of which reported studies conducted in the United States of America (n = 21, 50%) and the United Kingdom (n = 13, 31%). Across studies, a wide range of factors were examined (n = 123), almost half of which were found to be associated with FS screening use at least once (n = 60). Sociodemographic and health and lifestyle factors that were frequently positively associated with FS screening use included: male gender, higher socioeconomic status and a family history of CRC. Frequently positively associated psychosocial factors included low perceived barriers and high perceived benefits. Findings suggest that future research should focus on developing a theoretical framework of cancer screening behaviour to allow a greater level of consistency and specificity in measuring key constructs.
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8
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Cotter G, DuHamel K, Schofield E, Jandorf L. Processes of Change for Colonoscopy: Limited Support for Use Among Navigated Latinos. J Racial Ethn Health Disparities 2018; 6:327-334. [PMID: 30302744 DOI: 10.1007/s40615-018-0528-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/17/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
This study assessed the role of the processes of change (POC), a construct of the transtheoretical model, in colorectal cancer (CRC) screening among Latinos. Latinos participate in CRC screening less often and are diagnosed with CRC at a later stage than whites. POC items were administered to 344 English- and Spanish-speaking Latinos at average risk for CRC who had not had a colonoscopy in the past 5 years and received a colonoscopy referral. POC were measured at three timepoints: following informed consent (T1) at time of referral, 2 weeks prior to scheduled colonoscopy (T2), and 1 month after scheduled colonoscopy (T3). Participants received patient navigation as part of a randomized controlled trial to promote screening colonoscopy. POC scores were examined for changes during the course of the intervention, and logistic regression models assessed the relationship between POC scores and CRC screening adherence. Total POC scores decreased between T1 and T2 (p = 0.03) but were unchanged between T1 and T3. CRC screening adherence was not significantly associated with POC scores or change in POC scores over time. The POC instrument was not found useful for predicting colonoscopy adherence among Latinos in conjunction with patient navigation. Total POC scores did not increase during a patient navigation intervention despite high colonoscopy completion rates.
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Affiliation(s)
- Gina Cotter
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, USA.,Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA.,Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA, 19104, USA
| | - Katherine DuHamel
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA.
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA
| | - Lina Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, USA
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9
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Gonzales G, Zinone R. Cancer diagnoses among lesbian, gay, and bisexual adults: results from the 2013-2016 National Health Interview Survey. Cancer Causes Control 2018; 29:845-854. [PMID: 30043193 DOI: 10.1007/s10552-018-1060-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/17/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE The objective of this study was to compare cancer diagnoses by age, gender, and sexual orientation. METHODS This study used data on 129,431 heterosexual adults and 3,357 lesbian, gay, and bisexual (LGB) adults in the 2013-2016 National Health Interview Survey. Logistic regression models compared the prevalence of cancer diagnoses by sexual orientation while controlling for demographics, socioeconomic status, and health profiles. Then, using coefficients from fully adjusted models, we estimated average marginal effects to compare the probability of a cancer diagnosis by sexual orientation across five age categories. RESULTS After controlling for demographic and socioeconomic characteristics, gay men (odds ratio [OR] 1.54; 95% confidence interval [CI] 1.10-2.18) were more likely to have been diagnosed with cancer compared to heterosexual men, and bisexual women (OR 1.70; 95% CI 1.16-2.48) were more likely to have been diagnosed with cancer compared to heterosexual women. Gay men aged 65 years and older were 6.0% points (p < 0.05) more likely to be diagnosed with cancer compared to heterosexual men of the same age. Bisexual women aged 65 years and older were 7.6% points (p < 0.05) more likely to be diagnosed with cancer compared to women of the same age. CONCLUSIONS Some sexual minorities may be at greater risk for cancer (or having a personal history of cancer) compared to heterosexuals. More research on cancer detection, treatment, and survivorship in sexual minorities is critically needed. Health care providers and public health practitioners should be aware of the unique health care needs in LGB adults, including their elevated cancer risks.
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Affiliation(s)
- Gilbert Gonzales
- Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End Suite 1200, Nashville, TN, 37203, USA.
| | - Ryan Zinone
- Vanderbilt University School of Medicine, Nashville, TN, 37203, USA
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10
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Saengow U, Birch S, Geater A, Chongsuwiwatvong V. Willingness to Pay for Colorectal Cancer Screening and Effect of Copayment in Southern Thailand. Asian Pac J Cancer Prev 2018; 19:1727-1734. [PMID: 29938473 PMCID: PMC6103562 DOI: 10.22034/apjcp.2018.19.6.1727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: The incidence rate of colorectal cancer in Thailand is increasing. Hence, the nationwide screening programme with copayment is being considered. There are two proposed screening alternatives: annual fecal immunochemical test (FIT) and once-in-10-year colonoscopy. A copayment for FIT is 60 Thai baht (THB) per test (≈ 1.7 USD); a copayment for colonoscopy is 2,300 THB per test (≈ 65.5 USD). Methods: The willingness to pay (WTP) technique, which is theoretically founded on a cost-benefit analysis, was used to assess an effect of copayment on the uptake. Subjects were patients aged 50-69 years without cancer or screening experience. WTP for the proposed tests was elicited. Results: Nearly two thirds of subjects were willing to pay for FIT. Less than half of subjects were willing to pay for colonoscopy. Among them, median WTP for both tests was greater than the proposed copayments. In a probit model, knowing CRC patient and presence of companion were associated with non-zero WTP for FIT. Presence of companion, female, and family history of cancer were associated with non-zero WTP for colonoscopy. After adjustment for starting price in the linear model, marital status, drinking behavior, and risk attitude were associated with WTP. None of factors was significant for colonoscopy. Uptake decreased as levels of copayment increased. At proposed copayments, the uptake rates of 59.8% and 21.6% were estimated for colonoscopy and FIT respectively. The demand for FIT was price inelastic; the demand for colonoscopy was price elastic. Estimates of optimal copayment were 62.1 THB for FIT and 460.2 THB for colonoscopy. At the optimal copayment, uptake rates would be 59.8% for FIT and 42.3% for colonoscopy. Conclusion(s): More subjects were willing to pay for FIT than for colonoscopy (59.0% versus 46.5%). The estimated uptake rates were 59.8% and 21.6% for colonoscopy and FIT at the proposed copayments.
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Affiliation(s)
- Udomsak Saengow
- Center of Excellence in Health System and Medical Research (CE-HSMR), Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.,School of Medicine, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.
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11
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Carter-Harris L, Davis LL, Rawl SM. Lung Cancer Screening Participation: Developing a Conceptual Model to Guide Research. Res Theory Nurs Pract 2018; 30:333-352. [PMID: 28304262 DOI: 10.1891/1541-6577.30.4.333] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To describe the development of a conceptual model to guide research focused on lung cancer screening participation from the perspective of the individual in the decision-making process. METHODS Based on a comprehensive review of empirical and theoretical literature, a conceptual model was developed linking key psychological variables (stigma, medical mistrust, fatalism, worry, and fear) to the health belief model and precaution adoption process model. RESULTS Proposed model concepts have been examined in prior research of either lung or other cancer screening behavior. To date, a few studies have explored a limited number of variables that influence screening behavior in lung cancer specifically. Therefore, relationships among concepts in the model have been proposed and future research directions presented. CONCLUSION This proposed model is an initial step to support theoretically based research. As lung cancer screening becomes more widely implemented, it is critical to theoretically guide research to understand variables that may be associated with lung cancer screening participation. Findings from future research guided by the proposed conceptual model can be used to refine the model and inform tailored intervention development.
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Abstract
Appalachia has a higher incidence of and mortality from colon cancer (CC) than other regions of the United States; thus, it is important to know the potential impact of elevated risk on cancer worry. Guided by the Self-regulation model, we investigated the association of demographic, cultural (e.g., fatalism, religious commitment), and psychological factors (e.g., perceived risk, general mood) with CC worry among a sample of Appalachian women. A mixed method design was utilized. Appalachian women completed surveys in the quantitative section (n = 134) and semi-structured interviews in the qualitative section (n = 24). Logistic regression was employed to calculate odds ratios (OR) for quantitative data, and immersion/crystallization was utilized to analyze qualitative data. In the quantitative section, 45% of the participants expressed some degree of CC worry. CC worry was associated with higher than high school education (OR 3.63), absolute perceived risk for CC (OR 5.82), high anxiety (OR 4.68), and awareness of easy access (OR 3.98) or difficult access (OR 3.18) to health care specialists as compared to not being aware of the access. there was no association between CC worry and adherence to CC screening guidelines. The qualitative section revealed fear, disengagement, depression, shock, and worry. Additionally, embarrassment, discomfort, and worry were reported with regard to CC screening. Fears included having to wear a colostomy bag and being a burden on family. CC worry was common in Appalachians and associated with higher perceptions of risk for CC and general anxiety, but not with adherence to screening guidelines. The mixed method design allowed for enhanced understanding of CC-related feelings, especially CC worry, including social/contextual fears.
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Affiliation(s)
- Omar F Attarabeen
- Department of Pharmacy Practice, Administration, & Research, Marshall University, Coon Education Building, One John Marshall Drive, Huntington, WV, 25755, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems & Policy, Robert C. Byrd Health Sciences Center (North), West Virginia University, P.O. Box 9510, Morgantown, WV, 26506-9510, USA
| | - Kevin T Larkin
- Department of Psychology, Eberly College of Arts and Sciences, West Virginia University, Room 2220, Life Sciences Building, P. O. Box 6040, Morgantown, WV, 26506, USA
| | - Kimberly M Kelly
- Department of Pharmaceutical Systems & Policy, Robert C. Byrd Health Sciences Center (North), West Virginia University, P.O. Box 9510, Morgantown, WV, 26506-9510, USA.
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13
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Bui NC, Cho HN, Lee YY, Suh M, Park B, Jun JK, Kim Y, Choi KS. Stages of Adoption for Fecal Occult Blood Test and Colonoscopy Tests for Colorectal Cancer Screening in Korea. Cancer Res Treat 2017; 50:416-427. [PMID: 28494531 PMCID: PMC5912127 DOI: 10.4143/crt.2017.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/06/2017] [Indexed: 12/18/2022] Open
Abstract
Purpose While colorectal cancer (CRC) is common in Asian countries, screening for CRC is not. Moreover, CRC screening behaviors in Asian populations remain largely unknown. The present study aimed to investigate the stages of adopting CRC screening in Korea according to screening modality. Materials and Methods Data were obtained from the 2014 Korean National Cancer Screening Survey, a cross-sectional survey that utilized nationally representative random sampling to investigate cancer screening rates. A total of 2,066 participants aged 50-74 years were included in this study. Chi-square test and multinomial logistic regressionwere applied to determine stages of adoption for fecal occult blood test (FOBT) and colonoscopy and factors associated with each stage. Results Of 1,593 participants included in an analysis of stage of adoption for FOBT, 36% were in action/maintenance stages, while 18%, 40%, and 6% were in precontemplation, contemplation, and relapse/relapse risk stages, respectively. Of 1,371 subjects included in an analysis of stage of adoption for colonoscopy, 48% were in action/maintenance stages, with 21% in precontemplation, 21% in contemplation, and 11% in relapse/relapse risk stages. Multinomial logistic regression highlighted sex, household income, place of residency, family history of cancer, having private cancer insurance, smoking status, alcohol use, and regular exercise as being associated with stages of adoption for FOBT and colonoscopy. Conclusion This study outlines the distributions of stages of adoption for CRC screening by screening modality. Interventions to improve screening rates should be tailored to individuals in particular stages of adoption for CRC screening by modality.
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Affiliation(s)
- Nhung Cam Bui
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Ha Na Cho
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Yoon Young Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.,National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.,National Cancer Control Institute, National Cancer Center, Goyang, Korea
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14
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Kiviniemi MT, Ellis EM, Hall MG, Moss JL, Lillie SE, Brewer NT, Klein WM. Mediation, moderation, and context: Understanding complex relations among cognition, affect, and health behaviour. Psychol Health 2017; 33:98-116. [DOI: 10.1080/08870446.2017.1324973] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Marc T. Kiviniemi
- Department of Community Health and Health Behavior, University at Buffalo, SUNY, Buffalo, NY, USA
| | - Erin M. Ellis
- Behavioral Research Program, National Cancer Institute, Rockville, MD, USA
| | - Marissa G. Hall
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer L. Moss
- Behavioral Research Program, National Cancer Institute, Rockville, MD, USA
| | - Sarah E. Lillie
- Minneapolis Veteran Affairs Health Care System, Minneapolis, MN, USA
| | - Noel T. Brewer
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - William M.P. Klein
- Behavioral Research Program, National Cancer Institute, Rockville, MD, USA
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Ruberg JL, Helm CW, Felleman BI, Helm JE, Studts JL. Is attendance at an ovarian cancer screening clinic a worry-reducing event? Findings from pre- to post-screening. Gynecol Oncol 2016; 144:363-368. [PMID: 27986270 DOI: 10.1016/j.ygyno.2016.11.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Many studies have examined the relationship between worry and cancer screening. Due to methodological inconsistencies, results of these studies have varied and few conclusions can be made when generalizing across studies. The purpose of the current study was to better understand the worry-cancer screening relationship using a prospective research design. METHOD 180 women enrolled in an annual ovarian cancer (OC) screening clinic completed surveys at three time points-pre-screening, day of screening, and post-screening-using three measures of cancer-specific worry. RESULTS OC worry was highest in the weeks prior to screening and mere presentation at a screening clinic was associated with a significant worry decline. Observed elevations in worry following abnormal screening were not universal and varied by the instrument used to measure worry. CONCLUSIONS In contrast to our hypotheses, it appears that mere presentation at a cancer screening clinic may be a worry-reducing event. Receipt of abnormal results was not necessarily associated with increased worry.
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Affiliation(s)
- Joshua L Ruberg
- University of Louisville, Louisville, KY 40292, United States; James Graham Brown Cancer Center, 529 South Jackson Street, Louisville, KY 40202, United States; VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, United States; Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA.
| | - C William Helm
- University of Louisville, Louisville, KY 40292, United States; James Graham Brown Cancer Center, 529 South Jackson Street, Louisville, KY 40202, United States
| | - Benjamin I Felleman
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, United States
| | - Jane E Helm
- University of Louisville, Louisville, KY 40292, United States; James Graham Brown Cancer Center, 529 South Jackson Street, Louisville, KY 40202, United States
| | - Jamie L Studts
- University of Louisville, Louisville, KY 40292, United States; University of Kentucky College of Medicine, Lexington, KY 40536-0086, United States; James Graham Brown Cancer Center, 529 South Jackson Street, Louisville, KY 40202, United States; Lucille P. Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, United States
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16
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Coughlin SS, Thompson T. Physician Recommendation for Colorectal Cancer Screening by Race, Ethnicity, and Health Insurance Status Among Men and Women in the United States, 2000. Health Promot Pract 2016; 6:369-78. [PMID: 16210678 DOI: 10.1177/1524839905278742] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this study, the authors examined whether men and women in the United States had received a physician recommendation to get a colorectal cancer screening test, by race, ethnicity, and health insurance status using data from the 2000 National Health Interview Survey. Among men and women who had had a doctor visit in the past year but who had not had a recent fecal occult blood test, about 94.6% (95% CI 94.0-95.2) reported that their doctor had not recommended the test in the past year. African Americans, Hispanics, and American Indians/Alaska Natives were less likely to report receiving a recommendation for endoscopy compared to Whites.
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Affiliation(s)
- Steven S Coughlin
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention in Atlanta, Georgia, USA
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17
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Wee LE, Lim LY, Koh GCH. Two sides of the coin: A qualitative study of patient and provider perspectives on colorectal, breast and cervical cancer screening in a low-income Asian community. PROCEEDINGS OF SINGAPORE HEALTHCARE 2016. [DOI: 10.1177/2010105815616404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Patient and provider barriers to cancer screening in disadvantaged Asian populations are understudied. We conducted a qualitative study of attitudes to screening for colorectal, cervical and breast cancer within low-income communities in Singapore. Methods: Interviewers elicited perceptions of barriers/enablers to cancer screening amongst patients eligible for fecal occult blood test (FOBT)/Pap smear/mammograms, and providers serving these low-income communities. Interview transcripts were analyzed thematically using established qualitative methodology. Results: Twenty patients and nine providers were interviewed. Patient and provider comments were grouped into seven content areas: primary care characteristics (PCC), procedural issues, knowledge, costs, priorities, attitudes, and information sources. For FOBT, the most frequently mentioned content areas were knowledge (61.2%) and attitudes (16.9%) for patients, and knowledge (19.5%) and PCC (18.6%) for providers. For Pap smears, it was knowledge (23.6%) and costs (20.5%) for patients, and PCC (33.8%) and knowledge (19.1%) for providers. For mammograms, it was knowledge (41.4%) and sources of information (15.9%) for patients, and knowledge (28.8%) and procedural issues (19.2%) for providers. Conclusion: While PCC, knowledge and costs were the main contributors as perceived by physicians, knowledge and attitudes were the biggest barriers from patients’ perspectives. Differences in perceptions of cancer screening exist between low-income patients and providers serving them.
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Affiliation(s)
- Liang En Wee
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Li Yan Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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18
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Edwardson N, Bolin JN, McClellan DA, Nash PP, Helduser JW. The cost-effectiveness of training US primary care physicians to conduct colorectal cancer screening in family medicine residency programs. Prev Med 2016; 85:98-105. [PMID: 26872393 DOI: 10.1016/j.ypmed.2016.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Demand for a wide array of colorectal cancer screening strategies continues to outpace supply. One strategy to reduce this deficit is to dramatically increase the number of primary care physicians who are trained and supportive of performing office-based colonoscopies or flexible sigmoidoscopies. This study evaluates the clinical and economic implications of training primary care physicians via family medicine residency programs to offer colorectal cancer screening services as an in-office procedure. METHODS Using previously established clinical and economic assumptions from existing literature and budget data from a local grant (2013), incremental cost-effectiveness ratios are calculated that incorporate the costs of a proposed national training program and subsequent improvements in patient compliance. Sensitivity analyses are also conducted. RESULTS Baseline assumptions suggest that the intervention would produce 2394 newly trained residents who could perform 71,820 additional colonoscopies or 119,700 additional flexible sigmoidoscopies after ten years. Despite high costs associated with the national training program, incremental cost-effectiveness ratios remain well below standard willingness-to-pay thresholds under base case assumptions. Interestingly, the status quo hierarchy of preferred screening strategies is disrupted by the proposed intervention. CONCLUSIONS A national overhaul of family medicine residency programs offering training for colorectal cancer screening yields satisfactory incremental cost-effectiveness ratios. However, the model places high expectations on primary care physicians to improve current compliance levels in the US.
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Affiliation(s)
- Nicholas Edwardson
- School of Public Administration, University of New Mexico, Albuquerque, NM, United States.
| | - Jane N Bolin
- School of Public Health; Texas A&M Health Science Center, College Station, United States
| | - David A McClellan
- College of Medicine, Texas A&M Health Science Center, College Station, United States
| | - Philip P Nash
- College of Medicine, Texas A&M Health Science Center, College Station, United States
| | - Janet W Helduser
- School of Public Health; Texas A&M Health Science Center, College Station, United States
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19
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Atkinson TM, Salz T, Touza KK, Li Y, Hay JL. Does colorectal cancer risk perception predict screening behavior? A systematic review and meta-analysis. J Behav Med 2015; 38:837-50. [PMID: 26280755 DOI: 10.1007/s10865-015-9668-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 08/07/2015] [Indexed: 01/22/2023]
Abstract
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.
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Affiliation(s)
- Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
| | - Talya Salz
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
| | - Kaitlin K Touza
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
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20
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Sohler NL, Jerant A, Franks P. Socio-psychological factors in the Expanded Health Belief Model and subsequent colorectal cancer screening. PATIENT EDUCATION AND COUNSELING 2015; 98:901-7. [PMID: 25892503 PMCID: PMC4430351 DOI: 10.1016/j.pec.2015.03.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/29/2015] [Indexed: 05/14/2023]
Abstract
OBJECTIVE CRC screening interventions tailored to the Expanded Health Belief Model (EHBM) socio-psychological factors have been developed, but the contributions of individual factors to screening outcomes are unclear. METHODS In observational analyses of data from a randomized intervention trial, we examined the independent associations of five EHBM factors - CRC screening knowledge, self-efficacy, stage of readiness, barriers, and discussion with a provider - with objectively measured CRC screening after one year. RESULTS When all five factors were added simultaneously to a base model including other patient and visit characteristics, three of the factors were associated with CRC screening: self-efficacy (OR=1.32, p=0.001), readiness (OR=2.72, p<0.001), and discussion of screening with a provider (OR=1.59, p=0.009). Knowledge and barriers were not independently associated with screening. Adding the five socio-psychological factors to the base model improved prediction of CRC screening (area under the curve) by 7.7%. CONCLUSION Patient CRC screening self-efficacy, readiness, and discussion with a provider each independently predicted subsequent screening. PRACTICE IMPLICATIONS Self-efficacy and readiness measures might be helpful in parsimoniously predicting which patients are most likely to engage in CRC screening. The importance of screening discussion with a provider suggests the potential value of augmenting patient-focused EHBM-tailored interventions with provider-focused elements.
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Affiliation(s)
- Nancy L Sohler
- Community Health and Social Medicine, Sophie Davis School of Biomedical Education, City College of New York, New York, USA.
| | - Anthony Jerant
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, USA.
| | - Peter Franks
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, USA
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21
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Greiner KA, Daley CM, Epp A, James A, Yeh HW, Geana M, Born W, Engelman KK, Shellhorn J, Hester CM, LeMaster J, Buckles DC, Ellerbeck EF. Implementation intentions and colorectal screening: a randomized trial in safety-net clinics. Am J Prev Med 2014; 47:703-14. [PMID: 25455115 PMCID: PMC4311575 DOI: 10.1016/j.amepre.2014.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 07/08/2014] [Accepted: 08/05/2014] [Indexed: 02/06/2023]
Abstract
CONTEXT Low-income and racial/ethnic minority populations experience disproportionate colorectal cancer (CRC) burden and poorer survival. Novel behavioral strategies are needed to improve screening rates in these groups. BACKGROUND The study aimed to test a theoretically based "implementation intentions" intervention for improving CRC screening among unscreened adults in urban safety-net clinics. DESIGN Randomized controlled trial. SETTING/PARTICIPANTS Adults (N=470) aged ≥50 years, due for CRC screening, from urban safety-net clinics were recruited. INTERVENTION The intervention (conducted in 2009-2011) was delivered via touchscreen computers that tailored informational messages to decisional stage and screening barriers. The computer then randomized participants to generic health information on diet and exercise (Comparison group) or "implementation intentions" questions and planning (Experimental group) specific to the CRC screening test chosen (fecal immunochemical test or colonoscopy). MAIN OUTCOME MEASURES The primary study outcome was completion of CRC screening at 26 weeks based on test reports (analysis conducted in 2012-2013). RESULTS The study population had a mean age of 57 years and was 42% non-Hispanic African American, 28% non-Hispanic white, and 27% Hispanic. Those receiving the implementation intentions-based intervention had higher odds (AOR=1.83, 95% CI=1.23, 2.73) of completing CRC screening than the Comparison group. Those with higher self-efficacy for screening (AOR=1.57, 95% CI=1.03, 2.39), history of asthma (AOR=2.20, 95% CI=1.26, 3.84), no history of diabetes (AOR=1.86, 95% CI=1.21, 2.86), and reporting they had never heard that "cutting on cancer" makes it spread (AOR=1.78, 95% CI=1.16, 2.72) were more likely to complete CRC screening. CONCLUSIONS The results of this study suggest that programs incorporating an implementation intentions approach can contribute to successful completion of CRC screening even among very low-income and diverse primary care populations. Future initiatives to reduce CRC incidence and mortality disparities may be able to employ implementation intentions in large-scale efforts to encourage screening and prevention behaviors.
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Affiliation(s)
- K Allen Greiner
- Department of Family Medicine; University of Kansas Cancer Center.
| | - Christine M Daley
- Department of Family Medicine; Center for American Indian Community Health; Department of Preventive Medicine; University of Kansas Cancer Center
| | | | - Aimee James
- Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Hung-Wen Yeh
- Department of Biostatistics; University of Kansas Cancer Center
| | - Mugur Geana
- Department of Family Medicine; University of Kansas Cancer Center; Center of Excellence for Health Communications to Underserved Populations, William Allen White School of Journalism and Mass Communications
| | | | | | - Jeremy Shellhorn
- School of Architecture Design and Planning, University of Kansas, Kansas City, Kansas
| | | | | | - Daniel C Buckles
- Department of Internal Medicine, University of Kansas Medical Center
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22
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Harmon BE, Little MA, Woekel ED, Ettienne R, Long CR, Wilkens LR, Le Marchand L, Henderson BE, Kolonel LN, Maskarinec G. Ethnic differences and predictors of colonoscopy, prostate-specific antigen, and mammography screening participation in the multiethnic cohort. Cancer Epidemiol 2014; 38:162-7. [PMID: 24667037 PMCID: PMC4325992 DOI: 10.1016/j.canep.2014.02.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/12/2014] [Accepted: 02/17/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE Given the relation between screening and improved cancer outcomes and the persistence of ethnic disparities in cancer mortality, we explored ethnic differences in colonoscopy, prostate-specific antigen (PSA), and mammography screening in the Multiethnic Cohort Study. METHODS Logistic regression was applied to examine the influence of ethnicity as well as demographics, lifestyle factors, comorbidities, family history of cancer, and previous screening history on self-reported screening participation collected in 1999-2002. RESULTS The analysis included 140,398 participants who identified as white, African American, Native Hawaiian, Japanese American, US born-Latino, or Mexican born-Latino. The screening prevalences overall were mammography: 88% of women, PSA: 45% of men, and colonoscopy: 35% of men and women. All minority groups reported 10-40% lower screening utilization than whites, but Mexican-born Latinos and Native Hawaiian were lowest. Men were nearly twice as likely to have a colonoscopy (OR=1.94, 95% CI=1.89-1.99) as women. A personal screening history, presence of comorbidities, and family history of cancer predicted higher screening utilization across modalities, but to different degrees across ethnic groups. CONCLUSIONS This study confirms previously reported sex differences in colorectal cancer screening and ethnic disparities in screening participation. The findings suggest it may be useful to include personal screening history and family history of cancer into counseling patients about screening participation.
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Affiliation(s)
- Brook E Harmon
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA.
| | - Melissa A Little
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Erica D Woekel
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Reynolette Ettienne
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Camonia R Long
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Lynne R Wilkens
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Loic Le Marchand
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Brian E Henderson
- University of Southern California, Health Sciences Campus, NRT Lg 1502, Los Angeles, CA 90089, USA
| | - Laurence N Kolonel
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Gertraud Maskarinec
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
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Abstract
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.
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Affiliation(s)
- Hyenam Hwang
- School of Nursing, University of Texas at Austin, Texas, USA.
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24
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Leung DYP, Wong EML, Chan CWH. Adapting Champion's Breast Cancer Fear Scale to colorectal cancer: psychometric testing in a sample of older Chinese adults. Eur J Oncol Nurs 2014; 18:281-5. [PMID: 24629503 DOI: 10.1016/j.ejon.2014.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 01/21/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE Colorectal cancer (CRC) is the most common type of cancer in both men and women, and older adults are more susceptible to this disease. Previous studies suggest that cancer fear may be a key predictor of participation in cancer screening. Yet there is a lack of validated measuring tools of fear relating to CRC for the Chinese older adult population. This study aims to test the psychometric properties of the Chinese version of the Colorectal Cancer Fear Scale (CRCFS), adapting from the Champion's Breast Cancer Fear Scale. METHODS The CRCFS was developed by altering the wording 'breast cancer' to 'colorectal cancer'. Interviewer-administered surveys were carried out with a convenience sample of 250 community-dwelling adults aged at least 60 years old without a history of cancer. A subsample of 40 participants completed the scale again at one-month. RESULTS Confirmatory factor analysis revealed that the one-factor model provided excellent fits to the overall data, and two randomly split samples. Cronbach's alpha of the scale was 0.95 and test-retest reliability was 0.52. Positive and significant correlations of CRC Cancer Fear with CRC-related susceptibility, severity and barriers were observed. A non-linear relationship with benefits was found. CONCLUSIONS The findings provide support for the psychometric properties of a Chinese version of the Champion Cancer Fear with an adaption to CRC in a sample of community dwelling older Chinese adults. The scale provides a useful tool to assess CRC-related fear, which interventions should address in order to improve screening rates among older Chinese adults.
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Affiliation(s)
- Doris Y P Leung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Esther Lee Building, Shatin, Hong Kong.
| | - Eliza M L Wong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Esther Lee Building, Shatin, Hong Kong.
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Esther Lee Building, Shatin, Hong Kong.
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25
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Christy SM, Mosher CE, Rawl SM. Integrating men's health and masculinity theories to explain colorectal cancer screening behavior. Am J Mens Health 2014; 8:54-65. [PMID: 23813927 PMCID: PMC3849215 DOI: 10.1177/1557988313492171] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Colorectal cancer (CRC) is the third most common cause of cancer deaths among men in the United States. Although CRC screening has been found to reduce CRC incidence and mortality, current screening rates among men are suboptimal due to various practical and psychosocial barriers. One potential barrier to CRC screening identified in qualitative studies with men is the threat to masculinity that endoscopic screening methods pose. Indeed, beliefs about masculinity have been predictive of other preventive health behaviors among men. In this review article, we propose a novel conceptual framework to explain men's CRC screening behavior that integrates masculinity norms, gender role conflict, men's health care experiences, behaviors, and beliefs, and social and background variables. This framework has the potential to guide future research on men's CRC screening behaviors and other health behaviors and may inform gender-sensitive interventions that target masculinity beliefs to increase preventive health behaviors.
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Affiliation(s)
- Shannon M Christy
- 1Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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26
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Dignan M, Shelton B, Slone SA, Tolle C, Mohammad S, Schoenberg N, Pearce K, Van Meter E, Ely G. Effectiveness of a primary care practice intervention for increasing colorectal cancer screening in Appalachian Kentucky. Prev Med 2014; 58:70-4. [PMID: 24212061 PMCID: PMC3925970 DOI: 10.1016/j.ypmed.2013.10.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 09/30/2013] [Accepted: 10/27/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This report describes findings from a randomized controlled trial of an intervention to increase colorectal cancer (CRC) screening in primary care practices in Appalachian Kentucky. METHODS Sixty-six primary care practices were randomized to early or delayed intervention groups. The intervention was provided at practices using academic detailing, a method of education where providers receive information on a specific topic through personal contact. Data were collected in cross-sectional surveys of medical records at baseline and six months post-intervention. RESULTS A total of 3844 medical records were reviewed at baseline and 3751 at the six-month follow-up. At baselines, colonoscopy was recommended more frequently (43.4%) than any other screening modality, followed by fecal occult blood testing (18.0%), flexible sigmoidoscopy (0.4%), and double-contrast barium enema (0.3%). Rates of documented screening results were higher for all practices at the six-month follow-up for colonoscopy (31.8% vs 29.6%) and fecal occult blood testing (12.2% vs 11.2%). For early intervention practices that recommended screening, colonoscopy rates increased by 15.7% at six months compared to an increase of 2.4% in the delayed intervention practices (p=.01). CONCLUSIONS Using academic detailing to reach rural primary care providers with a CRC screening intervention was associated with an increase in colonoscopy.
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Affiliation(s)
- Mark Dignan
- University of Kentucky, Department of Internal Medicine, 800 Rose Street, Room CC444, Lexington, KY 40536-0093, USA.
| | - Brent Shelton
- Department of Biostatistics, University of Kentucky, USA; Markey Cancer Center, University of Kentucky, USA
| | | | - Cheri Tolle
- Markey Cancer Center, University of Kentucky, USA
| | | | | | - Kevin Pearce
- Department of Family & Community Medicine, University of Kentucky, USA
| | | | - Gretchen Ely
- College of Social Work, University of Kentucky, USA
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27
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Jimbo M, Kelly-Blake K, Sen A, Hawley ST, Ruffin MT. Decision Aid to Technologically Enhance Shared decision making (DATES): study protocol for a randomized controlled trial. Trials 2013; 14:381. [PMID: 24216139 PMCID: PMC3842677 DOI: 10.1186/1745-6215-14-381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 10/29/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Clinicians face challenges in promoting colorectal cancer screening due to multiple competing demands. A decision aid that clarifies patient preferences and improves decision quality can aid shared decision making and be effective at increasing colorectal cancer screening rates. However, exactly how such an intervention improves shared decision making is unclear. This study, funded by the National Cancer Institute, seeks to provide detailed understanding of how an interactive decision aid that elicits patient's risks and preferences impacts patient-clinician communication and shared decision making, and ultimately colorectal cancer screening adherence. METHODS/DESIGN This is a two-armed single-blinded randomized controlled trial with the target of 300 patients per arm. The setting is eleven community and three academic primary care practices in Metro Detroit. Patients are men and women aged between 50 and 75 years who are not up to date on colorectal cancer screening. ColoDATES Web (intervention arm), a decision aid that incorporates interactive personal risk assessment and preference clarification tools, is compared to a non-interactive website that matches ColoDATES Web in content but does not contain interactive tools (control arm). Primary outcomes are patient uptake of colorectal cancer screening; patient decision quality (knowledge, preference clarification, intent); clinician's degree of shared decision making; and patient-clinician concordance in the screening test chosen. Secondary outcome incorporates a Structural Equation Modeling approach to understand the mechanism of the causal pathway and test the validity of the proposed conceptual model based on Theory of Planned Behavior. Clinicians and those performing the analysis are blinded to arms. DISCUSSION The central hypothesis is that ColoDATES Web will improve colorectal cancer screening adherence through improvement in patient behavioral factors, shared decision making between the patient and the clinician, and concordance between the patient's and clinician's preferred colorectal cancer screening test. The results of this study will be among the first to examine the effect of a real-time preference assessment exercise on colorectal cancer screening and mediators, and, in doing so, will shed light on the patient-clinician communication and shared decision making 'black box' that currently exists between the delivery of decision aids to patients and subsequent patient behavior. TRIAL REGISTRATION ClinicalTrials.gov ID NCT01514786.
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Affiliation(s)
- Masahito Jimbo
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Karen Kelly-Blake
- Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI, USA
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sarah T Hawley
- Departments of Internal Medicine and Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Mack T Ruffin
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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Christy SM, Rawl SM. Shared decision-making about colorectal cancer screening: a conceptual framework to guide research. PATIENT EDUCATION AND COUNSELING 2013; 91:310-7. [PMID: 23419327 PMCID: PMC3756595 DOI: 10.1016/j.pec.2013.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 12/27/2012] [Accepted: 01/11/2013] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To develop a conceptual framework to guide research on shared decision-making about colorectal cancer (CRC) screening among persons at average risk and their providers. METHODS Based upon a comprehensive review of empirical literature and relevant theories, a conceptual framework was developed that incorporated patient characteristics, cultural beliefs, provider/health care system variables, health belief/knowledge/stage of adoption variables, and shared decision-making between patients and providers that may predict behavior. Relationships among concepts in the framework, shared decision-making process and outcomes, and CRC screening behavior were proposed. Directions for future research were presented. RESULTS Many of the concepts in the proposed framework have been examined in prior research. However, these elements have not been combined previously to explain shared decision-making about CRC screening. CONCLUSION Research is needed to test the proposed relationships and hypotheses and to refine the framework. PRACTICE IMPLICATIONS Findings from future research guided by the proposed framework may inform clinical practice to facilitate shared decision-making about CRC screening.
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Affiliation(s)
- Shannon M Christy
- Purdue School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, USA.
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Abstract
OBJECTIVES Although research shows that African Americans and Hispanics frequently receive less colorectal cancer screening (CRCS) than whites, few studies have focused on CRCS among Asians. The aims of this study were to compare CRCS between Asians and whites and to evaluate for clinical predictors of CRCS. METHODS From the 2007 California Health Interview Survey, we identified all Asian and white respondents who were eligible for CRCS. Logistic regression was performed to evaluate for differences in CRCS. We used stratified and interaction analyses to examine whether associations between race and CRCS were modified by insurance status, birthplace, or language skills, while controlling for other confounders. RESULTS Baseline characteristics were similar between Asians and whites. Only 58% of Asians and 66% of whites reported undergoing up-to-date CRCS (P < 0.01). In multivariate analyses, visiting a physician more than 5 times produced the highest odds of being up-to-date with screening. When compared with whites, Asians had decreased odds of being up-to-date with screening. Stratified analyses showed that this disparity existed mainly in the insured, but not in the uninsured, and it was not modified by place of birth or English language proficiency. CONCLUSIONS Despite its ability to reduce mortality, CRCS is suboptimal in our US population-based cohort of Asians when compared with whites. A contributing factor to this problem for the Chinese and Koreans may be a lack of awareness regarding CRCS, whereas the source of the problem in the Vietnamese seems to be related to healthcare access.
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Choi KC, So WKW, Chan DNS, Shiu ATY, Ho SSM, Chan HYL, Lam WWT, Cheng KKF, Goggins WB, Chan CWH. Gender differences in the use of colorectal cancer tests among older Chinese adults. Eur J Oncol Nurs 2013; 17:603-9. [PMID: 23462304 DOI: 10.1016/j.ejon.2013.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 12/20/2012] [Accepted: 01/05/2013] [Indexed: 01/15/2023]
Abstract
PURPOSE The study aimed to explore the gender difference in using colorectal cancer (CRC) tests among Chinese aged 50 years or over. METHODS A cross-sectional study was conducted in 2004 Chinese older adults through anonymous telephone survey which covered socio-demographic variables, health status, use of complementary therapy, health-related perceptions and use of CRC tests. RESULTS The uptake rate of flexible sigmoidoscopy (FS)/colonoscopy was 14% for males and 10% for females, with males significantly more likely to have had the test after adjusting for their differences in socio-demographics, health status, use of complementary therapies, health-related perceptions and recommendation received from health professionals (adjusted OR = 1.5, 95% CI: 1.1-2.0, p = 0.005). The uptake of fecal occult blood test was nearly the same (19%) for both genders. Further interaction analyses indicates that the effect of a family history of cancer on the uptake of a FS/colonoscopy is significantly weaker in males than in females (the interaction odds ratio = 0.4, 95% CI: 0.2-0.8, p = 0.011), whereas a male perceived that visiting a doctor is good for health will be more likely to have an uptake of a FS/colonoscopy than a female with such perception (the interaction odds ratio = 2.1, 95% CI: 1.1-3.8, p = 0.018). CONCLUSIONS The uptake of CRC tests was low in this average-risk population. More effort is needed to educate the public about the importance and benefits of CRC tests. In view of the gender differences in some determinants of FS/colonoscopy uptake, particular attention should be given to develop gender-specific strategies to improve the rate.
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Affiliation(s)
- Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
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Rowe S, Goldsmith G, Price R, Brooks A, Harvey A. Health care providers' perspectives of an intervention designed to improve colorectal cancer screening rates in family medicine residency clinics : a qualitative study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:695-702. [PMID: 22826203 DOI: 10.1007/s13187-012-0393-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose of this study was to obtain feedback from family medicine residents and clinic nurses regarding a colorectal cancer screening (CRCS) intervention. Focus groups were used to ask participants three questions about their perceptions of the intervention and subsequent patient screening behaviors. Content analysis and constant comparison were used to yield two meaningful themes from the participant responses: patient-specific issues and study design issues. Patient-specific issues included: lack of education and fear, finances and insurance coverage, and compliance. Study design issues included: lack of time, a need for reminders to discuss CRCS with patients, quality of the nurse's role, and a need for better clinical staff education and awareness. Results show ways to significantly improve future implementation of the CRCS intervention. Ultimately, future use of clinic-based CRCS interventions could be vastly improved by utilizing strategies to promote teamwork and increase the sense of mutual ownership among clinic staff.
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Affiliation(s)
- Sara Rowe
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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Abstract
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.
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So W, Choi K, Chan D, Shiu A, Ho S, Chan H, Lam W, Cheng K, Goggins W, Chan C. Colorectal cancer screening behaviour and associated factors among Chinese aged 50 and above in Hong Kong – A population-based survey. Eur J Oncol Nurs 2012; 16:413-8. [DOI: 10.1016/j.ejon.2011.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 09/14/2011] [Accepted: 09/20/2011] [Indexed: 10/15/2022]
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Messina CR, Lane DS, Anderson JC. Body mass index and screening for colorectal cancer: gender and attitudinal factors. Cancer Epidemiol 2012; 36:400-8. [PMID: 22386859 PMCID: PMC4230010 DOI: 10.1016/j.canep.2012.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 02/03/2012] [Accepted: 02/06/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND Overweight/obese women and men are at increased risk for colorectal cancer (CRC) incidence and mortality. Research examining body mass index (BMI) and CRC screening has had mixed results. A clearer understanding of the extent to which high-BMI subgroups are screened for CRC is needed to inform planning for CRC screening promotions targeting BMI. METHODS Data were obtained from a random, population-based sample of women and men at average-risk for CRC (aged 50-75 years) during 2004 (n = 1098). Multiple logistic regression analyses were conducted to evaluate whether BMI category was significantly associated with the probability of reporting recent CRC screening and with the probability of agreeing with statements denoting attitudes/perceptions about CRC and screening. Attitudes/perceptions about CRC and screening were evaluated as potential mediators and moderators of the association between BMI category and CRC screening. RESULTS After controlling for characteristics associated with CRC screening, overweight and obese women were each 40% less likely to have CRC screening than women with normal-BMI (OR = 0.6, 95% CI:0.4-0.9 and OR = 0.6, 95% CI:0.3-0.9). BMI category was unrelated to screening among men. Obese women (but not men) were less aware than normal-BMI women that obesity increased risk for CRC (OR = 0.5, 95% CI:0.3-0.9) and less worried about CRC (OR = 0.5, 95% CI:0.3-0.8). However, findings suggest that attitudes/perceptions about CRC and screening did not mediate or moderate the association between BMI category and CRC screening. CONCLUSION Overweight/obese women are at increased risk for CRC because of their greater BMI and their propensity not to screen for CRC. Study findings suggest that potentially modifiable perceptions, e.g., lack of awareness of risk for CRC and less worry about CRC, in this subgroup may not explain the relationship between BMI category and reduced screening.
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Affiliation(s)
- Catherine R. Messina
- Department of Preventive Medicine, HSC L3, Rm 086, Stony Brook University, Stony Brook NY 11794-8036
| | - Dorothy S. Lane
- Department of Preventive Medicine, HSC L3, Rm 086, Stony Brook University, Stony Brook NY 11794-8036
| | - Joseph C. Anderson
- Department of Gastroenterology, University of Connecticut, 263 Farmington Avenue Farmington, CT 06030 and VA Outcomes Group, VA Medical Center, 215 Main Street, Gastroenterology (111E), White River Junction, Vermont 05009
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Brittain K, Taylor JY, Loveland-Cherry C, Northouse L, Caldwell CH. Family Support and Colorectal Cancer Screening among Urban African Americans. J Nurse Pract 2012; 8:522-533. [PMID: 23086216 PMCID: PMC3474367 DOI: 10.1016/j.nurpra.2011.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer death among African Americans. Less than 50% of African Americans have had CRC screening. This study examined the relationships between family support and influence, cultural identity, CRC beliefs, and a screening informed decision among 129 urban African Americans. Family support (p < .01) significantly predicted CRC beliefs and CRC beliefs significantly predicted informed decision (p < .01). Based on study results, practitioners should routinely assess family support and CRC beliefs with African Americans patients. This may improve patient-provider shared decision-making satisfaction and CRC screening adherence among African American patients.
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Affiliation(s)
- Kelly Brittain
- College of Nursing, Michigan State University, East Lansing
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Griffith KA, Passmore SR, Smith D, Wenzel J. African Americans With a Family History of Colorectal Cancer: Barriers and Facilitators to Screening. Oncol Nurs Forum 2012; 39:299-306. [DOI: 10.1188/12.onf.299-306] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Feldstein AC, Perrin N, Liles EG, Smith DH, Rosales AG, Schneider JL, Lafata JE, Myers RE, Mosen DM, Glasgow RE. Primary care colorectal cancer screening recommendation patterns: associated factors and screening outcomes. Med Decis Making 2012; 32:198-208. [PMID: 21652776 PMCID: PMC3624016 DOI: 10.1177/0272989x11406285] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The relationship of a primary care provider's (PCP's) colorectal cancer (CRC) screening strategies to completion of screening is poorly understood. OBJECTIVE To describe PCP test recommendation patterns and associated factors and their relationship to patient test completion. DESIGN This cross-sectional study used a PCP survey, in-depth PCP interviews, and electronic medical records. SETTING Kaiser Permanente Northwest health maintenance organization. PARTICIPANTS Participants included 132 PCPs and 49,259 eligible patients aged 51 to 75. MEASUREMENTS The authors grouped PCPs by patterns of CRC screening recommendations based on reported frequency of recommending fecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), and colonoscopy. They then compared PCP demographics, reported CRC screening test influences, concerns, decision-making and counseling processes, and actual rates of patient CRC screening completion by PCP group. RESULTS The authors identified 4 CRC screening recommendation groups: a "balanced" group (n = 54; 40.9%) that recommended the tests nearly equally, an FOBT group (n = 31; 23.5%) that largely recommended FOBT, an FOBT + FS group (n = 25; 18.9%), and a colonoscopy + FOBT group (n = 22; 16.7%) that recommended these tests nearly equally. Internal medicine (v. family medicine) PCPs were more common in groups more frequently recommending endoscopy. The FOBT and FOBT + FS groups were most influenced by clinical guidelines. Groups recommending more endoscopy were most concerned that FOBT generates a relatively high number of false positives and FOBT can miss cancers. The FOBT and FOBT + FS groups were more likely to recommend a specific screening strategy compared to the colonoscopy + FOBT and balanced groups, which were more likely to let the patient decide. CRC screening rates were 63.9% balanced, 62.9% FOBT, 61.7% FOBT + FS, and 62.2% colonoscopy + FOBT; rates did not differ significantly by group. LIMITATIONS Small numbers within PCP groups. CONCLUSIONS Specialty, the influence of guidelines, test concerns, and the "jointness" of the test selection decision distinguished CRC screening recommendation patterns. All patterns were associated with similar overall screening rates.
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Affiliation(s)
- Adrianne C. Feldstein
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
- Northwest Permanente, Kaiser Permanente Northwest, Portland, OR, USA
| | - Nancy Perrin
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Elizabeth G. Liles
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
- Northwest Permanente, Kaiser Permanente Northwest, Portland, OR, USA
| | - David H. Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | | | - Jennifer E. Lafata
- Henry Ford Health System, Detroit, Michigan, USA and Medical College of Virginia at Virginia Commonwealth University, Richmond, VA
| | - Ronald E. Myers
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David M. Mosen
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Russell E. Glasgow
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
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Brittain K, Loveland-Cherry C, Northouse L, Caldwell CH, Taylor JY. Sociocultural differences and colorectal cancer screening among African American men and women. Oncol Nurs Forum 2012; 39:100-7. [PMID: 22201660 PMCID: PMC3354616 DOI: 10.1188/12.onf.100-107] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine sociocultural factors that influence an informed decision about colorectal cancer (CRC) screening among African American men and women. DESIGN Descriptive, cross-sectional. SETTING A medical center, a National Cancer Institute-designated comprehensive cancer center, and various social organizations and barbershops in a midwestern city of the United States. SAMPLE A purposive sample of African American women (n = 65) and African American men (n = 64) aged 50 years and older. METHODS Participants completed a self-administered survey. MAIN RESEARCH VARIABLES Cultural identity, CRC beliefs, family support, and informed decision. FINDINGS Family support was positively related to CRC beliefs among participants, and CRC beliefs were positively related to an informed decision. However, among men, family support positively related to an informed decision about CRC screening. In addition, t-test results indicated that the men and women were significantly different. Family support predicted CRC beliefs among men (p < 0.01) and women (p < 0.01). CRC beliefs predicted CRC screening informed decisions among men (p < 0.01) and women (p < 0.05). However, the accounted variance was dissimilar, suggesting a difference in the impact of the predictors among the men and women. CONCLUSIONS Family support has a significant impact on CRC beliefs about CRC screening among African Americans. However, how men and women relate to the variables differs. IMPLICATIONS FOR NURSING To improve CRC screening rates, informed decision-making interventions for African Americans should differ for men and women and address family support, CRC beliefs, and elements of cultural identity.
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Affiliation(s)
- Kelly Brittain
- College of Nursing, Michigan State University, East Lansing, USA.
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Factors influencing colorectal cancer screening participation. Gastroenterol Res Pract 2011; 2012:483417. [PMID: 22190913 PMCID: PMC3235570 DOI: 10.1155/2012/483417] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 10/18/2011] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer (CRC) is a major health problem worldwide. Although population-based CRC screening is strongly recommended in average-risk population, compliance rates are still far from the desirable rates. High levels of screening uptake are necessary for the success of any screening program. Therefore, the investigation of factors influencing participation is crucial prior to design and launches a population-based organized screening campaign. Several studies have identified screening behaviour factors related to potential participants, providers, or health care system. These influencing factors can also be classified in non-modifiable (i.e., demographic factors, education, health insurance, or income) and modifiable factors (i.e., knowledge about CRC and screening, patient and provider attitudes or structural barriers for screening). Modifiable determinants are of great interest as they are plausible targets for interventions. Interventions at different levels (patient, providers or health care system) have been tested across the studies with different results. This paper analyzes factors related to CRC screening behaviour and potential interventions designed to improve screening uptake.
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Kiviniemi MT, Bennett A, Zaiter M, Marshall JR. Individual-level factors in colorectal cancer screening: a review of the literature on the relation of individual-level health behavior constructs and screening behavior. Psychooncology 2011; 20:1023-33. [PMID: 21954045 PMCID: PMC3038178 DOI: 10.1002/pon.1865] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 09/10/2010] [Accepted: 09/16/2010] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Marc T Kiviniemi
- Department of Health Behavior, University at Buffalo, New York 14124, USA.
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DuHamel K, Li Y, Rakowski W, Samimi P, Jandorf L. Validity of the process of change for colorectal cancer screening among African Americans. Ann Behav Med 2011; 41:271-83. [PMID: 21165726 DOI: 10.1007/s12160-010-9250-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Process of change (POC) is a construct of the transtheoretical model that proposes to promote healthy behaviors. PURPOSE African Americans participate in colorectal cancer (CRC) screening less often than whites, while disease onset is younger, and incidence and mortality from CRC are higher. METHODS POC items for CRC screening were administered to 158 African Americans, the majority of whom were female (75.9%) and were not employed (85.4%). Confirmatory factor analysis was used to validate four factors reflecting the POC sub-domains. RESULTS Support of the factor validity of the POC with internal consistency of standardized alpha for the four factors was found. A logistic regression showed predictive validity in predicting current screening stage for two of the four sub-domains. CONCLUSION These data support the application of the POC to prediction of CRC screening intention among African Americans.
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Affiliation(s)
- Katherine DuHamel
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, NY 10022, USA.
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Krishnan S, Wolf JL. Colorectal cancer screening and prevention in women. ACTA ACUST UNITED AC 2011; 7:213-26. [PMID: 21410347 DOI: 10.2217/whe.11.7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is the third most common cause of cancer in women. Screening for CRC increases early detection of cancer and premalignant polyps and decreases morbidity from this disease. However, adherence to the screening guidelines continues to remain inadequate both at the physician and patient levels. Several factors are of special importance to women. Presence of prior gynecological malignancies may increase the risk of CRC in women. Furthermore, new studies have shown other factors such as obesity and smoking to increase the risk of CRC in women. This article highlights issues unique to women with regards to CRC and outlines special considerations for determining screening intervals in women, identifies factors that make screening more difficult in women, and reviews studies that identify preventative strategies which, together with screening, may reduce the burden of CRC.
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Affiliation(s)
- Sandeep Krishnan
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
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Mitchell KA, Rawl SM, Champion VL, Jeffries PR, Welch JL. Development and Psychometric Testing of the Colonoscopy Embarrassment Scale. West J Nurs Res 2011; 34:548-64. [DOI: 10.1177/0193945911410328] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Colorectal cancer, the third leading cause of cancer-related death in the United States, could largely be prevented if more people had polyps removed via colonoscopies. Embarrassment is one important barrier to colonoscopy, but little is known about embarrassment in this context, and there were no reliable and valid measures of this construct. The purpose of this study was to develop a reliable and valid instrument to measure colonoscopy-related embarrassment. Transtheoretical Model of Behavior Change and Health Belief Model provided the theoretical basis for this study. Participants were health maintenance organization members aged 50 to 65 years ( N = 234). Using a cross-sectional, descriptive research design, data were collected using a mailed survey. Internal consistency (Cronbach’s α = .96) and construct validity of the 13-item instrument were demonstrated. This unidimensional scale shows promise as a valid and reliable instrument to measure colonoscopy-related embarrassment and to inform development of interventions to reduce embarrassment, leading to higher colonoscopy completion rates and lower mortality.
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Presence and correlates of racial disparities in adherence to colorectal cancer screening guidelines. J Gen Intern Med 2011; 26:251-8. [PMID: 21088920 PMCID: PMC3043189 DOI: 10.1007/s11606-010-1575-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 05/18/2010] [Accepted: 10/25/2010] [Indexed: 01/06/2023]
Abstract
OBJECTIVES We examined the presence and correlates of Black/White racial disparities in adherence to guidelines for colorectal cancer screening (CRCS). METHODS The sample included 328 Black and 1827 White patients age 50-75 from 24 VA medical facilities who responded to a mailed survey with phone follow-up (response rate: 73% for Blacks and 89% for Whites). CRCS adherence and race were obtained through surveys and supplemented with administrative data. Logistic regressions estimated the contribution of demographic, health, cognitive, and environmental factors to racial disparities in adherence to CRCS guidelines. RESULTS In unadjusted analyses, Blacks had slightly lower rates of adherence to CRCS guidelines than Whites (72% versus 77%, p<0.05). This racial disparity in CRCS adherence was explained by race differences in demographic, health, and environmental factors but not by cognitive factors. Tests for interactions revealed that the association of race with adherence varied significantly across levels of income, education, and marital status. In particular, among those who were married with higher levels of education, CRCS adherence was significantly higher for Whites; whereas among those who were unmarried, with low levels of education, adherence was significantly higher for Blacks. CONCLUSION We found that disparities in CRCS are greatly attenuated in the VA system and both Whites and Blacks have substantially higher rates of CRCS than the national average. These results point to the success of the VA at implementing CRCS system-wide. Our findings also suggest additional initiatives may be needed for unmarried low income white men and higher income black men.
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Bridou M, Aguerre C, Reveillere C, Haguenoer K, Viguier J. Facteurs psychologiques d’adhésion au dépistage du cancer colorectal par le test Hémoccult® II. PSYCHO-ONCOLOGIE 2011. [DOI: 10.1007/s11839-011-0304-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Engaging diverse underserved communities to bridge the mammography divide. BMC Public Health 2011; 11:47. [PMID: 21255424 PMCID: PMC3036625 DOI: 10.1186/1471-2458-11-47] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 01/21/2011] [Indexed: 11/10/2022] Open
Abstract
Background Breast cancer screening continues to be underutilized by the population in general, but is particularly underutilized by traditionally underserved minority populations. Two of the most at risk female minority groups are American Indians/Alaska Natives (AI/AN) and Latinas. American Indian women have the poorest recorded 5-year cancer survival rates of any ethnic group while breast cancer is the number one cause of cancer mortality among Latina women. Breast cancer screening rates for both minority groups are near or at the lowest among all racial/ethnic groups. As with other health screening behaviors, women may intend to get a mammogram but their intentions may not result in initiation or follow through of the examination process. An accumulating body of research, however, demonstrates the efficacy of developing 'implementation intentions' that define when, where, and how a specific behavior will be performed. The formulation of intended steps in addition to addressing potential barriers to test completion can increase a person's self-efficacy, operationalize and strengthen their intention to act, and close gaps between behavioral intention and completion. To date, an evaluation of the formulation of implementation intentions for breast cancer screening has not been conducted with minority populations. Methods/Design In the proposed program, community health workers will meet with rural-dwelling Latina and American Indian women one-on-one to educate them about breast cancer and screening and guide them through a computerized and culturally tailored "implementation intentions" program, called Healthy Living Kansas - Breast Health, to promote breast cancer screening utilization. We will target Latina and AI/AN women from two distinct rural Kansas communities. Women attending community events will be invited by CHWs to participate and be randomized to either a mammography "implementation intentions" (MI2) intervention or a comparison general breast cancer prevention informational intervention (C). CHWs will be armed with notebook computers loaded with our Healthy Living Kansas - Breast Health program and guide their peers through the program. Women in the MI2 condition will receive assistance with operationalizing their screening intentions and identifying and addressing their stated screening barriers with the goal of guiding them toward accessing screening services near their community. Outcomes will be evaluated at 120-days post randomization via self-report and will include mammography utilization status, barriers, and movement along a behavioral stages of readiness to screen model. Discussion This highly innovative project will be guided and initiated by AI/AN and Latina community members and will test the practical application of emerging behavioral theory among minority persons living in rural communities. Trial Registration ClinicalTrials (NCT): NCT01267110
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Gregory TA, Wilson C, Duncan A, Turnbull D, Cole SR, Young G. Demographic, social cognitive and social ecological predictors of intention and participation in screening for colorectal cancer. BMC Public Health 2011; 11:38. [PMID: 21232156 PMCID: PMC3034679 DOI: 10.1186/1471-2458-11-38] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 01/14/2011] [Indexed: 11/10/2022] Open
Abstract
Background Previous research points to differences between predictors of intention to screen for colorectal cancer (CRC) and screening behavior, and suggests social ecological factors may influence screening behavior. The aim of this study was to compare the social cognitive and social ecological predictors of intention to screen with predictors of participation. Methods People aged 50 to 74 years recruited from the electoral roll completed a baseline survey (n = 376) and were subsequently invited to complete an immunochemical faecal occult blood test (iFOBT). Results Multivariate analyses revealed five predictors of intention to screen and two predictors of participation. Perceived barriers to CRC screening and perceived benefits of CRC screening were the only predictor of both outcomes. There was little support for social ecological factors, but measurement problems may have impacted this finding. Conclusions This study has confirmed that the predictors of intention to screen for CRC and screening behaviour, although overlapping, are not the same. Research should focus predominantly on those factors shown to predict participation. Perceptions about the barriers to screening and benefits of screening are key predictors of participation, and provide a focus for intervention programs.
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Affiliation(s)
- Tess A Gregory
- School of Psychology, University of Adelaide, Adelaide 5000, Australia.
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Koo JH, Arasaratnam MM, Liu K, Redmond DM, Connor SJ, Sung JJ, Leong RW. Knowledge, perception and practices of colorectal cancer screening in an ethnically diverse population. Cancer Epidemiol 2010; 34:604-10. [DOI: 10.1016/j.canep.2010.05.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 05/10/2010] [Accepted: 05/25/2010] [Indexed: 11/29/2022]
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Walsh JME, Karliner L, Burke N, Somkin CP, Pham LA, Pasick R. Physicians' approaches to recommending colorectal cancer screening: a qualitative study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2010; 25:385-90. [PMID: 20204571 PMCID: PMC2936570 DOI: 10.1007/s13187-010-0058-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 11/05/2009] [Accepted: 01/22/2010] [Indexed: 05/10/2023]
Abstract
Little is known about strategies that physicians use to encourage receipt of colorectal cancer screening (CRCS). This study conducted focus groups with physicians. Twenty-seven physicians participated in four focus groups. Physicians described four categories of approaches: (1) why screening is important, (2) providing test information, (3) motivational strategies, and (4) tailoring strategies. Participants reported tailoring based on their relationship with a patient, as well as to patient gender, education, and language. Tailoring to cultural background or ethnicity was not prominent. Most physicians reported a typical approach to CRCS and reported some tailoring based on gender, education, and language, but not on ethnicity.
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Affiliation(s)
- Judith M E Walsh
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, 1635 Divisadero Street, Suite 600, San Francisco, CA 94115-1793, USA.
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Ferrer RR, Ramirez M, Beckman LJ, Danao LL, Ashing-Giwa KT. The impact of cultural characteristics on colorectal cancer screening adherence among Filipinos in the United States: a pilot study. Psychooncology 2010; 20:862-70. [PMID: 20597065 DOI: 10.1002/pon.1793] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 05/14/2010] [Accepted: 05/27/2010] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Studies on colorectal cancer screening among specific Asian American groups are limited despite the fact that Asians are comprised of culturally distinct subgroups. The purpose of this study was to investigate the impact of cultural characteristics on colorectal cancer screening adherence among Filipinos in the United States. METHODS One hundred and seventeen Filipino men and women aged 50 years or older participated in the cross-section research design. Lifetime proportion of immigration, language preference and cultural beliefs of personal control regarding health outcomes measured cultural characteristics. Demographic and healthcare variables were also measured to describe the study sample. Participant recruitment employed culturally responsive sampling methods. RESULTS There was no significant association between language preference and screening. Likewise, perceived personal internal control of health outcome was not related to screening. However, personal external control revealed a marginally significant association. The percent of lifetime residence in the United States was significantly greater among those who were adherent to screening than those who were not adherent. After adjusting for demographic and healthcare variables, the relationship between length of immigration and screening adherence was no longer significant. Finally, age and doctor's recommendation showed significant impact on colorectal cancer screening adherence. DISCUSSION This pilot study adds to the knowledge regarding cultural factors associated with colorectal cancer screening behaviors among Filipino Americans. Future research is needed to confirm findings that will be useful in developing culturally appropriate strategies to increase screening adherence.
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Affiliation(s)
- Rizaldy R Ferrer
- California School of Professional Psychology, Alliant International University, Alhambra, CA 91803, USA.
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