Colorectal cancer screening at community health centers: A survey of clinicians' attitudes, practices, and perceived barriers

Implementing Mailed Colorectal Cancer Fecal Screening Tests in Real-World Primary Care Settings: Promising Implementation Practices and Opportunities for Improvement

Colorectal cancer (CRC) screening reduces morbidity and mortality, but screening rates in the USA remain suboptimal. The Colorectal Cancer Control Program (CRCCP) was established in 2009 to increase screening among groups disproportionately affected. The CRCCP utilizes implementation science to support health system change as a strategy to reduce disparities in CRC screening by directing resources to primary care clinics to implement evidence-based interventions (EBIs) proven to increase CRC screening. As COVID-19 continues to impede in-person healthcare visits and compel the unpredictable redirection of clinic priorities, understanding clinics' adoption and implementation of EBIs into routine care is crucial. Mailed fecal testing is an evidence-based screening approach that offers an alternative to in-person screening tests and represents a promising approach to reduce CRC screening disparities. However, little is known about how mailed fecal testing is implemented in real-world settings. In this retrospective, cross-sectional analysis, we assessed practices around mailed fecal testing implementation in 185 clinics across 62 US health systems. We sought to (1) determine whether clinics that do and do not implement mailed fecal testing differ with respect to characteristics (e.g., type, location, and proportion of uninsured patients) and (2) identify implementation practices among clinics that offer mailed fecal testing. Our findings revealed that over half (58%) of clinics implemented mailed fecal testing. These clinics were more likely to have a CRC screening policy than clinics that did not implement mailed fecal testing (p = 0.007) and to serve a larger patient population (p = 0.004), but less likely to have a large proportion of uninsured patients (p = 0.01). Clinics that implemented mailed fecal testing offered it in combination with EBIs, including patient reminders (92%), provider reminders (94%), and other activities to reduce structural barriers (95%). However, fewer clinics reported having the leadership support (58%) or funding stability (29%) to sustain mailed fecal testing. Mailed fecal testing was widely implemented alongside other EBIs in primary care clinics participating in the CRCCP, but multiple opportunities for enhancing its implementation exist. These include increasing the proportion of community health centers/federally qualified health centers offering mailed screening; increasing the proportion that provide pre-paid return mail supplies with the screening kit; increasing the proportion of clinics monitoring both screening kit distribution and return; ensuring patients with abnormal tests can obtain colonoscopy; and increasing sustainability planning and support.

Knowledge, Attitude, Practice, and Perceived Barriers Regarding Colorectal Cancer Screening Practices Among Healthcare Practitioners: A Systematic Review

The recommendations of medical professionals play a significant role in colorectal cancer (CRC) screening. This study aims to systematically review knowledge, attitude, practice, and perceived barriers regarding CRC screening practices among healthcare practitioners (HCPs). From January 2023 to December 2023, a comprehensive literature search was conducted using online databases, including Web of Science, PubMed, Scopus, and Research Gate, by using the following keywords in combination: "knowledge," "attitude," "practice," "perceived barriers," "colorectal cancer," and "health practitioners." The researchers screened and examined the retrieved literature. A total of 21 studies were considered relevant for the current review. Among these studies, eight assessed the level of knowledge, attitude, practices, and perceived barriers toward CRC screening among various health practitioners. Three studies assessed knowledge and attitudes toward CRC screening among health practitioners. The remaining ten studies assessed awareness, perceived barriers, or only knowledge of CRC screening among HCPs. In addition, all the included studies employed a cross-sectional design. The review shows that many healthcare providers need more fundamental knowledge of CRC screening. Healthcare procedures must be improved to enhance the knowledge, attitudes, and practices of healthcare professionals regarding CRC screening and their understanding of the associated barriers.

Provider communication contributes to colorectal cancer screening intention through improving screening outcome expectancies and perceived behavioral control

Colorectal cancer (CRC) screening continues to be underutilized in the US despite the availability of multiple effective, guideline-recommended screening options. Provider recommendation has been consistently shown to improve screening completion. Yet, available literature provides little information as to how specific information providers communicate influence patient decision-making about CRC screening. We tested the pathways through which information communicated by providers about the "Why" and "How" of CRC screening using the mt-sDNA test contributes to intention to complete the test. Data came from a behavioral theory-informed survey that we developed to identify psychosocial factors associated with mt-sDNA screening. RTI International administered the survey between 03/2022-06/2022 to a sample of US adults ages 45-75 who received a valid order for mt-sDNA screening with a shipping date between 5/2021-9/2021. Participants completed an electronic or paper survey. We tested the proposed relationships using structural equation modeling and tested indirect effects using Monte Carlo method. A total of 2,973 participants completed the survey (response rate: 21.7%) and 81.6% (n = 2,427) reported have had a conversation with their health care provider about mt-sDNA screening before the test was ordered. We found that "Why" information from providers was positively associated with perceived effectiveness of mt-sDNA screening, while "How" information was positively associated with perceived ease of use. "Why" information contributed to screening intention through perceived effectiveness while "How" information contributed to screening intention through perceived ease of use. These findings emphasize the critical role of provider communication in shaping patient decision-making regarding CRC screening. CRC screening interventions could consider implementing provider-patient communication strategies focusing on improving patient understanding of the rationale for CRC screening and the effectiveness of available screening options as well as addressing barriers and enhancing patients' self-efficacy in completing their preferred screening option.

Perceived effectiveness of cancer screening among family medicine and internal medicine physicians in the United States

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There are limited data on family medicine and internal medicine physicians’ beliefs regarding perceived cancer screening effectiveness.

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Perceiving specific cancer screening tests as very effective differed in some cases by gender, age, graduation year, and race/ethnicity.

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Physicians’ perceived effectiveness about cancer screening tests varies widely and may influence their recommendations or usage of these tests.

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Understanding physicians’ beliefs on screening effectiveness can help improve uptake of evidence-based screening by providers and patients to promote early detection and successful treatment.

Family and internal medicine physicians play an important role in cancer screening, yet there are limited data on their beliefs regarding effectiveness of screening tests, which may affect physicians’ likelihood to recommend such tests. The study purpose was to assess current beliefs among family medicine and internal medicine physicians regarding effectiveness of various types of cancer screening. A national sample of 582 physicians from the American Medical Association’s Physician Masterfile were surveyed. Participants were asked about their perceived effectiveness of screening for colon, lung, breast, prostate, and cervical cancer among average, healthy individuals. Chi-square tests were conducted to assess relationships between perceiving screening tests to be ‘very effective in reducing cancer-related mortality’ and demographic characteristics. A substantial majority of physicians perceived colonoscopy (83.8%) and Pap smear (82.9%) to be very effective. Perceiving low-dose computed tomography (LDCT), Pap smear, and prostate-specific antigen (PSA) as ‘very effective’ differed by gender, with females less likely to endorse LDCT and Pap smear but more likely to endorse PSA. Perceiving PSA as ‘very effective’ differed by age and graduation year, with younger or more recently graduated physicians being less likely to perceive PSA as ‘very effective’. Non-Hispanic Black/African-American physicians were more likely to perceive mammography as ‘very effective’ than other groups. Physicians’ perceived effectiveness about cancer screening tests varies widely and may influence their recommendations or usage of these tests. Understanding physicians’ beliefs can help in improving uptake of evidence-based screening tests by providers and patients to promote early detection and successful treatment.

Factors Associated With Clinician Recommendations for Colorectal Cancer Screening Among Average-Risk Patients: Data From a National Survey

Introduction

Colorectal cancer (CRC) screening among average-risk patients is underused in the US. Clinician recommendation is strongly associated with CRC screening completion. To inform interventions that improve CRC screening uptake among average-risk patients, we examined clinicians’ routine recommendations of 7 guideline-recommended screening methods and factors associated with these recommendations.

Methods

We conducted an online survey in November and December 2019 among a sample of primary care clinicians (PCCs) and gastroenterologists (GIs) from a panel of US clinicians. Clinicians reported whether they routinely recommend each screening method, screening method intervals, and patient age at which they stop recommending screening. We also measured the influence of various factors on screening recommendations.

Results

Nearly all 814 PCCs (99%) and all 159 GIs (100%) reported that they routinely recommend colonoscopy for average-risk patients, followed by stool-based tests (more than two-thirds of PCCs and GIs). Recommendation of other visualization-based methods was less frequent (PCCs, 26%–35%; GIs, 30%–41%). A sizable proportion of clinicians reported guideline-discordant screening intervals and age to stop screening. Guidelines and clinical evidence were most frequently reported as very influential to clinician recommendations. Factors associated with routine recommendation of each screening method included clinician-perceived effectiveness of the method, clinician familiarity with the method, Medicare coverage, clinical capacity, and patient adherence.

Conclusion

Clinician education is needed to improve knowledge, familiarity, and experience with guideline-recommended screening methods with the goal of effectively engaging patients in informed decision making for CRC screening.

The Significant Predictors for Breast, Cervical, Colorectal, or Oral Cancer Screening Intention and Behavior in Taiwan

BACKGROUND

Cancer screening can improve outcomes in patients with cancer. Accordingly, under the direction of the National Health Insurance program, the Taiwan government conducts screenings for breast cancer, cervical cancer, oral cancer, and colorectal cancer.

OBJECTIVE

The aim of this study was to identify the primary predictors of cancer screening intention and behavior at 1 and 6 months after patients are provided information and an invitation by telephone to attend cancer screenings.

METHODS

In this prospective longitudinal study, 339 participants meeting the screening criteria were recruited. At baseline, telephone interviews were used to collect information on demographic characteristics, exercise and smoking habits, family cancer history, screening beliefs, and screening intention. Screening behavior was followed up at 1 and 6 months after the telephone interviews.

RESULTS

At baseline, 87.02% of the participants intended to undergo screening, and 31.86% and 63.42% had undergone screening after 1 and 6 months, respectively. The predictors of screening intention were awareness of the screening policy, willingness to learn about screening, and believing in the health benefits of screening. The predictor of screening behavior after 1 month was screening intention at baseline, and the predictors of behavior after 6 months were screening intention, marital status, and belief that cancer is a hereditary disease.

CONCLUSION

Adults with screening intention tended to undergo cancer screenings.

IMPLICATIONS FOR PRACTICE

The use of strategies based on screening intention, beliefs, and information can be used to improve participation in cancer screening in Taiwan.

Community Health Centers' Performance in Cancer Screening and Prevention

INTRODUCTION

Little is known about what clinic-level factors differentiate community health centers that achieve high performance on cancer-preventive care metrics. This study aims to describe the longitudinal trends in the delivery of 3 cancer-preventive care metrics (cervical and colorectal cancer screenings and tobacco-cessation intervention) and define and compare community health centers with high cancer-preventive care performance with those with low cancer-preventive care performance.

METHODS

This observational study used 2012-2019 community health center data (N=933) from the Uniform Data System. High/low performance was based on Healthy People 2020 targets and sample distribution. For each cancer-preventive care metric, the percentage of community health centers that met high (≥70.5% at cervical or colorectal cancer screening or >80% tobacco-cessation intervention) and low thresholds at 1, 2, and all the 3 screenings was estimated. Multivariable generalized estimating equations logistic regression modeling was used to assess the community health center‒level factors associated with screening performance.

RESULTS

The community health centers' performance for tobacco-cessation intervention remained at ≥80%, with a small increase over time. Performance for cervical cancer screening remained unchanged with about 50% of patients screened. Colorectal cancer screening performance increased from around 30% in 2012 to 44% in 2019. Very few community health centers reached high performance (3%) in all the 3 indicators, and 13% of community health centers were high in any 2 of the outcomes in 2019. Higher patient volume, a greater proportion of Hispanic patients, fewer uninsured patients, and community health centers located in the Northeast region were associated with high performance in 2019.

CONCLUSIONS

Very few community health centers meet all Healthy People 2020 goals in cancer screenings and may struggle to achieve the 2030 goals. Very few indicators differentiated high performers from low performers.

Factors associated with patients' decision on colorectal cancer screening

ABSTRACT

Cancer prevention and control are critical public health concerns. However, the screening uptake and referral rate for colorectal cancer (CRC) in Taiwan remain low. This study focused on the factors influencing whether a patient with a CRC diagnosis chooses to undergo referral follow-up.A cross-sectional research and used the Health Belief Model was method applied in this study. Variables such as demographic factors, CRC diagnosis-related knowledge factors, and health belief factors were employed to investigate the decisive factors that affect the health behavior of patients diagnosed with CRC who test positive on the fecal occult blood test. Study identified prospective participants in Daliao District, Kaohsiung City, Taiwan aged 50 to 75 years. A structured questionnaire was administered to the individuals, and 200 responded. The questionnaires of 100 who went for a referral group and 80 who did not a nonreferral group were analyzed. The questionnaire was reliable and valid, as determined through an expert evaluation and pretest, respectively.Among the 200 participants, T test indicated that those who underwent a referral were significantly more likely to be younger (Age [Mean ± SD] n: 62.7, 7.1%; Unreferred group: n: 65.1, 7.0%; Referred group: n:60.7, 6.6%; P ≤ .001), be more educated (P = .002), exercise more (P < .05), and have more family members with cancer (P = .001) or CRC (P < .05). Participants who underwent a referral also had significantly more knowledge (P < .001). Furthermore, those who underwent a referral had significantly perceived greater susceptibility (P < .05), greater benefits (P = .002), and lower barriers (P < .001) of screening; they also received greater encouragement to do so from sources (e.g., clinicians or the media) around them (P = .009).Age, education level, number of family members with cancer or CRC, exercise habits, knowledge of CRC, perceived susceptibility, perceived benefits, perceived barriers, and encouragement from others influence referral behavior. Government policy should focus on older patients and health education, especially in the mass media. Hospitals should also ensure the ease of referrals to lower perceived barriers.

Systematic Review of Interventions to Increase Stool Blood Colorectal Cancer Screening in African Americans

African Americans experience colorectal cancer (CRC) related disparities compared to other racial groups in the United States. African Americans are frequently diagnosed with CRC at a later stage, screening is underutilized, and mortality rates are highest in this group. This systematic review focused on intervention studies using stool blood CRC screening among African Americans in primary care and community settings. Given wide accessibility, low cost, and ease of dissemination of stool-based CRC screening tests, this review aims to determine effective interventions to improve participation rates. This systematic review included intervention studies published between January 1, 2000 and March 16, 2019. After reviewing an initial search of 650 studies, 11 studies were eventually included in this review. The included studies were studies conducted in community and clinical settings, using both inreach and outreach strategies to increase CRC screening. For each study, an unadjusted odds ratio (OR) for the CRC screening intervention compared to the control arm was calculated based on the data in each study to report effectiveness. The eleven studies together recruited a total of 3334 participants. The five studies using two-arm experimental designs ranged in effectiveness with ORs ranging from 1.1 to 13.0 using interventions such as mailed reminders, patient navigation, and tailored educational materials. Effective strategies to increase stool blood testing included mailed stool blood tests augmented by patient navigation, tailored educational materials, and follow-up calls or mailings to increase trust in the patient-provider relationship. More studies are needed on stool blood testing interventions to determine effectiveness in this population.

A Survey of Provider Attitudes, Beliefs, and Perceived Barriers Regarding a Centralized Direct-Mail Colorectal Cancer Screening Approach at Community Health Centers

Background: Colorectal cancer screening (CRC) rates are low, particularly among individuals with low socioeconomic status. Organized CRC screening programs have demonstrated success in increasing screening rates. Little is known about provider attitudes, beliefs, and practices related to CRC screening or how they are influenced by an organized CRC screening program. Methods: In 2014 and 2016, providers from 26 safety net clinics in Oregon and Northern California were invited to complete baseline and follow-up online surveys for the Strategies and Opportunities to Stop Colon Cancer in Priority Populations (STOP CRC) study. The provider survey link was sent electronically to primary care providers serving adult patients. Providers were sent reminders every 2 weeks via email to complete the survey, up to 3 reminders total. In this article, we describe learnings about provider attitudes, beliefs, and practices related to CRC screening after implementation of the STOP CRC program. Results: A total of 166 unique providers completed baseline and/or follow-up surveys, representing 228 responses. Main themes included (1) favorable shifts in attitude toward fecal immunochemical test (FIT) and direct-mail cancer screening programs, (2) changes in provider perception of key barriers, and (3) growing interest in centralized automated systems for identifying patients due for CRC screening and eligible for population-based outreach. Discussion: Providers are interested in improved information systems for identifying patients due for CRC screening and delivering population-based outreach (ie, to distribute FIT kits outside of the clinic visit) to help reduce health system- and patient-level barriers to screening. Trial Registration: National Clinical Trial (NCT) Identifier NCT01742065.

Geospatial analysis of the influence of family doctor on colorectal cancer screening adherence

BACKGROUND

Despite the well-recognised relevance of screening in colorectal cancer (CRC) control, adherence to screening is often suboptimal. Improving adherence represents an important public health strategy. We investigated the influence of family doctors (FDs) as determinant of CRC screening adherence by comparing each FDs practice participation probability to that of the residents in the same geographic areas using the whole population geocoded.

METHODS

We used multilevel logistic regression model to investigate factors associated with CRC screening adherence, among 333,843 people at their first screening invitation. Standardized Adherence Rates (SAR) by age, gender, and socioeconomic status were calculated comparing FDs practices to the residents in the same geographic areas using geocoded target population.

RESULTS

Screening adherence increased from 41.0% (95% CI, 40.8-41.2) in 2006-2008 to 44.7% (95% CI, 44.5-44.9) in 2011-2012. Males, the most deprived and foreign-born people showed low adherence. FD practices and the percentage of foreign-born people in a practice were significant clustering factors. SAR for 145 (21.4%) FDs practices differed significantly from people living in the same areas. Predicted probabilities of adherence were 31.7% and 49.0% for FDs with low and high adherence, respectively.

DISCUSSION

FDs showed a direct and independent effect to the CRC screening adherence of the people living in their practice. FDs with significantly high adherence level could be the key to adherence improvement.

IMPACT

Most deprived individuals and foreigners represent relevant targets for interventions in public health aimed to improve CRC screening adherence.

Formative Research on Knowledge and Preferences for Stool-based Tests compared to Colonoscopy: What Patients and Providers Think

The rates of colorectal cancer (CRC) screening in the U.S. remain below national targets, so many people at risk are not being screened. The objective of this qualitative research project was to assess patient and provider knowledge and preferences about CRC screening modalities and specifically the use of the fecal immunochemical test (FIT) as a first line screening choice. Nine focus groups were conducted with a medically underserved patient population and qualitative interviews were administered to their medical providers. Thematic analysis was used to synthesize key findings. Both providers and patients thought that the FIT would be a good option for CRC screening both as an individual choice and for an overall program approach. The test is less expensive and therefore more readily available for patients compared to colonoscopy. Overall, there was consensus that the FIT offers a reasonably priced, simple approach to CRC screening which has broad appeal to both providers and patients. Concerns identified by patients and providers included the possibility of false positives with the FIT which could be caused by test contamination or failing to perform the test properly. Patients also described feelings of disgust toward performing the FIT and difficulties in following the instructions. Study findings indicate provider and patient support for using the FIT for CRC screening at both the individual and system-wide levels of implementation. While barriers to the use of the FIT were listed, benefits of using the FIT were perceived as positive motivators to engage previously unscreened and uninsured or under-insured individuals in CRC screening.

Should Measures of Health Care Availability Be Based on the Providers or the Procedures? A Case Study with Implications for Rural Colorectal Cancer Disparities

PURPOSE

Patients with colorectal cancer (CRC) living in rural areas have lower survival rates than those in urban areas, potentially because of lack of access to quality CRC screening and treatment. The purpose of this study was to compare traditional physician density (ie, colonoscopy provider availability per capita) against a new physician density measure using an example case of colonoscopy volume and quality. The latter is particularly relevant for rural providers, who may have fewer patients and are more frequently nongastroenterologists.

METHODS

We conducted a secondary data analysis of the 2014 Medicare Provider Utilization and Payment Database and the National Cancer Institute State Cancer Profile Database. Volume-weighted physician density scores at the state and county levels were created, accounting for (1) the physician's annual colonoscopy volume and (2) whether the physician performs ≥100 procedures per year. We compared volume-weighted versus traditional density, overall and by rurality, and examined their correlation with CRC screening, incidence, and mortality rates.

FINDINGS

The difference between volume-weighted and traditional density scores was particularly large in rural parts of the West and Midwest, and it was most similar in the Northeast. Although weak, correlations with CRC outcomes were stronger for volume-weighted density, and they did not differ by rurality.

CONCLUSIONS

Our new method is an improvement over traditional methods because it considers the variation of physician procedure volume, and it has a stronger correlation with population health outcomes. Weighted density scores portray a more realistic picture of physician supply, particularly in rural areas.

Implementation successes and challenges in participating in a pragmatic study to improve colon cancer screening: perspectives of health center leaders

Little is known about the challenges faced by community clinics who must address clinical priorities first when participating in pragmatic studies. We report on implementation challenges faced by the eight community health centers that participated in Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC), a large comparative effectiveness cluster-randomized trial to evaluate a direct-mail program to increase the rate of colorectal cancer (CRC) screening. We conducted interviews, at the onset of implementation and 1 year later, with center leaders to identify challenges with implementing and sustaining an electronic medical record (EMR)-driven mailed program to increase CRC screening rates. We used the Consolidated Framework for Implementation Research to thematically analyze the content of meeting discussions and identify anticipated and experienced challenges. Common early concerns were patients' access to colonoscopy, patients' low awareness of CRC screening, time burden on clinic staff to carry out the STOP CRC program, inability to accurately identify eligible patients, and incompatibility of the program's approach with the patient population or organizational culture. Once the program was rolled out, time burden remained a primary concern and new organizational capacity and EMR issues were raised (e.g., EMR staffing resources and turnover in key leadership positions). Cited program successes were improved CRC screening processes and rates, more patients reached, reduced costs, and improved patient awareness, engagement, or satisfaction. These findings may inform any clinic considering mailed fecal testing programs and future pragmatic research efforts in community health centers.

Barriers to Colorectal Cancer Screening in a Primary Care Setting in Turkey

Colorectal cancer (CRC) is the third most common form of cancer in men worldwide and the second most common in women. The purpose of this study was to determine both barriers established by primary health care providers (PHCPs) and barriers perceived by them and to produce solutions for achieving the desired results. A four-part questionnaire was administered to family physicians (FPs) and family health personnels (FHPs) in Samsun, Turkey on 01-15 May, 2016. Sixty-six percent of PHCPs were contacted. Data were evaluated as numbers and percentages, and statistical significance was analyzed using the Chi square and t tests. 478 PHCPs participated; 49.4 % were FPs and 50.6 % FHPs. Of the participants, 86.6 % stated that they performed CRC screening on patients. The level of participants knowing that screening should start at age 50 and conclude at age 70 was 49.7 %. The level of subjects requesting the fecal occult blood test (FOBT) at the correct intervals was 29.7 %, but only 6.9 % recommended colonoscopy at the correct intervals. Additionally, 18.2 % of subjects knew that the test used is immunochemical FOBT, and 60.5 % reported not using reminders. PHCPs' low levels of knowledge, awareness and advice compatible with guidelines concerning CRC screening may represent an obstacle to such screening. Barriers perceived by PHCPs include patients' inability to access definite medical information, deficiencies in the reminder system and patients' lack of interest in CRC screening. Additions to the screening program will be useful in overcoming barriers.

Perceptions of colorectal cancer screening and recommendation behaviors among physicians in Korea

Background

Physician recommendations for colorectal cancer (CRC) screening have consistently been shown to be a strong predictor of screening. The aim of this study was to investigate perceptions of CRC screening modalities and recommendation behaviors among physicians in Korea.

Methods

A cross-sectional, nationally representative survey conducted between November 2013 and February 2014. In total, 379 physicians (241 primary care physicians and 138 physicians affiliated with the Korean Association for the Study of Intestinal Diseases responded to this survey (overall response rate of 31.4%).

Results

About 29% of all respondents “always” recommended and about 67% “sometimes” recommended CRC screening. Colonoscopy was perceived as an effective primary screening tool for CRC, and 80% of the physicians recommended colonoscopy for CRC screening. Only 7% recommended FOBT. In multivariate analysis, recommending FOBT was associated with stronger belief in the screening efficacy of FOBT (aOR 3.70, 95% CI 2.09, 6.57), weaker belief in the screening efficacy of colonoscopy (aOR 0.29, 95% CI 0.12, 0.69), and negative decisional balance for colonoscopy screening (aOR 0.82, 95% CI 0.71, 0.95).

Conclusions

Although FOBT is provided free-of-charge through a nationwide CRC screening program, colonoscopy was more commonly recommended and preferred by physicians.

Electronic supplementary material

The online version of this article (10.1186/s12885-017-3881-5) contains supplementary material, which is available to authorized users.

Colorectal cancer screening at US community health centers: Examination of sociodemographic disparities and association with patient-provider communication

BACKGROUND

Colorectal cancer (CRC) screening rates are low among underserved populations. High-quality patient-physician communication potentially influences patients' willingness to undergo CRC screening. Community health centers (HCs) provide comprehensive primary health care to underserved populations. This study's objectives were to ascertain national CRC screening rates and to explore the relations between sociodemographic characteristics and patient-provider communication on the receipt of CRC screening among HC patients.

METHODS

Using 2014 Health Center Patient Survey data, bivariate and multivariate analyses examined the association of sociodemographic variables (sex, race/ethnicity, age, geography, preferred language, household income, insurance, and employment status) and patient-provider communication with the receipt of CRC screening.

RESULTS

Patients between the ages of 65 and 75 years (adjusted odds ratio [aOR], 2.49; 95% confidence interval [CI], 1.33-4.64) and patients not in the labor force (aOR, 2.32; 95% CI, 1.37-3.94) had higher odds of receiving CRC screening, whereas patients who were uninsured (aOR, 0.33; 95% CI, 0.18-0.61) and patients who were non-English-speaking (aOR, 0.42; 95% CI, 0.18-0.99) had lower odds. Patient-provider communication was not associated with the receipt of CRC screening.

CONCLUSIONS

The CRC screening rate for HC patients was 57.9%, whereas the rate was 65.1% according to the 2012 Behavioral Risk Factor Surveillance System and 58.2% according to the 2013 National Health Interview Survey. The high ratings of patient-provider communication, regardless of the screening status, suggest strides toward a patient-centered medical home practice transformation that will assist in a positive patient experience. Addressing the lack of insurance, making culturally and linguistically appropriate patient education materials available, and training clinicians and care teams in cultural competency are critical for increasing future CRC screening rates. Cancer 2017;123:4185-4192. © 2017 American Cancer Society.