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Annor E, Atarere J, Ubah N, Akhiwu T, Orhurhu V, Abegunde AT. Impact of Primary Care Providers and Health Insurance Type on Colorectal Cancer Screening in the United States. Am J Gastroenterol 2024; 119:2134-2137. [PMID: 38775955 DOI: 10.14309/ajg.0000000000002809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/02/2024] [Indexed: 10/05/2024]
Abstract
INTRODUCTION Colorectal cancer (CRC) is a major cause of cancer deaths. We evaluated the effect of health insurance type and primary care provider (PCP) access on CRC screening. METHODS HINTS data were used to analyze CRC screening. RESULTS Individuals aged 50 to 65 years had comparable screening rates across all insurance types. Beyond 65 years, individuals with Medicare or Medicare with private insurance were more likely to undergo screening than private insurance users. PCP access increased CRC screening rates. Among PCP users, Medicare, income, and smoking status influenced screening. DISCUSSION Medicare and PCP access influence CRC screening. All individuals should be linked with PCPs.
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Affiliation(s)
- Eugene Annor
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, Illinois, USA
| | - Joseph Atarere
- Department of Medicine, MedStar Health, Baltimore, Maryland, USA
| | - Nneoma Ubah
- College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Ted Akhiwu
- Department of Medicine, MedStar Health, Baltimore, Maryland, USA
| | - Vwaire Orhurhu
- Department of Anesthesiology, University of Pittsburgh Medical Centre, Williamsport, Pennsylvania, USA
| | - Ayokunle T Abegunde
- Department of Gastroenterology and Nutrition, Loyola University Medical Center, Chicago, Illinois, USA
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Abdul Malik TF, Beh HC, Selvaraj CS, Mallen CD, Ng CJ, Lee YK. Interventions to promote colorectal cancer screening among people with a family history of colorectal cancer: A scoping review. Prev Med 2024; 189:108137. [PMID: 39277034 DOI: 10.1016/j.ypmed.2024.108137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 09/10/2024] [Accepted: 09/10/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND The global incidence of colorectal cancer (CRC) is rising, with people having a family history of CRC (PFH-CRC) facing double the risk compared to the average-risk population. Despite this, CRC screening uptake among PFH-CRC remains low. There is a lack of systematic mapping of interventions promoting CRC screening in this high-risk population. OBJECTIVE We conducted a scoping review to identify the types of interventions targeting PFH-CRC, their effectiveness in increasing CRC screening uptake, and the elements associated with the outcomes. METHODS The Joanna Briggs Institute methodology for scoping review was followed. The search for eligible articles was conducted from the inception of each database until 17 July 2024 in PubMed, EMBASE, CINAHL, Cochrane, PsycINFO and Web of Science with no restrictions on language. RESULTS Thirty studies from 1995 to 2023 across 13 countries were included; mostly from high-income countries. There was considerable variability in study design, intervention characteristics, and screening outcomes. Eleven studies used theoretical frameworks in intervention development. Fourteen studies reported statistically significant increases in screening uptake among PFH-CRC, most using complex, multiple-component interventions. Tailored print materials and patient navigation more consistently demonstrated increased screening uptake, while counselling yielded mixed results. CONCLUSION Interventions for promoting CRC screening uptake in PFH-CRC commonly incorporate print material, patient navigation and counselling, often combined into complex interventions. Future research should include more implementation studies to translate these interventions into real-world settings. Additionally, there are gaps in research from low- and middle-income countries, highlighting the need for further research in these resource-limited settings.
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Affiliation(s)
- Tun Firzara Abdul Malik
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Hooi Chin Beh
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Christine Shamala Selvaraj
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia.
| | | | - Chirk Jenn Ng
- Department of Research, SingHealth Polyclinics, Singapore 150167, Singapore; Duke-NUS Medical School, Singapore 169857, Singapore.
| | - Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia.
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Tsai MH, Bevel MS, Andrzejak SE, Moore JX. Receipt of follow-up care plans on colorectal cancer screening among breast, prostate, and lung cancer survivors. J Cancer Surviv 2024; 18:781-790. [PMID: 36574189 PMCID: PMC10293471 DOI: 10.1007/s11764-022-01309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/28/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Our study aimed to examine whether receipt of follow-up care plans is associated with greater guideline-concordant CRC screening stratified by breast, prostate, and lung cancer survivors. METHODS We used data from years 2016, 2018, and 2020 of the Behavioral Risk Factor Surveillance System on 3339 eligible treatment-utilizing cancer survivors with complete treatment. We performed descriptive statistics and multivariable logistic regression to examine the mentioned association. RESULTS We observed that 83.9% of breast and 88.2% of prostate cancer survivors with follow-care plans received CRC screening (p-value < 0.001). The lowest CRC screening use was observed among lung cancer (70.8%). In multivariable analysis, receipt of follow-up care plans was strongly associated with greater odds of receiving CRC screening in breast (OR, 2.67; 95% CI: 1.71-4.16) and prostate (OR, 3.81; 95% CI: 2.30-6.31) cancer survivors. Regardless of provider type, 84 to 88% reduced likelihood of receipt of CRC screening when they received follow-up care plans among lung cancer survivors. Among those without follow-up care plans, breast (OR, 0.29; 95% CI: 0.09-0.92) and lung (OR, 0.05; 95% CI: 0.01-0.25) cancer survivors who received care from general practices were less likely to receive CRC screening compared to those who received care from non-general practices. CONCLUSIONS Receipt of follow-up care plans was associated with greater CRC screening use in breast and prostate cancers. Lung cancer survivors demonstrated lower screening use despite receipt of follow-up care plans. IMPLICATION FOR CANCER SURVIVORS Patient and provider communication regarding CRC screening recommendation should be included in their follow-up care plans.
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Affiliation(s)
- Meng-Han Tsai
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA.
- Georgia Prevention Institute, Augusta University, 1457 Walton Way, Augusta, GA, 30901, USA.
| | - Malcolm S Bevel
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
| | - Sydney E Andrzejak
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
| | - Justin X Moore
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
- Institute of Public and Preventive Health, Augusta University, 1120 15Th Street, Augusta, GA, 30912, USA
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Atarere J, Chido-Amajuoyi O, Mensah B, Onyeaka H, Adewunmi C, Umoren M, Mele AA, Kanth P. Primary Care Telehealth Visits and Its Association with Provider Discussion on Colorectal Cancer Screening in the United States. Telemed J E Health 2024; 30:1325-1329. [PMID: 38265693 DOI: 10.1089/tmj.2023.0605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Background: Provider discussions about colorectal cancer (CRC) screening are the single most important predictor for CRC screening uptake. Methods: Using cross-sectional data from the 2022 Health Information National Trends Survey, we evaluated the relationship between telehealth use and provider discussion about CRC screening with a multivariable logistic regression model. Results: Of adults aged 45-75 years, 20.3% used telehealth services in the past year of which 69.5% had discussed CRC screening with their providers. There was no difference in provider discussion about CRC screening between telehealth users and nonusers (OR 1.26; 95% confidence interval 0.83-1.90). Conclusion: Telehealth is an important adjunct in health care delivery, enhancing patient-provider discussions about CRC screening.
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Affiliation(s)
- Joseph Atarere
- Department of Medicine, MedStar Health, Baltimore, Maryland, USA
| | - Onyema Chido-Amajuoyi
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Boniface Mensah
- Department of Medicine, MedStar Health, Baltimore, Maryland, USA
| | - Henry Onyeaka
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Comfort Adewunmi
- Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mfoniso Umoren
- Division of Gastroenterology, Georgetown University, Washington DC, USA
| | | | - Priyanka Kanth
- Division of Gastroenterology, Georgetown University, Washington DC, USA
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Nguyen D, Gilad O, Drogan CM, Eilers Z, Liao C, Kupfer SS. Risk perception and surveillance uptake in individuals at increased risk for pancreatic ductal adenocarcinoma. J Med Genet 2024; 61:270-275. [PMID: 37852748 DOI: 10.1136/jmg-2023-109539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Surveillance for pancreatic ductal adenocarcinoma (PDAC) is recommended for high-risk individuals with genetic variants in PDAC-associated genes and/or family history. Surveillance uptake and adherence may depend on the perception of PDAC risk and cancer worry. We aimed to determine PDAC risk perception in at-risk individuals and assess factors associated with PDAC surveillance uptake. METHODS At-risk individuals identified from a prospective academic registry were sent a survey electronically. PDAC risk perception, cancer worry and surveillance uptake were surveyed. Factors associated with increased risk perception and surveillance were assessed. Five-year PDAC risk was calculated using the PancPRO risk assessment model, and correlation with subjective risk assessment was assessed. RESULTS The overall survey response rate was 34% (279/816). The median perceived PDAC risk was twofold (IQR 1-4) above respondents' estimates of general population risk. Factors significantly associated with higher perceived PDAC risk included non-Hispanic white race, post-graduate education level, PDAC-affected first-degree relative, genetic variants and lack of personal cancer history. Cancer worry had a very weak correlation across PDAC risk estimates (r=0.16). No correlation between perceived PDAC risk and 5-year calculated PDAC risk was found. Older age, having a first-degree relative with PDAC, meeting with a medical provider about PDAC cancer risk and awareness of surveillance modalities were significant predictors of undergoing PDAC surveillance. CONCLUSIONS Individuals at risk for PDAC do not report risk perception that correlates with calculated risk. This presents an opportunity for counselling of at-risk patients to individualise management and improve surveillance uptake for eligible individuals.
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Affiliation(s)
- Denis Nguyen
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Ophir Gilad
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Christine M Drogan
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Zoe Eilers
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Chuanhong Liao
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Sonia S Kupfer
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois, USA
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Petrik AF, Johnson ES, Mummadi R, Slaughter M, Coronado GD, Lin SC, Savitz L, Wallace N. The use of individual and multilevel data in the development of a risk prediction model to predict patients' likelihood of completing colorectal cancer screening. Prev Med Rep 2023; 36:102366. [PMID: 37732019 PMCID: PMC10507149 DOI: 10.1016/j.pmedr.2023.102366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/22/2023] Open
Abstract
Promotion of colorectal cancer (CRC) screening can be expensive and unnecessary for many patients. The use of predictive analytics promises to help health systems target the right services to the right patients at the right time while improving population health. Multilevel data at the interpersonal, organizational, community, and policy levels, is rarely considered in clinical decision making but may be used to improve CRC screening risk prediction. We compared the effectiveness of a CRC screening risk prediction model that uses multilevel data with a more conventional model that uses only individual patient data. We used a retrospective cohort to ascertain the one-year occurrence of CRC screening. The cohort was determined from a Health Maintenance Organization, in Oregon. Eligible patients were 50-75 years old, health plan members for at least one year before their birthday in 2018 and were due for screening. We created a risk model using logistic regression first with data available in the electronic health record (EHR), and then added multilevel data. In a cohort of 59,249 patients, 36.1% completed CRC screening. The individual level model included 14 demographic, clinical and encounter based characteristics, had a bootstrap-corrected C-statistic of 0.722 and sufficient calibration. The multilevel model added 9 variables from clinical setting and community characteristics, and the bootstrap-corrected C-statistic remained the same with continued sufficient calibration. The predictive power of the CRC screening model did not improve after adding multilevel data. Our findings suggest that multilevel data added no improvement to the prediction of the likelihood of CRC screening.
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Affiliation(s)
- Amanda F. Petrik
- Kaiser Permanente Center for Health Research, Portland, OR, USA
- Northwest Permanente, Portland, OR, USA
| | - Eric S. Johnson
- Kaiser Permanente Center for Health Research, Portland, OR, USA
- Northwest Permanente, Portland, OR, USA
| | - Rajasekhara Mummadi
- Kaiser Permanente Center for Health Research, Portland, OR, USA
- Northwest Permanente, Portland, OR, USA
| | | | | | - Sunny C. Lin
- Oregon Health & Science University/Portland State University School of Public Health, Portland, OR, USA
- Washington University, St. Louis, MO, USA
| | - Lucy Savitz
- Kaiser Permanente Center for Health Research, Portland, OR, USA
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Neal Wallace
- Oregon Health & Science University/Portland State University School of Public Health, Portland, OR, USA
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Rogers CR, Korous KM, De Vera MA, Shaukat A, Brooks E, Rifelj KK, Henley C, Johnson W, Rogers TN. "It's Probably Just Hemorrhoids": A Qualitative Exploration of the Lived Experiences and Perceptions of Long-term Survivors of Early-Onset Colorectal Cancer. Cancer Epidemiol Biomarkers Prev 2023; 32:1617-1624. [PMID: 37619592 PMCID: PMC10873071 DOI: 10.1158/1055-9965.epi-23-0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/24/2023] [Accepted: 08/22/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Colorectal cancer among adults aged <50 years [early-onset colorectal cancer (EOCRC)] is projected to be the leading cause of cancer-related death by 2030. Although evidence-based guidelines for colorectal cancer screening now recommend beginning screening at age 45, the needs of many at-risk young adults are potentially being overlooked. Unanswered questions also remain regarding the effects of EOCRC on quality-of-life and psychosocial outcomes. This qualitative study explored the lived experiences and perceptions of a sample of adult EOCRC survivors in the United States through one-on-one interviews. METHODS An EOCRC advocate survivor team member led 27 structured virtual interviews using a 10-question interview guide. Data were analyzed using a 9-step inductive approach. RESULTS Participants were geographically diverse. Most were women (66.6%) who self-identified as non-Hispanic White (85.2%). The mean age at interview was 40.19 ± 5.99; at diagnosis, 33.93 ± 5.90. Six overarching themes emerged: signs and symptoms, risk factors, system-level factors, quality of life, social support, and reflection. CONCLUSIONS The specific needs of individuals in this younger population of patients with colorectal cancer should be considered during treatment and future interventions and throughout survivorship. IMPACT While the reasons for the increasing incidence of EOCRC are currently unknown, the lived experiences and perceptions of EOCRC survivors noted in this study highlight specific needs of this population that can inform educational materials, comprehensive care, future research, and policy change.
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Affiliation(s)
- Charles R. Rogers
- Medical College of Wisconsin, Institute for Health & Equity, Milwaukee, Wisconsin, United States of America
| | - Kevin M. Korous
- Medical College of Wisconsin, Institute for Health & Equity, Milwaukee, Wisconsin, United States of America
| | - Mary A. De Vera
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Aasma Shaukat
- New York University, Grossman School of Medicine, Department of Medicine, New York, New York, United States of America
| | - Ellen Brooks
- University of Utah School of Medicine, Department of Family & Preventive Medicine, Salt Lake City, Utah, United States of America
| | - Kelly Krupa Rifelj
- Medical College of Wisconsin, Institute for Health & Equity, Milwaukee, Wisconsin, United States of America
| | - Candace Henley
- The Blue Hat Foundation, Chicago, Illinois, United States of America
| | - Wenora Johnson
- Patient-Centered Outcomes Research Institute, Chicago, Illinois, United States of America
| | - Tiana N. Rogers
- University of Utah, Eccles School of Business, Sorenson Impact Center, Salt Lake City, Utah, United States of America
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Miller EA, Pinsky PF. Changes in uptake of stool-based colorectal cancer screening during the Covid-19 pandemic. Cancer Causes Control 2023; 34:887-895. [PMID: 37310565 DOI: 10.1007/s10552-023-01733-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE Colorectal cancer (CRC) screening is underutilized and endoscopic colon screening includes a number of barriers that were exacerbated by the Covid-19 pandemic. At-home stool-based screening (SBS) increased during the pandemic and potentially reached eligible adults hesitant to be screened by endoscopy. The purpose of this analysis was to examine the change in uptake of SBS during the pandemic among adults not screened within guidelines by endoscopy. METHODS We used data from the 2019 and 2021 National Health Interview Surveys to estimate uptake of SBS among adults aged 50-75 years, without a previous diagnosis of CRC and without guideline-concordant endoscopic screening. We also examined provider recommendations for screening tests. To examine if changes in uptake differed during the pandemic by demographic and health characteristics, we combined survey years and ran logistic regression models with an interaction term for each factor and survey year. RESULTS In our study population, SBS increased 74% overall from 2019 to 2021 (8.7% to 15.1%; p < 0.001), with the largest percent increase among those aged 50-52 years (3.5% to 9.9%; p < 0.001). Among those aged 50-52 years, the ratio of endoscopy to SBS changed from 83%/17% in 2019 to 55%/45% in 2021. Cologuard was the only screening test where recommendations by healthcare providers significantly increased from 2019 (10.6% to 16.1%; p = 0.002). CONCLUSIONS Use and recommendations for SBS increased substantially during the pandemic. Increased awareness among patients could potentially improve future CRC screening rates if uptake of SBS occurs among those unable or unwilling to be screened by endoscopy.
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Affiliation(s)
- Eric A Miller
- Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
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Cobb S, Ekwegh T, Adinkrah E, Ameli H, Dillard A, Kibe LW, Bazargan M. Examining colorectal cancer screening uptake and health provider recommendations among underserved middle aged and older African Americans. Health Promot Perspect 2022; 12:399-409. [PMID: 36852204 PMCID: PMC9958235 DOI: 10.34172/hpp.2022.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 02/22/2023] Open
Abstract
Background: The purpose of this study is to determine whether underserved middle-aged and older African Americans are receiving a colorectal cancer (CRC) screening test (sigmoidoscopy or colonoscopy) and if recommended by their provider. Additionally, we examined correlates of both provider recommendation and uptake of CRC screening. Methods: Seven hundred forty African American individuals, aged 55 and older, participated in this local community cross-sectional survey. We used a multivariate technique of logistic regression. Results: One out of three participants reported that they never received a sigmoidoscopy or colonoscopy for CRC screening. More than 31% indicted that their providers never suggested CRC testing. However, participants who indicated that their providers recommended sigmoidoscopy/colonoscopy were almost 49 times (odds ratio [OR]: 48.9, 95% confidence interval [CI]: 29.5-81.2) more likely to obtain it compared to their counterparts who were not advised to have these procedures. Our data suggest that African American men were significantly less likely than women to receive recommendations from their providers (OR: 0.70, 95% CI: 0.50-0.91). Furthermore, controlling for other variables, the following factors: 1) living arrangement (OR: 1.44, 95% CI: 1.02-2.04), 2) health maintenance organization (HMO) membership (OR: 1.84, 95% CI: 1.28-2.67), 3) number of providers (OR: 1.15, 95% CI: 1.01-1.32), 4) satisfaction with access to and quality of care (OR: 1.24, 95% CI: 1.03-1.51), 5) depressive symptoms (OR: 0.92, 95% CI: 0.86-0.98), and 6) gastrointestinal conditions (OR: 1.73, 95% CI: 1.16-2.58) were associated with obtaining a sigmoidoscopy or colonoscopy test. Conclusion: Our findings suggest that the absence of a provider recommendation is the primary barrier preventing underserved older African Americans from obtaining CRC screening. In addition, our data revealed significant association between obtaining CRC screening and some of the predisposing characteristics of participants, satisfaction with access to and quality of care, and physical and mental health. These findings are consistent with this notion that disparities in health care for African Americans can be traced back to four primary factors: patients, healthcare providers, the healthcare system, and society as a whole, and emphasize the need for establishing theory-driven, culturally-sensitive, and cost-effective CRC screening interventions that recognize and address the constraints to cancer screening experienced by this segment of population.
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Affiliation(s)
- Sharon Cobb
- Mervyn M. Dymally School of Nursing, Charles R. Drew University of Medicine and Science (CDU), CA, USA
| | - Tavonia Ekwegh
- Mervyn M. Dymally School of Nursing, Charles R. Drew University of Medicine and Science (CDU), CA, USA
| | - Edward Adinkrah
- Department of Public Health, College of Science & Health, CDU, CA, USA
| | | | - Attallah Dillard
- Mervyn M. Dymally School of Nursing, Charles R. Drew University of Medicine and Science (CDU), CA, USA
| | - Lucy W. Kibe
- Physician Assistant Program, College of Science & Health, CDU, CA, USA
| | - Mohsen Bazargan
- Department of Family Medicine, College of Medicine, CDU, CA, USA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, CA, USA
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Korous KM, Farr DE, Brooks E, Tuuhetaufa F, Rogers CR. Economic Pressure and Intention to Complete Colorectal Cancer Screening: A Cross-Sectional Analysis Among U.S. Men. Am J Mens Health 2022; 16:15579883221125571. [PMID: 36121251 PMCID: PMC9490476 DOI: 10.1177/15579883221125571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Although men's lives can be saved by colorectal cancer (CRC) screening, its utilization remains below national averages among men from low-income households. However, income has not been consistently linked to men's CRC screening intent. This study tested the hypothesis that men who perceive more economic pressure would have lower CRC screening intent. Cross-sectional data were collected via an online survey in February 2022. Men (aged 45-75 years) living in the U.S. (N = 499) reported their CRC screening intent (outcome) and their perception of their economic circumstances (predictors). Adjusted binary and ordinal logistic analyses were conducted. All analyses were conducted in March 2022. Men who perceived greater difficulty paying bills or affording the type of clothing or medical care they needed (i.e., economic strain) were less likely to have CRC screening intent (OR = 0.67, 95% CI: 0.49, 0.93). This association was no longer significant when prior screening behavior was accounted for (OR = 0.75, 95% CI: 0.52, 1.10). Contrary to our hypothesis, men who reported more financial cutbacks were more likely to report wanting to be screened for CRC within the next year (OR = 1.06, 95% CI: 1.01, 1.11). This is one of the first studies to demonstrate that men's perceptions of their economic circumstances play a role in their intent to complete early-detection screening for CRC. Future research should consider men's perceptions of their economic situation in addition to their annual income when aiming to close the gap between intent and CRC screening uptake.
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Affiliation(s)
- Kevin M. Korous
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA,Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA,Kevin M. Korous, Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Deeonna E. Farr
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - Ellen Brooks
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Fa Tuuhetaufa
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Charles R. Rogers
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA,Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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Shergill J, Makaroff KE, Lauzon M, Spiegel BM, Almario CV. Fecal immunochemical test (FIT) versus colonoscopy: Does knowing that a positive FIT requires a follow-up colonoscopy affect initial decision making in the US? Prev Med Rep 2022; 27:101825. [PMID: 35656227 PMCID: PMC9152796 DOI: 10.1016/j.pmedr.2022.101825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 12/09/2022] Open
Abstract
Although many people prefer fecal immunochemical test (FIT) over colonoscopy due to its noninvasive nature, it is unclear whether FIT would still be preferred for colorectal cancer (CRC) screening if they were explicitly informed that + FIT requires follow-up colonoscopy. To address this gap, we administered two conjoint analysis surveys-one that explained the need for a follow-up colonoscopy after + FIT while the other did not-to a US nationwide sample of Americans and then assessed whether there were differences in colonoscopy/FIT preferences between cohorts. We recruited adults ≥ 40yo who had not undergone CRC screening via an online survey research firm. We deployed two surveys that used conjoint analysis to assess decision making surrounding CRC screening tests: Survey 1 (4/2-4/15/2021)-did not inform participants that they need a colonoscopy following a + FIT; Survey 2 (4/29-6/2/2021)-informed respondents of the potential need. Using the conjoint analysis data, we determined the proportion of those who preferred FIT or colonoscopy and then used logistic regression to assess for differences in colonoscopy/FIT preferences between the cohorts. Overall, 501 and 1,000 individuals completed Survey 1 (without description of need for colonoscopy after + FIT) and Survey 2 (with description), respectively. There was no difference in test preference between cohorts after adjusting for covariates in the logistic regression (adjusted p = 0.09): Survey 1 (without description)-colonoscopy 28.5%, FIT 71.5%; Survey 2 (with description)-colonoscopy 26.7%, FIT 73.3%. Thus, knowledge that a + FIT requires a follow-up colonoscopy does not alter people's strong preference for non-invasive stool testing with FIT.
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Affiliation(s)
- Jaspreet Shergill
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Katherine E. Makaroff
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Marie Lauzon
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Cancer, Los Angeles, CA, USA
| | - Brennan M.R. Spiegel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Cancer Prevention & Control Program, Cedars-Sinai Cancer, Los Angeles, CA, USA
| | - Christopher V. Almario
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Cancer Prevention & Control Program, Cedars-Sinai Cancer, Los Angeles, CA, USA
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12
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Farr DE, Cofie LE, Brenner AT, Bell RA, Reuland DS. Sociodemographic correlates of colorectal cancer screening completion among women adherent to mammography screening guidelines by place of birth. BMC Womens Health 2022; 22:125. [PMID: 35449050 PMCID: PMC9022316 DOI: 10.1186/s12905-022-01694-1] [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: 09/29/2021] [Accepted: 03/31/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Colorectal cancer screening rates in the U.S. still fall short of national goals, while screening rates for other cancer sites, such as breast, remain high. Understanding characteristics associated with colorectal cancer screening among different groups of women adherent to breast cancer screening guidelines can shed light on the facilitators of colorectal cancer screening among those already engaged in cancer prevention behaviors. The purpose of this study was to explore which demographic characteristics, healthcare access factors, and cancer-related beliefs were associated with colorectal cancer screening completion among U.S. and foreign-born women adherent to mammography screening recommendations. METHODS Analyses of the 2015 National Health Interview Survey were conducted in 2019. A sample of 1206 women aged 50-74 who had a mammogram in the past 2 years and were of average risk for colorectal cancer was examined. Logistic regression was used to determine demographic, health service, and health belief characteristics associated with colorectal cancer screening completion. RESULTS Fifty-five percent of the sample were adherent to colorectal cancer screening recommendations. Women over the age of 65 (AOR = 1.76, 95% CI 1.06-2.91), with any type of health insurance, and who were bilingual (AOR = 3.84, 95% CI 1.83-8.09) were more likely to complete screening, while foreign-born women (AOR = 0.53, 95% CI 0.34-0.83) were less likely. Cancer-related beliefs did not influence adherence. Stratified analyses by nativity revealed additional associations. CONCLUSIONS Demographic and health service factors interact to influence colorectal cancer screening among women completing breast cancer screening. Colorectal cancer screening interventions targeting specific underserved groups and financing reforms may enhance women's colorectal cancer screening rates.
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Affiliation(s)
- Deeonna E Farr
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 2307 Carol G. Belk Building, Mail Stop 529, Greenville, NC, 27858, USA.
| | - Leslie E Cofie
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 2307 Carol G. Belk Building, Mail Stop 529, Greenville, NC, 27858, USA
| | - Alison T Brenner
- Department of Medicine, Department of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Ronny A Bell
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Daniel S Reuland
- Department of Medicine, Department of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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13
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Johnston FM, Yeo HL, Clark C, Stewart JH. Bias Issues in Colorectal Cancer Management: A Review. Ann Surg Oncol 2021; 29:2166-2173. [PMID: 34142287 DOI: 10.1245/s10434-021-10232-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/02/2021] [Indexed: 12/11/2022]
Abstract
Based on census data, over one-third of the US population identifies as a racial or ethnic minority. This group of racial and ethnic minorities is more likely to develop cancer and die from it when compared with the general population of the USA. These disparities are most pronounced in the African American community. Despite overall CRC rates decreasing nationally and within certain racial and ethnic minorities in the USA, there continue to be disparities in incidence and mortality when compared with non-Hispanic Whites. The disparities in CRC incidence and mortality are related to systematic racism and bias inherent in healthcare systems and society. Disparities in CRC management will continue to exist until specific interventions are implemented in the context of each racial and ethnic group. This review's primary aim is to highlight the disparities in CRC among African Americans in the USA. For surgeons, understanding these disparities is formative to creating change and improving the quality of care, centering equity for all patients.
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Affiliation(s)
- Fabian M Johnston
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
| | - Heather L Yeo
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Callisia Clark
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John H Stewart
- Department of Surgery, The University of Illinois at Chicago, Chicago, IL, USA.,University of Illinois Cancer Center, Chicago, IL, USA
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14
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Lam H, Quinn M, Cipriano-Steffens T, Jayaprakash M, Koebnick E, Randal F, Liebovitz D, Polite B, Kim K. Identifying actionable strategies: using Consolidated Framework for Implementation Research (CFIR)-informed interviews to evaluate the implementation of a multilevel intervention to improve colorectal cancer screening. Implement Sci Commun 2021; 2:57. [PMID: 34059156 PMCID: PMC8167995 DOI: 10.1186/s43058-021-00150-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/28/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Many evidence-based interventions (EBIs) found to be effective in research studies often fail to translate into meaningful patient outcomes in practice. The purpose of this study was to identify facilitators and barriers that affect the implementation of three EBIs to improve colorectal cancer (CRC) screening in an urban federally qualified health center (FQHC) and offer actionable recommendations to improve future implementation efforts. METHODS We conducted 16 semi-structured interviews guided by the Consolidation Framework for Implementation Research (CFIR) to describe diverse stakeholders' implementation experience. The interviews were conducted in the participant's clinic, audio-taped, and professionally transcribed for analysis. RESULTS We used the five CFIR domains and 39 constructs and subconstructs as a coding template to conduct a template analysis. Based on experiences with the implementation of three EBIs, stakeholders described barriers and facilitators related to the intervention characteristics, outer setting, and inner setting. Implementation barriers included (1) perceived burden and provider fatigue with EHR (Electronic Health Record) provider reminders, (2) unreliable and ineffectual EHR provider reminders, (3) challenges to providing health care services to diverse patient populations, (4) lack of awareness about CRC screening among patients, (5) absence of CRC screening goals, (6) poor communication on goals and performance, and (7) absence of printed materials for frontline implementers to educate patients. Implementation facilitators included (1) quarterly provider assessment and feedback reports provided real-time data to motivate change, (2) integration with workflow processes, (3) pressure from funding requirement to report quality measures, (4) peer pressure to achieve high performance, and (5) a culture of teamwork and patient-centered mentality. CONCLUSIONS The CFIR can be used to conduct a post-implementation formative evaluation to identify barriers and facilitators that influenced the implementation. Furthermore, the CFIR can provide a template to organize research data and synthesize findings. With its clear terminology and meta-theoretical framework, the CFIR has the potential to promote knowledge-building for implementation. By identifying the contextual determinants, we can then determine implementation strategies to facilitate adoption and move EBIs to daily practice.
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Affiliation(s)
- Helen Lam
- Center for Asian Health Equity, University of Chicago, 5841 S Maryland Ave, Rm S406, MC 1140, Chicago, IL, 60637, USA.
| | - Michael Quinn
- Department of Internal Medicine Section of General Internal Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Toni Cipriano-Steffens
- University of Chicago Medicine, 5841 S. Maryland Ave, MC 2115, Suite G109, Chicago, IL, 60637, USA
| | - Manasi Jayaprakash
- Center for Asian Health Equity, University of Chicago, 5841 S Maryland Ave, Rm S406, MC 1140, Chicago, IL, 60637, USA
| | - Emily Koebnick
- Center for Asian Health Equity, University of Chicago, 5841 S Maryland Ave, Rm S406, MC 1140, Chicago, IL, 60637, USA
| | - Fornessa Randal
- Center for Asian Health Equity, University of Chicago, 5841 S Maryland Ave, Rm S406, MC 1140, Chicago, IL, 60637, USA
| | - David Liebovitz
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL, 60611, USA
| | - Blasé Polite
- University of Chicago Medicine Hematology and Oncology, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Karen Kim
- Center for Asian Health Equity, University of Chicago, 5841 S Maryland Ave, Rm S406, MC 1140, Chicago, IL, 60637, USA
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15
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Zhao L, Zhang X, Chen Y, Wang Y, Zhang W, Lu W. Does self-reported symptom questionnaire play a role in nonadherence to colonoscopy for risk-increased population in the Tianjin colorectal cancer screening programme? BMC Gastroenterol 2021; 21:117. [PMID: 33750307 PMCID: PMC7944887 DOI: 10.1186/s12876-021-01701-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 02/28/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A colorectal cancer screening programme (CCSP) was implemented from 2012 to 2017 in Tianjin, China. Residents with a positive faecal immunochemical test (FIT) or positive self-reported symptom questionnaire (SRSQ) were recommended to undergo colonoscopy. The objective was to investigate the potential factors associated with nonadherence to colonoscopy among a risk-increased population. METHODS Data were obtained from the CCSP database, and 199,522 residents with positive FIT or positive SRSQ during two screening rounds (2012-2017) were included in the analysis. Logistic regression analysis was performed to assess the association between nonadherence to colonoscopy and potential predictors. RESULTS A total of 152,870 (76.6%) individuals did not undergo colonoscopy after positive FIT or positive SRSQ. Residents with positive SRSQ but without positive FIT were more likely not to undergo colonoscopy (negative FIT: OR, 2.35; 95% CI, 2.29-2.41, no FIT: OR, 1.27; 95% CI, 1.24-1.31). Patients without a cancer history were less likely to undergo colonoscopy even if they received risk-increased reports based on the SRSQ. CONCLUSION In the CCSP, seventy-seven percent of the risk-increased population did not undergo colonoscopy. FIT should be recommended since positive FIT results are related to improved adherence to colonoscopy. Residents with negative FIT but positive SRSQ should be informed of the potential cancer risk to ensure adherence to colonoscopy.
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Affiliation(s)
- Lizhong Zhao
- Department of Gastroenterology, Tianjin Union Medical Center, Tianjin, China
| | - Xiaorui Zhang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Yongjie Chen
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Yuan Wang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Weihua Zhang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.
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16
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Alyabsi M, Meza J, Islam KMM, Soliman A, Watanabe-Galloway S. Colorectal Cancer Screening Uptake: Differences Between Rural and Urban Privately-Insured Population. Front Public Health 2020; 8:532950. [PMID: 33330301 PMCID: PMC7710856 DOI: 10.3389/fpubh.2020.532950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022] Open
Abstract
Earlier studies investigated rural-urban colorectal cancer (CRC) screening disparities among older adults or used surveys. The objective was to compare screening uptake between rural and urban individuals 50–64 years of age using private health insurance. Data were analyzed from 58,774 Blue Cross Blue Shield of Nebraska beneficiaries. Logistic regression was used to assess the association between rural-urban and CRC screening use. Results indicate that rural individuals were 56% more likely to use the Fecal Occult Blood Test (FOBT) compared with urban residents, but rural females were 68% less likely to use FOBT. Individuals with few Primary Care Physician (PCP) visits and rural-women are the least to receive screening. To enhance CRC screening, a policy should be devised for the training and placement of female PCP in rural areas. In particular, multilevel interventions, including education, more resources, and policies to increase uptake of colorectal cancer screening, are needed. Further research is warranted to investigate barriers to CRC screening in rural areas.
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Affiliation(s)
- Mesnad Alyabsi
- Population Health Research Section, King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Jane Meza
- Department of Biostatistics, Nebraska Medical Center, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - K M Monirul Islam
- Department of Epidemiology, Nebraska Medical Center, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Amr Soliman
- Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, United States
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, Nebraska Medical Center, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
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17
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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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18
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Chawla K, Kibreab A, Scott V, Lee EL, Aduli F, Brim H, Ashktorab H, Howell CD, Laiyemo AO. Association of Patients' Perception of Quality of Healthcare Received and Colorectal Cancer Screening Uptake: An Analysis of 2 National Surveys in the USA. Med Princ Pract 2020; 30:331-338. [PMID: 33049736 PMCID: PMC8436667 DOI: 10.1159/000512233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE It is not known whether patients' ratings of the quality of healthcare services they receive truly correlate with the quality of care from their providers. Understanding this association can potentiate improvement in healthcare delivery. We evaluated the association between patients' ratings of the quality of healthcare services received and uptake of colorectal cancer (CRC) screening. SUBJECTS AND METHODS We used 2 iterations of the Health Information National Trends Survey (HINTS) of adults in the USA. HINTS 2007 (4,007 respondents; weighted population = 75,397,128) evaluated whether respondents were up to date with CRC screening while HINTS 4 cycle 3 (1,562 respondents; weighted population = 76,628,000) evaluated whether participants had ever received CRC screening in the past. All included respondents from both surveys were at least 50 years of age, had no history of CRC, and had rated the quality of healthcare services that they had received at their healthcare provider's office in the previous 12 months. RESULTS HINTS 2007 data showed that respondents who rated their healthcare as good or fair/poor were significantly less likely to be up to date with CRC screening compared to those who rated their healthcare as excellent. We found comparable results from analysis of HINTS 4 cycle 3 data with poorer uptake of CRC screening as the healthcare quality ratings of respondents reduced. CONCLUSION Our study suggests that patients who reported receiving lower quality of healthcare services were less likely to have undergone and be compliant with CRC screening recommendations. It is important to pay close attention to patient feedback surveys in order to improve healthcare delivery.
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Affiliation(s)
- Karan Chawla
- Department of Medicine, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Angesom Kibreab
- Department of Medicine, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Victor Scott
- Department of Medicine, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Edward L. Lee
- Department of Pathology, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Farshad Aduli
- Department of Medicine, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Hassan Brim
- Department of Pathology, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Hassan Ashktorab
- Department of Medicine, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Charles D. Howell
- Department of Medicine, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Adeyinka O. Laiyemo
- Department of Medicine, Howard University College of Medicine, Washington, District of Columbia, USA
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White PM, Itzkowitz SH. Barriers Driving Racial Disparities in Colorectal Cancer Screening in African Americans. Curr Gastroenterol Rep 2020; 22:41. [PMID: 32647903 DOI: 10.1007/s11894-020-00776-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Colorectal cancer screening has been shown to decrease mortality from colorectal cancer. Screening disparities continue to exist among ethnic minorities, particularly for African Americans. We herein review the barriers of colorectal cancer screening in this population. RECENT FINDINGS At its foundation are patient barriers, which are further compounded by physician-related barriers and the idiosyncrasies of the healthcare system. Interventions to address the barriers include patient outreach, provider education, and healthcare legislation addressing financial barriers. Recent research has focused on factors predicting intentions to undergo colorectal cancer screening. Underlying all of the barriers is the systemic racism that affects and influences the healthcare system as much as all other institutions and contributes to inequities in the delivery of effective cancer prevention efforts. Perpetual disparities in CRC screening within the African American community are due to multifactorial barriers from the individual patient to provider and healthcare system and societal influences. An awareness of the behavioral and systemic factors that affect African Americans must underpin efforts to reach full equity in delivering CRC screening to this often medically underserved segment of our society.
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Affiliation(s)
- Pascale M White
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box 1069, New York, NY, 10029, USA
| | - Steven H Itzkowitz
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box 1069, New York, NY, 10029, USA.
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20
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Goldshore MA, Mehta SJ, Fletcher W, Tzanis G, Doubeni CA, Paulson EC. An RCT of Fecal Immunochemical Test Colorectal Cancer Screening in Veterans Without Recent Primary Care. Am J Prev Med 2020; 59:41-48. [PMID: 32564804 PMCID: PMC7388415 DOI: 10.1016/j.amepre.2020.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The use of screening can prevent death from colorectal cancer, yet people without regular healthcare visits may not realize the benefits of this preventive intervention. The objective of this study was to determine the effectiveness of a mailed screening invitation or mailed fecal immunochemical test in increasing colorectal cancer screening uptake in veterans without recent primary care encounters. STUDY DESIGN Three-arm pragmatic randomized trial. SETTING/PARTICIPANTS Participants were screening-eligible veterans aged 50-75 years, without a recent primary care visit who accessed medical services at the Corporal Michael J. Crescenz Veteran Affairs Medical Center between January 1, 2017, and July 31, 2017. All data were analyzed from March 1, 2018, to July 31, 2018. INTERVENTION Participants were randomized to (1) usual opportunistic screening during a healthcare visit (n=260), (2) mailed invitation to screen and reminder phone calls (n=261), or (3) mailed fecal immunochemical test outreach plus reminder calls (n=61). MAIN OUTCOME MEASURES The main outcome under investigation was the completion of colorectal cancer screening within 6 months after randomization. RESULTS Of 782 participants in the trial, 53.9% were aged 60-75 years and 59.7% were African American. The screening rate was higher in the mailed fecal immunochemical test group (26.1%) compared with usual care (5.8%) (rate difference=20.3%, 95% CI=14.3%, 26.3%; RR=4.52, 95% CI=2.7, 7.7) or screening invitation (7.7%) (rate difference=18.4%, 95% CI=12.2%, 24.6%; RR=3.4, 95% CI=2.1, 5.4). Screening completion rates were similar between invitation and usual care (rate difference=1.9%, 95% CI= -2.4%, 6.2%; RR=1.3, 95% CI=0.7, 2.5). CONCLUSIONS Mailed fecal immunochemical test screening promotes colorectal cancer screening participation among veterans without a recent primary care encounter. Despite the addition of reminder calls, an invitation letter was no more effective in screening participation than screening during outpatient appointments. TRIAL REGISTRATION This study is registered at clinicaltrials.gov NCT02584998.
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Affiliation(s)
- Matthew A Goldshore
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Shivan J Mehta
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Woodrow Fletcher
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - George Tzanis
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Chyke A Doubeni
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota; Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
| | - E Carter Paulson
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Goding Sauer A, Siegel RL, Jemal A, Fedewa SA. Current Prevalence of Major Cancer Risk Factors and Screening Test Use in the United States: Disparities by Education and Race/Ethnicity. Cancer Epidemiol Biomarkers Prev 2020; 28:629-642. [PMID: 30944145 DOI: 10.1158/1055-9965.epi-18-1169] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/11/2019] [Accepted: 02/21/2019] [Indexed: 11/16/2022] Open
Abstract
Overall cancer death rates in the United States have declined since 1990. The decline could be accelerated by eliminating socioeconomic and racial disparities in major risk factors and screening utilization. We provide an updated review of the prevalence of modifiable cancer risk factors, screening, and vaccination for U.S. adults, focusing on differences by educational attainment and race/ethnicity. Individuals with lower educational attainment have higher prevalence of modifiable cancer risk factors and lower prevalence of screening versus their more educated counterparts. Smoking prevalence is 6-fold higher among males without a high school (HS) education than female college graduates. Nearly half of women without a college degree are obese versus about one third of college graduates. Over 50% of black and Hispanic women are obese compared with 38% of whites and 15% of Asians. Breast, cervical, and colorectal cancer screening utilization is 20% to 30% lower among those with <HS education compared with college graduates. Screening for breast, cervical, and colorectal cancers is also lower among Hispanics, Asians, and American Indians/Alaska Natives relative to whites and blacks. Enhanced, multilevel efforts are needed to further reduce the prevalence of modifiable risk factors and improve screening and vaccination, particularly among those with lower socioeconomic status and racial/ethnic minorities.
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Affiliation(s)
- Ann Goding Sauer
- Intramural Research Department, American Cancer Society, Atlanta, Georgia.
| | - Rebecca L Siegel
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
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22
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Sharma T. Analysis of the effectiveness of two noninvasive fecal tests used to screen for colorectal cancer in average-risk adults. Public Health 2020; 182:70-76. [PMID: 32179290 DOI: 10.1016/j.puhe.2020.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/16/2020] [Accepted: 01/30/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States. Although a significant proportion of CRC cases and deaths are preventable by screening, the morbidity and mortality from CRC remains high and is attributed to suboptimal screening rates. Low levels of population CRC screening uptake may be due to reluctance toward invasiveness of some screening tests, embarrassment, exposure to anesthesia, and grueling preparation, especially for the invasive screening tests. Noninvasive tests overcome many of these barriers because they are more convenient and potentially more attractive to patients compared to invasive tests. This study uses Markov cohort simulation model developed with the help of TreeAge pro software to compare two noninvasive fecal CRC screens, fecal immunohistochemical test (FIT) and multitarget stool DNA test (Mt-sDNA) with no screening in order to identify the more effective noninvasive fecal test to screen for colorectal cancer in average-risk adults. STUDY DESIGN Simulation study developed with Markov model using TreeAge pro software, which included a hypothetical cohort at the average risk of developing colorectal cancer. METHODS Markov model was used to compare population-level CRC-related cases and deaths averted, life-years gained (LYG), and colonoscopies required for two noninvasive CRC screening strategies compared with no screening: annual fecal immunohistochemical testing (FIT) and 3-yearly multitarget stool DNA testing (Mt-sDNA). The model simulated the natural history of the adenoma-carcinoma sequence in average-risk persons starting at age 50 years, and natural history parameters were estimated from the literature and via verification to data on precancerous lesions (i.e. adenomas) and CRC incidence. Screening strategies were then superimposed on the natural history component of the model, allowing for precancerous lesions to be detected and removed, or CRC to be detected and treated at a potentially earlier stage. The sensitivity and specificity for each screen for precancerous lesions and CRC were the performance parameters used to estimate the effectiveness. RESULTS Annual FIT was more effective than three yearly Mt-sDNA in reducing CRC cases, averting CRC-related deaths, and increasing the LYG compared to no screening. On average, annual FIT resulted in 3.5 fewer CRC cases, and 2.9 fewer CRC deaths per 1000 persons screened compared to 3-yearly Mt-sDNA. Annual FIT usage resulted in a 0.18 LYG compared to Mt-sDNA, which allowed 0.16 LYG, and an annual FIT screening led to a total of 203 more colonoscopies performed compared to Mt-sDNA. One-way sensitivity analysis conducted over the sensitivity rates of each screen by type of lesion showed that FIT remained the more effective strategy for all ranges of sensitivity. Threshold analysis results identified the lowest FIT sensitivity value at which Mt-sDNA performed better for conventional high-risk adenomas and CRC detection to be 0.16 and 0.052, respectively. CONCLUSION Both the noninvasive screens were effective compared to no screening. Additionally, annual FIT as a first step noninvasive screening test for CRC appears to be more effective compared to three-yearly Mt-sDNA.
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Affiliation(s)
- T Sharma
- Public Health Administration and Policy (PHAP Program), Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.
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Carethers JM, Doubeni CA. Causes of Socioeconomic Disparities in Colorectal Cancer and Intervention Framework and Strategies. Gastroenterology 2020; 158:354-367. [PMID: 31682851 PMCID: PMC6957741 DOI: 10.1053/j.gastro.2019.10.029] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 12/18/2022]
Abstract
Colorectal cancer (CRC) disproportionately affects people from low socioeconomic backgrounds and some racial minorities. Disparities in CRC incidence and outcomes might result from differences in exposure to risk factors such as unhealthy diet and sedentary lifestyle; limited access to risk-reducing behaviors such as chemoprevention, screening, and follow-up of abnormal test results; or lack of access to high-quality treatment resources. These factors operate at the individual, provider, health system, community, and policy levels to perpetuate CRC disparities. However, CRC disparities can be eliminated. Addressing the complex factors that contribute to development and progression of CRC with multicomponent, adaptive interventions, at multiple levels of the care continuum, can reduce gaps in mortality. These might be addressed with a combination of health care and community-based interventions and policy changes that promote healthy behaviors and ensure access to high-quality and effective measures for CRC prevention, diagnosis, and treatment. Improving resources and coordinating efforts in communities where people of low socioeconomic status live and work would increase access to evidence-based interventions. Research is also needed to understand the role and potential mechanisms by which factors in diet, intestinal microbiome, and/or inflammation contribute to differences in colorectal carcinogenesis. Studies of large cohorts with diverse populations are needed to identify epidemiologic and molecular factors that contribute to CRC development in different populations.
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Affiliation(s)
- John M Carethers
- Division of Gastroenterology, Department of Internal Medicine, Department of Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan.
| | - Chyke A Doubeni
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota; Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
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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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Alyabsi M, Charlton M, Meza J, Islam KMM, Soliman A, Watanabe-Galloway S. The impact of travel time on colorectal cancer stage at diagnosis in a privately insured population. BMC Health Serv Res 2019; 19:172. [PMID: 30885199 PMCID: PMC6423832 DOI: 10.1186/s12913-019-4004-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rural residents are less likely to receive screening for colorectal cancer (CRC) than urban residents. However, the mechanisms underlying this disparity, especially among people aged 50-64 years old with private health insurance, are not well understood. We examined the impact of travel time on stage at CRC diagnosis. METHODS This retrospective cohort study used data from the Blue Cross and Blue Shield of Nebraska. Members of this private insurance company aged 50-64 years, diagnosed with CRC during the period 2012-2016, and continuously enrolled in the insurance plan for at least 6 months prior to CRC diagnosis, were selected for this study. Using Google Maps, we estimated patients' travel time from their home ZIP code to the ZIP code of their colonoscopy provider. Using logistic regression, we analyzed the association between stage at CRC diagnosis, travel time, use of preventive services (i.e., check-ups or counseling to prevent or detect illness at an early stage) and patient characteristics. RESULTS A total of 307 subjects met the inclusion criteria. People who had not used preventive services 6 months prior to CRC diagnosis had 2.80 (95% CI, 1.00-7.90) times the odds of metastatic CRC compared to those who had used these services. No statistically significant association was found between travel time and metastatic CRC diagnosis (P = 0.99; 95% CI, 0.98-1.01). CONCLUSIONS The fact that 13% of the study population presented with metastatic CRC suggests some noncompliance with preventive services such as screening guidelines. To increase screening uptake and reduce metastatic cases, employers should offer incentives for their employees to make use of preventive services such as CRC screening.
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Affiliation(s)
- Mesnad Alyabsi
- Department of Population Health Research, King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences, P.O. Box 3660, Riyadh, 11481, 1515 Saudi Arabia
| | - Mary Charlton
- Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Iowa City, Iowa, 52242 USA
| | - Jane Meza
- Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, 984375 Nebraska Medical Center, Omaha, NE 68198–4395 USA
| | - K. M. Monirul Islam
- Department of Epidemiology, University of Nebraska Medical Center, College of Public Health, 984395 Nebraska Medical Center, Omaha, NE 68198–4395 USA
| | - Amr Soliman
- City University of New York School of Medicine, Community Health and Social Medicine, 160 Convent Avenue, New York, NY 10031 USA
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, University of Nebraska Medical Center, College of Public Health, 984395 Nebraska Medical Center, Omaha, NE 68198–4395 USA
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Adherence to colorectal cancer screening measured as the proportion of time covered. Gastrointest Endosc 2018; 88:323-331.e2. [PMID: 29477302 PMCID: PMC6050149 DOI: 10.1016/j.gie.2018.02.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/15/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Colorectal cancer (CRC) screening can reduce CRC incidence and mortality, but measuring screening adherence over time is challenging. We examined adherence using a novel measure characterizing the proportion of time covered (PTC) by screening tests. METHODS Eligible patients were age 50 to 60 years and followed at a large, safety-net health care system between January 2010 and September 2014. We estimated PTC as the number of days up to date with screening divided by the number of days from cohort entry until study end, CRC diagnosis, or death. We estimated mean and median PTC and used least-significant difference tests to assess differences in adherence by patient characteristics. RESULTS Of 18,257 patients, most were non-Hispanic black (40.5%) or Hispanic (34.9%) and/or female (62.4%). Approximately 40% (n = 7559) were never screened during the study period; the remaining 10,698 patients completed 19,105 screening examinations (14,481 fecal immunochemical tests [FITs], 4393 colonoscopies, 94 sigmoidoscopies, and 137 barium enemas). Overall, the mean PTC was 29.1% (95% confidence interval [CI], 28.6%-29.5%). Among those who completed at least one screening test (n = 10,698), the mean PTC was 49.0% (95% CI, 48.5%-49.5%). The most common reasons for non-adherence were lack of repeat FIT and no diagnostic colonoscopy after abnormal results for the FIT. The mean PTC increased with the number of primary care visits (0 visits, 21%; 1 visit, 29%; 2-3 visits, 35%; ≥4 visits, 37%; all P < .05). CONCLUSIONS PTC provides a reliable estimate of screening adherence, capturing breakdowns in the CRC screening process amenable to intervention. Repeat FIT and diagnostic colonoscopy are important intervention targets that may increase adherence in underserved populations.
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Intervention Mediators in a Randomized Controlled Trial to Increase Colonoscopy Uptake Among Individuals at Increased Risk of Familial Colorectal Cancer. Ann Behav Med 2018; 51:694-706. [PMID: 28236077 DOI: 10.1007/s12160-017-9893-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Understanding the pathways by which interventions achieve behavioral change is important for optimizing intervention strategies. PURPOSE We examined mediators of behavior change in a tailored-risk communication intervention that increased guideline-based colorectal cancer screening among individuals at increased familial risk. METHODS Participants at increased familial risk for colorectal cancer (N = 481) were randomized to one of two arms: (1) a remote, tailored-risk communication intervention (Tele-Cancer Risk Assessment and Evaluation (TeleCARE)) or (2) a mailed educational brochure intervention. RESULTS Structural equation modeling showed that participants in TeleCARE were more likely to get a colonoscopy. The effect was partially mediated through perceived threat (β = 0.12, p < 0.05), efficacy beliefs (β = 0.12, p < 0.05), emotions (β = 0.22, p < 0.001), and behavioral intentions (β = 0.24, p < 0.001). Model fit was very good: comparative fit index = 0.95, root-mean-square error of approximation = 0.05, and standardized root-mean-square residual = 0.08. CONCLUSION Evaluating mediating variables between an intervention (TeleCARE) and a primary outcome (colonoscopy) contributes to our understanding of underlying mechanisms that lead to health behavior change, thus leading to better informed and designed future interventions. TRIAL REGISTRATION NUMBER ClinicalTrials.gov , NCT01274143.
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Jih J, Nguyen MP, Ly I, Tsoh JY, Le GM, Woo K, Chan E, Gildengorin G, Stewart SL, Burke A, Pasick R, McPhee SJ, Nguyen TT. The Role of Physician Recommendation in Colorectal Cancer Screening Receipt Among Immigrant Chinese Americans. J Immigr Minor Health 2017; 20:1483-1489. [PMID: 29168060 DOI: 10.1007/s10903-017-0679-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Chinese Americans have low colorectal cancer (CRC) screening rates. It is unclear whether physicians should offer all CRC screening modalities (fecal occult blood test [FOBT], sigmoidoscopy, colonoscopy) to Chinese Americans to increase screening. Seven hundred and twenty-five Chinese Americans were asked in a survey if their physician had ever recommended CRC screening and to self-report receipt and type of CRC screening. Participants whose physician had recommended all CRC screening modalities were significantly more likely to report ever having screening (adjusted odds ratio 4.29, 95% CI 1.26-14.68) and being up-to-date (4.06, 95% CI 2.13-7.74) than those who reported that their physician only recommended FOBT. Participants who received a recommendation of only one type of screening did not report a significant difference in ever having or being up-to-date for screening. A potential strategy to increase CRC screening among Chinese Americans is for clinicians to recommend all available CRC screening modalities to each patient.
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Affiliation(s)
- Jane Jih
- Asian American Research Center on Health, San Francisco, CA, USA. .,Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA. .,Division of General Internal Medicine, University of California, San Francisco, 1545 Divisadero Street, P.O. Box 0320, San Francisco, CA, 94115, USA.
| | - Minh P Nguyen
- Asian American Research Center on Health, San Francisco, CA, USA
| | - Irene Ly
- Asian American Research Center on Health, San Francisco, CA, USA
| | - Janice Y Tsoh
- Asian American Research Center on Health, San Francisco, CA, USA.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Gem M Le
- Asian American Research Center on Health, San Francisco, CA, USA.,Division of General Internal Medicine, Zuckerberg San Francisco General Hospital/University of California, San Francisco, San Francisco, CA, USA
| | - Kent Woo
- NICOS Chinese Health Coalition, San Francisco, CA, USA
| | - Elaine Chan
- NICOS Chinese Health Coalition, San Francisco, CA, USA
| | - Ginny Gildengorin
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Susan L Stewart
- Division of Biostatistics, University of California, Davis, Davis, CA, USA
| | - Adam Burke
- Asian American Research Center on Health, San Francisco, CA, USA.,Department of Health Education, San Francisco State University, San Francisco, CA, USA
| | - Rena Pasick
- Asian American Research Center on Health, San Francisco, CA, USA.,Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Stephen J McPhee
- Asian American Research Center on Health, San Francisco, CA, USA.,Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Tung T Nguyen
- Asian American Research Center on Health, San Francisco, CA, USA.,Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
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Cheng SY, Li MC, Chia SL, Huang KC, Chiu TY, Chan DC, Chiu HM. Factors affecting compliance with confirmatory colonoscopy after a positive fecal immunochemical test in a national colorectal screening program. Cancer 2017; 124:907-915. [DOI: 10.1002/cncr.31145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/04/2017] [Accepted: 10/17/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital; National Taiwan University; Taipei Taiwan
| | - Ming-Chieh Li
- National Institute of Environmental Health Sciences; National Health Research Institutes; Miaoli Taiwan
| | - Shu-Li Chia
- Health Promotion Administration; Ministry of Health and Welfare; Taipei Taiwan
| | - Kuo-Chin Huang
- Department of Family Medicine, College of Medicine and Hospital; National Taiwan University; Taipei Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, College of Medicine and Hospital; National Taiwan University; Taipei Taiwan
| | - Ding-Cheng Chan
- Department of Internal Medicine, College of Medicine and Hospital; National Taiwan University; Taipei Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, College of Medicine and Hospital; National Taiwan University; Taipei Taiwan
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Kim SB. Unraveling the Determinants to Colorectal Cancer Screening Among Asian Americans: a Systematic Literature Review. J Racial Ethn Health Disparities 2017; 5:683-699. [PMID: 28779479 DOI: 10.1007/s40615-017-0413-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 11/26/2022]
Abstract
Colorectal cancer (CRC) is one of the top three cancers experienced among Asian American (AA) men and women. One effective way to decrease incidence and mortality from CRC is the adherence of regular CRC screening; however, AA continue to receive the lowest screening rates compared to other racial/ethnic groups. When disaggregating this heterogeneous population, further disparities exist between subgroups. Examination of facilitators and barriers to cancer screening among AA subgroups is fairly recent and the synthesis of this information is limited. As such, a systematic review was conducted examining the facilitators and the barriers among Chinese, Filipino, Korean, and Japanese Americans using a systematic literature review method. The Health Belief Model served as the primary theoretical framework for this study and used to organize and synthesize the facilitators and barriers to CRC screening. In total, 22 articles yielded 29 examinations of each of the AA subgroups. Different facilitators and barriers to screening uptake for each subgroup were revealed; however, consistent across all the subgroups was physician recommendation as a facilitator and participants' unawareness of screening tests and those stating having no problems/symptoms of CRC as a barrier across screening modalities. Tailored approach in outreach and intervention efforts are suggested when achieving to improve CRC screening in AA ethnic subgroups.
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Affiliation(s)
- Sophia B Kim
- University of Hawaii at Manoa, Myron B. Thompson School of Social Work, 2430 Campus Road, Gartley Hall, Honolulu, HI, 96822, USA.
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Keating NL, James O’Malley A, Onnela JP, Landon BE. Assessing the impact of colonoscopy complications on use of colonoscopy among primary care physicians and other connected physicians: an observational study of older Americans. BMJ Open 2017; 7:e014239. [PMID: 28645954 PMCID: PMC5623374 DOI: 10.1136/bmjopen-2016-014239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Psychological biases can distort treatment decision-making. The availability heuristic is one such bias, wherein events that are recent, vivid or easily imagined are readily 'available' to memory and are therefore judged more likely to occur than expected based on epidemiological data. We assessed if the occurrence of a serious colonoscopy complication for a primary care physician's patient influenced colonoscopy rates for the physician's other patients. DESIGN Longitudinal study with time-varying exposure variables. SETTING/PARTICIPANTS Individuals living in 51 hospital referral regions across the USA identified based on enrolment in fee-for-service Medicare during 2005-2010. We assigned patients to a primary care physician based on office visits during the prior 2 years. EXPOSURES For each physician in each month, we calculated the proportion of patients assigned to them who had a colonoscopy. We identified two serious complications of which the primary care provider would very likely be aware: gastrointestinal bleed or perforation leading to hospitalisation or death within 14 days of colonoscopy. MAIN OUTCOME MEASURES We employed Poisson regression models including physician fixed effects to assess the change in number of colonoscopies in the four quarters following an adverse colonoscopy event. RESULTS We identified 5 360 191 patients assigned to 30 704 physicians. 4864 physicians (16%) had at least one patient with an adverse event. The estimated change in the quarterly number of colonoscopies among physicians' patients was significantly lower in quarter 2 following an adverse colonoscopy event (change=-2.1% (95% CI -3.4 to -0.8%)), before returning to the rate expected in the absence of an adverse event. CONCLUSIONS Having a patient experience a serious adverse colonoscopy event was associated with a small and temporary decline in colonoscopy rates among a physician's other patients. This finding provides empirical evidence for the influence of notable adverse events on care, possibly due to the availability heuristic.
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Affiliation(s)
- Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - A James O’Malley
- The Department of Biomedical Data Science, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, Massachusetts, USA
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard T.H Chan School of Public Health, Boston, Massachusetts, USA
| | - Bruce E Landon
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Do Primary Care Provider Strategies Improve Patient Participation in Colorectal Cancer Screening? Am J Gastroenterol 2017; 112:622-632. [PMID: 28244494 DOI: 10.1038/ajg.2017.4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/06/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Screening rates for colorectal cancer (CRC) remain suboptimal. The impact of provider strategies to enhance screening participation in the population is uncertain. The objective of this study was to determine the effect of provider strategies to increase screening in a single-payer system. METHODS A population-based survey was conducted in primary care providers (PCPs) linked to patients using administrative data in Ontario, Canada. Patients were due for CRC screening from April 2012 to March 2013. Patients were followed up until 31 March 2014. We determined time to become up-to-date with CRC screening. Cox proportional hazards models examined the association between PCP strategies and uptake of screening, adjusted for physician and patient factors. RESULTS A total of 717 PCPs and their 147,834 rostered patients due for CRC screening were included. Most physicians employed strategies to enhance screening participation, including electronic medical record use, reminders, generation of lists, audit and feedback reports, or designating staff responsible for screening. No single strategy was strongly associated with screening. For those >1 year overdue, a systematic approach to generate lists of patients overdue for screening was weakly associated with screening uptake (hazard ratio (HR)=1.14, 95% CI: 1.03-1.26, P=0.04 >5 years overdue vs. <1 year overdue). The use of multiple PCP strategies was associated with screening participation (HR=1.27, 95% CI: 1.16-1.39, P<0.0001 for PCPs using 4-5 vs. 0-1 strategies). Practice-based strategies were self-reported. CONCLUSIONS In practice, while individual PCP strategies have little effect, the use of multiple strategies to enhance screening appears to improve CRC screening uptake in patients.
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Peterson EB, Ostroff JS, DuHamel KN, D'Agostino TA, Hernandez M, Canzona MR, Bylund CL. Impact of provider-patient communication on cancer screening adherence: A systematic review. Prev Med 2016; 93:96-105. [PMID: 27687535 PMCID: PMC5518612 DOI: 10.1016/j.ypmed.2016.09.034] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 09/17/2016] [Accepted: 09/25/2016] [Indexed: 12/18/2022]
Abstract
Cancer screening is critical for early detection and a lack of screening is associated with late-stage diagnosis and lower survival rates. The goal of this review was to analyze studies that focused on the role of provider-patient communication in screening behavior for cervical, breast, and colorectal cancer. A comprehensive search was conducted in four online databases between 1992 and 2016. Studies were included when the provider being studied was a primary care provider and the communication was face-to-face. The search resulted in 3252 records for review and 35 articles were included in the review. Studies were divided into three categories: studies comparing recommendation status to screening compliance; studies examining the relationship between communication quality and screening behavior; and intervention studies that used provider communication to improve screening behavior. There is overwhelming evidence that provider recommendation significantly improves screening rates. Studies examining quality of communication are heterogeneous in method, operationalization and results, but suggest giving information and shared decision making had a significant relationship with screening behavior. Intervention studies were similarly heterogeneous and showed positive results of communication interventions on screening behavior. Overall, results suggest that provider recommendation is necessary but not sufficient for optimal adherence to cancer screening guidelines. Quality studies suggest that provider-patient communication is more nuanced than just a simple recommendation. Discussions surrounding the recommendation may have an important bearing on a person's decision to get screened. Research needs to move beyond studies examining recommendations and adherence and focus more on the relationship between communication quality and screening adherence.
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Affiliation(s)
- Emily B Peterson
- George Mason University, 4400 University Drive, MSN 3D6, Fairfax, VA 22031, United States.
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Katherine N DuHamel
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Thomas A D'Agostino
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Marisol Hernandez
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Mollie R Canzona
- Wake Forest University, P.O. Box 7347, Winston-Salem, NC 27109, United States; Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, United States
| | - Carma L Bylund
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States; Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar
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Pathirana IN, Albert DM, Young PE, Womeldorph CM. Colorectal Cancer Screening: a North American Point of View. CURRENT COLORECTAL CANCER REPORTS 2016; 12:241-250. [DOI: 10.1007/s11888-016-0330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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35
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Ruzek SB, Bass SB, Greener J, Wolak C, Gordon TF. Randomized Trial of a Computerized Touch Screen Decision Aid to Increase Acceptance of Colonoscopy Screening in an African American Population with Limited Literacy. HEALTH COMMUNICATION 2016; 31:1291-1300. [PMID: 26940369 PMCID: PMC5310267 DOI: 10.1080/10410236.2015.1069165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The goal of this study was to assess the effectiveness of a touch screen decision aid to increase acceptance of colonoscopy screening among African American patients with low literacy, developed and tailored using perceptual mapping methods grounded in Illness Self-Regulation and Information-Communication Theories. The pilot randomized controlled trial investigated the effects of a theory-based intervention on patients' acceptance of screening, including their perceptions of educational value, feelings about colonoscopy, likelihood to undergo screening, and decisional conflict about colonoscopy screening. Sixty-one African American patients with low literacy, aged 50-70 years, with no history of colonoscopy, were randomly assigned to receive a computerized touch screen decision aid (CDA; n = 33) or a literacy appropriate print tool (PT; n = 28) immediately before a primary care appointment in an urban, university-affiliated general internal medicine clinic. Patients rated the CDA significantly higher than the PT on all indicators of acceptance, including the helpfulness of the information for making a screening decision, and reported positive feelings about colonoscopy, greater likelihood to be screened, and lower decisional conflict. Results showed that a touch screen decision tool is acceptable to African American patients with low iteracy and, by increasing intent to screen, may increase rates of colonoscopy screening.
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Sanders M, Fiscella K, Veazie P, Dolan JG, Jerant A. Does patient time spent viewing computer-tailored colorectal cancer screening materials predict patient-reported discussion of screening with providers? HEALTH EDUCATION RESEARCH 2016; 31:555-562. [PMID: 27343254 PMCID: PMC4945861 DOI: 10.1093/her/cyw032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 05/18/2016] [Indexed: 06/06/2023]
Abstract
The main aim is to examine whether patients' viewing time on information about colorectal cancer (CRC) screening before a primary care physician (PCP) visit is associated with discussion of screening options during the visit. We analyzed data from a multi-center randomized controlled trial of a tailored interactive multimedia computer program (IMCP) to activate patients to undergo CRC screening, deployed in primary care offices immediately before a visit. We employed usage time information stored in the IMCP to examine the association of patient time spent using the program with patient-reported discussion of screening during the visit, adjusting for previous CRC screening recommendation and reading speed.On average, patients spent 33 minutes on the program. In adjusted analyses, 30 minutes spent using the program was associated with a 41% increase in the odds of the patient having a discussion with their PCP (1.04, 1.59, 95% CI). In a separate analysis of the tailoring modules; the modules encouraging adherence to the tailored screening recommendation and discussion with the patient's PCP yielded significant results. Other predictors of screening discussion included better self-reported physical health and increased patient activation. Time spent on the program predicted greater patient-physician discussion of screening during a linked visit.Usage time information gathered automatically by IMCPs offers promise for objectively assessing patient engagement around a topic and predicting likelihood of discussion between patients and their clinician.
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Affiliation(s)
- Mechelle Sanders
- Departments of Family Medicine and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin Fiscella
- Departments of Family Medicine and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Peter Veazie
- Department of Public Health Science, University of Rochester Medical Center, Rochester, NY, USA
| | - James G Dolan
- Department of Public Health Science, University of Rochester Medical Center, Rochester, NY, USA
| | - Anthony Jerant
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
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Adegboyega A, Hatcher J. Factors Influencing Pap Screening Use Among African Immigrant Women. J Transcult Nurs 2016; 28:479-487. [PMID: 27470266 DOI: 10.1177/1043659616661612] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Papanicolau (Pap) screenings disparities exist for immigrant women in the United States. This study sought to have an understanding of factors influencing Pap screening among sub-Saharan African immigrant women. METHOD This is a qualitative descriptive study. Women were recruited from the community and by word of mouth following institutional review board approval. Data were gathered through in-depth focus group and demographic questionnaires. Interview sessions were digitally recorded and transcribed verbatim. Transcripts were analyzed for themes. FINDINGS Twenty-two women aged 24 to 65 years were interviewed. Barriers to screening included low knowledge of screening, cost, cultural beliefs, fear and communication issues. Motivators to improve Pap use include provider's recommendations, enlightenment, and family support. DISCUSSION Interventions addressing the barriers peculiar to this population may alleviate these barriers and improve Pap screening use in this population. Providers have the opportunity to influence screening attitudes of African-born women by providing awareness and patient-targeted interventions.
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Abstract
Colorectal cancer (CRC) is the second leading cause of cancer death. CRC screening with a fecal immunochemical test (FIT) is important as occult blood may be detected. To offer Iowa Research Network members in family physician offices the opportunity to provide FITs at no charge to patients in need and determine how many of the tests would be handed out to patients and how many would be returned to the office. Eight family physician offices agreed to participate and 50 two-day FITs were provided, potentially providing 400 patients a CRC screening test. One hundred and eighty (45%) of the 400 FITs were handed out to patients. Of the 92 (51%) patients who returned at least one card, 77 (84%) had negative results, 13 (14%) were positive, and 2 (2 %) were indeterminate. Of 13 patients with a positive result, 11 (85%) had a follow-up colonoscopy. Providing 400 FITs at no charge to the offices was an expensive endeavor. Implementing this forced a change in office routine and the type of fecal occult blood test used. Less than half of the FITs were given out to patients and of those given out, about half of the patients returned a FIT. For those who returned FITs and had positive findings, 85% followed-up with a colonoscopy. Office nurses implementing the CRC screening need to be included in the planning of the type of fecal occult blood test used and receptive to the project.
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Hagoel L, Feder-Bubis P. Mind the cancer screening gap between medical rationale and laypersons' reasoning. J Intern Med 2016; 279:563-5. [PMID: 26748535 DOI: 10.1111/joim.12472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L Hagoel
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - P Feder-Bubis
- Department of Health Systems Management, Faculty of Health Sciences & Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Schoenberg NE, Eddens K, Jonas A, Snell-Rood C, Studts CR, Broder-Oldach B, Katz ML. Colorectal cancer prevention: Perspectives of key players from social networks in a low-income rural US region. Int J Qual Stud Health Well-being 2016; 11:30396. [PMID: 26905402 PMCID: PMC4764956 DOI: 10.3402/qhw.v11.30396] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 12/26/2022] Open
Abstract
Social networks influence health behavior and health status. Within social networks, “key players” often influence those around them, particularly in traditionally underserved areas like the Appalachian region in the USA. From a total sample of 787 Appalachian residents, we identified and interviewed 10 key players in complex networks, asking them what comprises a key player, their role in their network and community, and ideas to overcome and increase colorectal cancer (CRC) screening. Key players emphasized their communication skills, resourcefulness, and special occupational and educational status in the community. Barriers to CRC screening included negative perceptions of the colonoscopy screening procedure, discomfort with the medical system, and misinformed perspectives on screening. Ideas to improve screening focused on increasing awareness of women's susceptibility to CRC, providing information on different screening tests, improving access, and the key role of health-care providers and key players themselves. We provide recommendations to leverage these vital community resources.
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Affiliation(s)
- Nancy E Schoenberg
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA;
| | - Kathryn Eddens
- Department of Health Behavior, University of Kentucky, Lexington, KY, USA
| | - Adam Jonas
- Gatton School of Business and Economics, University of Kentucky, Lexington, KY, USA
| | - Claire Snell-Rood
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Christina R Studts
- Department of Health Behavior, University of Kentucky, Lexington, KY, USA
| | | | - Mira L Katz
- College of Public Health, The Ohio State University, Columbus, OH, USA
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Green BB, Anderson ML, Chubak J, Fuller S, Meenan RT, Vernon SW. Impact of continued mailed fecal tests in the patient-centered medical home: Year 3 of the Systems of Support to Increase Colon Cancer Screening and Follow-Up randomized trial. Cancer 2015; 122:312-21. [PMID: 26488332 DOI: 10.1002/cncr.29734] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/21/2015] [Accepted: 09/15/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND The current study was conducted to determine the effect of continuing a centralized fecal occult blood test (FOBT) mailed program on screening adherence. METHODS A patient-level randomized controlled trial was conducted in 21 patient-centered medical home primary care clinics between January 2010 and November 2012. A total of 2208 patients ranging in age from 52 to 75 years in a substudy of the Systems of Support to Increase Colon Cancer Screening and Follow-Up (SOS) trial were randomized at year 3 to continued automated interventions (Continued group), which included mailed information regarding colorectal cancer (CRC) screening choices, and were mailed stool kit tests or to a group in which interventions were stopped (Stopped group). The main outcomes and measures were the completion of CRC screening in year 3 and by subgroup characteristics, respectively. RESULTS Adherence to CRC screening in year 3 was found to be significantly higher in patients in the Continued group compared with those in the Stopped group (53.3% vs 37.3%; adjusted net difference, 15.6% [P<.001]). This difference was entirely due to greater completion of FOBT (adjusted net difference, 18.0% [P<.001]). Year 3 CRC screening rates were highest in patients in the Continued group completing FOBT in both years 1 and 2 (77.2%), followed by patients completing only 1 FOBT in 1 of the 2 years (44.6%), with low rates of CRC testing reported among patients not completing any FOBT within the first 2 years (18.1%). CONCLUSIONS A centralized mailed FOBT CRC screening program continued to be more effective than patient-centered medical home usual-care interventions, but only for those patients who had previously completed FOBT testing. Research is needed regarding how to engage patients not completing CRC testing after being mailed at least 2 rounds of FOBT tests. Cancer 2016;122:312-321. © 2015 American Cancer Society.
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Affiliation(s)
- Beverly B Green
- Group Health Permanente, Seattle, Washington.,Group Health Research Institute, Seattle, Washington.,Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington
| | | | - Jessica Chubak
- Group Health Research Institute, Seattle, Washington.,University of Washington School of Public Health, Seattle, Washington
| | - Sharon Fuller
- Group Health Research Institute, Seattle, Washington
| | - Richard T Meenan
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Sally W Vernon
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
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Wang A, Shaukat A, Acosta RD, Bruining DH, Chandrasekhara V, Chathadi KV, Eloubeidi MA, Fanelli RD, Faulx AL, Fonkalsrud L, Gurudu SR, Kelsey LR, Khashab MA, Kothari S, Lightdale JR, Muthusamy VR, Pasha S, Saltzman JR, Yang J, Cash BD, DeWitt JM. Race and ethnicity considerations in GI endoscopy. Gastrointest Endosc 2015; 82:593-9. [PMID: 26260384 DOI: 10.1016/j.gie.2015.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/05/2015] [Indexed: 02/08/2023]
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Fedewa SA, Ma J, Sauer AG, Siegel RL, Smith RA, Wender RC, Doroshenk MK, Brawley OW, Ward EM, Jemal A. How many individuals will need to be screened to increase colorectal cancer screening prevalence to 80% by 2018? Cancer 2015; 121:4258-65. [PMID: 26308967 DOI: 10.1002/cncr.29659] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND A recent study estimates that 277,000 colorectal cancer (CRC) cases and 203,000 CRC deaths will be averted between 2013 and 2030 if the National Colorectal Cancer Roundtable goal of increasing CRC screening prevalence to 80% by 2018 is reached. However, the number of individuals who need to be screened (NNS) to achieve this goal is unknown. In this communication, the authors estimate the NNS to achieve 80% by 2018 nationwide and by state. METHODS The authors estimated the NNS by subtracting adults aged 50 to 75 years who would need to be screened to achieve an 80% CRC screening prevalence from the number who are currently guideline-compliant from population estimates for this age group. The 2013 National Health Interview Survey and the 2012 Behavioral Risk Factor Surveillance System were used to estimate CRC screening prevalence and data from the US Census Bureau were used to estimate population projections. The NNS were age-standardized and sex-standardized. RESULTS Nationwide, 24.39 million individuals (95% confidence interval, 24.37-24.41 million) aged 50 to 75 years will need to be screened to achieve 80% by 2018. By state, the NNS ranged from 45,400 in Vermont to 2.72 million in California. The majority of individuals who need to be screened are aged 50 to 64 years and the largest subgroup is privately insured. CONCLUSIONS The authors estimated that at least 24.4 million additional individuals in the United States will need to be screened to achieve the National Colorectal Cancer Roundtable goal of increasing CRC screening prevalence to 80% by 2018. To reach this goal, improving facilitators of CRC screening, including physician recommendation and patient awareness, is needed.
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Affiliation(s)
- Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.,Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Jiemin Ma
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Robert A Smith
- Cancer Control Science, American Cancer Society, Atlanta, Georgia
| | - Richard C Wender
- Cancer Control Science, American Cancer Society, Atlanta, Georgia
| | - Mary K Doroshenk
- Cancer Control Science, American Cancer Society, Atlanta, Georgia
| | - Otis W Brawley
- Office of the Chief Medical Officer, American Cancer Society, Atlanta, Georgia
| | - Elizabeth M Ward
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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Ojinnaka CO, Bolin JN, McClellan DA, Helduser JW, Nash P, Ory MG. The role of health literacy and communication habits on previous colorectal cancer screening among low-income and uninsured patients. Prev Med Rep 2015; 2:158-63. [PMID: 26844065 PMCID: PMC4721377 DOI: 10.1016/j.pmedr.2015.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To determine the association between health literacy, communication habits and colorectal cancer (CRC) screening among low-income patients. Methods Survey responses of patients who received financial assistance for colonoscopy between 2011 and 2014 at a family medicine residency clinic were analyzed using multivariate logistic regression (n = 456). There were two dependent variables: (1) previous CRC screening and (2) CRC screening adherence. Our independent variables of interest were health literacy and communication habits. Results Over two-thirds (67.13%) of respondents had not been previously screened for CRC. Multivariate analysis showed a decreased likelihood of previous CRC screening among those who had marginal (OR = 0.52; 95% CI = 0.29–0.92) or inadequate health literacy (OR = 0.49; 95% CI = 0.27–0.87) compared to those with adequate health literacy. Controlling for health literacy, the significant association between educational attainment and previous CRC screening was eliminated. Thus, health literacy mediated the relationship between educational attainment and previous CRC screening. There was no significant association between communication habits and previous CRC screening. There was no significant association between screening guideline adherence, and health literacy or communication. Conclusion Limited health literacy is a potential barrier to CRC screening. Suboptimal CRC screening rates reported among those with lower educational attainment may be mediated by limited health literacy. Lower educational attainment was associated with no prior colorectal cancer (CRC) screening. Inadequate health literacy was associated with not having a prior CRC screening. Health literacy eliminated the association between education and previous CRC screening. Health literacy level had no association with adhering to CRC screening guidelines. Patients' communication habits had no association with prior colorectal cancer screening.
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Affiliation(s)
- Chinedum O Ojinnaka
- Department of Health Policy and Management, Texas A&M Health Science Center School of Public Health, College Station, TX 77843-1266, USA
| | - Jane N Bolin
- Department of Health Policy and Management, Texas A&M Health Science Center School of Public Health, College Station, TX 77843-1266, USA
| | - David A McClellan
- Department of Family and Community Medicine, College of Medicine, Texas A&M Physicians Family Medicine Residency, Texas A&M Health Science Center, 2900 E.29TH Street, Bryan, TX 77803, USA; Texas A&M Physicians Family Residency, Texas A&M Health Science Center, 2900 E.29 Street, Bryan, TX 77803, USA
| | - Janet W Helduser
- Department of Health Policy and Management, Texas A&M Health Science Center School of Public Health, College Station, TX 77843-1266, USA
| | - Philip Nash
- Texas A&M Physicians Family Residency, Texas A&M Health Science Center, 2900 E.29 Street, Bryan, TX 77803, USA
| | - Marcia G Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Public Health, College Station, TX 77843-1266, USA
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Morales AL, Magulick JP, Womeldorph C, Young PE. Colonoscopy for Colorectal Cancer Screening: Current Challenges and Future Directions. CURRENT COLORECTAL CANCER REPORTS 2015. [DOI: 10.1007/s11888-014-0257-y] [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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