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Skinner CS, Gupta S, Halm EA, Wright S, McCallister K, Bishop W, Santini N, Mayorga C, Agrawal D, Moran B, Sanders JM, Singal AG. Development of the Parkland-UT Southwestern Colonoscopy Reporting System (CoRS) for evidence-based colon cancer surveillance recommendations. J Am Med Inform Assoc 2015; 23:402-6. [PMID: 26254481 DOI: 10.1093/jamia/ocv081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/21/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Through colonoscopy, polyps can be identified and removed to reduce colorectal cancer incidence and mortality. Appropriate use of surveillance colonoscopy, post polypectomy, is a focus of healthcare reform. MATERIALS AND METHODS The authors developed and implemented the first electronic medical record-based colonoscopy reporting system (CoRS) that matches endoscopic findings with guideline-consistent surveillance recommendations and generates tailored results and recommendation letters for patients and providers. RESULTS In its first year, CoRS was used in 98.6% of indicated cases. Via a survey, colonoscopists agreed/strongly agreed it is easy to use (83%), provides guideline-based recommendations (89%), improves quality of Spanish letters (94%), they would recommend it for other institutions (78%), and it made their work easier (61%), and led to improved practice (56%). DISCUSSION CoRS' widespread adoption and acceptance likely resulted from stakeholder engagement throughout the development and implementation process. CONCLUSION CoRS is well-accepted by clinicians and provides guideline-based recommendations and results communications to patients and providers.
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Affiliation(s)
- Celette Sugg Skinner
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Samir Gupta
- Veterans Affairs San Diego Healthcare System, Division of Gastroenterology, Department of Internal Medicine, and the Moores Cancer Center, University of California San Diego, USA
| | - Ethan A Halm
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA Parkland Health & Hospital System, Dallas, TX, USA
| | - Shaun Wright
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Katharine McCallister
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Wendy Bishop
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Noel Santini
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA Parkland Health & Hospital System, Dallas, TX, USA
| | - Christian Mayorga
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA Parkland Health & Hospital System, Dallas, TX, USA
| | - Deepak Agrawal
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA Parkland Health & Hospital System, Dallas, TX, USA
| | - Brett Moran
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA Parkland Health & Hospital System, Dallas, TX, USA
| | - Joanne M Sanders
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Amit G Singal
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA Parkland Health & Hospital System, Dallas, TX, USA
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Dodou D, de Winter JCF. Agreement between self-reported and registered colorectal cancer screening: a meta-analysis. Eur J Cancer Care (Engl) 2014; 24:286-98. [PMID: 24754544 DOI: 10.1111/ecc.12204] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2014] [Indexed: 12/29/2022]
Abstract
This random-effects meta-analysis investigates the accuracy of self-reported colorectal cancer screening history as a function of screening mode (colonoscopy, flexible sigmoidoscopy, faecal occult blood testing - FOBT, double-contrast barium enema - DCBE) and survey mode (written, telephone, face-to-face). Summary estimates of sensitivity, specificity, positive predictive value (PPV) and area under the receiver operating characteristic curve (AUC) were calculated. Medical record data were used as reference. We included 23 studies comprising 11,592 subjects. Colonoscopy yielded higher AUC [0.948, 95% confidence interval (CI) = 0.918, 0.968] than flexible sigmoidoscopy (0.883, 95% CI = 0.849, 0.911) and FOBT (0.869, 95% CI = 0.833, 0.898). Colonoscopy showed the highest sensitivity (0.888, 95% CI = 0.835, 0.931), whereas specificity was comparable between screening modes (ranging from 0.802 for FOBT to 0.904 for DCBE). AUC was not significantly different between survey modes. Prevalence of screening history correlated positively with sensitivity and negatively with specificity, possibly because of errors in the medical records. In conclusion, the accuracy of self-reported cancer screening is generally moderate, and higher for colonoscopy than for sigmoidoscopy and FOBT.
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Affiliation(s)
- D Dodou
- Department of BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands
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Reiter PL, Katz ML, Oliveri JM, Young GS, Llanos AA, Paskett ED. Validation of self-reported colorectal cancer screening behaviors among Appalachian residents. Public Health Nurs 2013; 30:312-22. [PMID: 23808856 PMCID: PMC3809100 DOI: 10.1111/phn.12038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We determined the validity of self-reported colorectal cancer (CRC) screening data provided by Appalachian Ohio residents and identified correlates of providing accurate data. DESIGN AND SAMPLE We conducted cross-sectional telephone interviews between September 2009 and April 2010. Our study included Appalachian Ohio residents (n = 721) ages 51-75 years. MEASURES We compared self-reported CRC screening data to medical records to determine validity. Multivariable logistic regression was used to identify correlates of providing accurate self-reported screening data. RESULTS About 68% of participants self-reported having any CRC screening test within recommended guidelines, whereas medical records indicated that only 49% were within guidelines (concordance = 0.76). Concordance was higher for flexible sigmoidoscopy and fecal occult blood test compared with colonoscopy, although sensitivity and positive predictive value were much higher for colonoscopy. Participants overreported CRC screening behaviors for all tests. Participants who had a regular checkup in the last 2 years (OR = 2.78, 95% CI: 1.15-6.73), or who self-rated their health as good or better (OR = 1.88, 95% CI: 1.12-3.16) were more likely to provide accurate screening data. CONCLUSIONS Many participants failed to provide accurate CRC screening data, and validity varied greatly across individual CRC screening tests. Future CRC screening studies among Appalachian residents should use medical records, if possible, to determine screening histories.
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Affiliation(s)
- Paul L Reiter
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, Ohio 43201, USA.
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White A, Vernon SW, Eberth JM, Tiro JA, Coan SP, Abotchie PN, Greisinger A. Correlates of self-reported colorectal cancer screening accuracy in a multi-specialty medical group practice. ACTA ACUST UNITED AC 2013; 3:20-24. [PMID: 24027657 DOI: 10.4236/ojepi.2013.31004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE We assessed whether accuracy of self-reported screening for colorectal cancer (CRC) varied by respondent characteristics or healthcare utilization. METHODS From 2005 to 2007, 857 respondents aged 51 - 74 were recruited from a multi-specialty medical group practice to answer a questionnaire about their CRC screening (CRCS) behaviors. Self-reports were compared with administrative and medical records to assess concordance, sensitivity, specificity, and report-to-records ratios for overall CRCS (fecal occult blood test, sigmoidoscopy, and/or colonoscopy). RESULTS Concordance was good (≥0.8 to <0.9) or fair (≥0.7 to <0.8) for most subgroups; respondents with >5 visits outside the clinic had poor (<0.7) concordance. Sensitivity estimates were mostly excellent (≥0.9) or good but poor for respondents whose healthcare provider did not advise a specific CRCS test. Specificity was poor for the following respondents: 65+ years, males, college graduates, family history of CRC, >5 visits outside of the clinic, or whose healthcare provider advised a specific CRCS test. Respondents 65+ years and with >5 outside visits over-reported CRCS. CONCLUSIONS With few exceptions, self-reports of CRCS in an insured population is reasonably accurate across subgroups. More work is needed to replicate these findings in diverse settings and populations to better understand subgroup differences and improve measures of CRCS.
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Affiliation(s)
- Arica White
- School of Public Health, Division of Epidemiology, University of Texas Health Science Center, Houston, USA
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Palmer RC, Chhabra D, McKinney S. Colorectal Cancer Screening Adherence in African–American Men and Women 50 Years of Age and Older Living in Maryland. J Community Health 2010; 36:517-24. [DOI: 10.1007/s10900-010-9336-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Han MA, Choi KS, Jun JK, Kim Y, Park EC, Lee HY. Factors associated with the intention to have colorectal cancer screening in Korean adults. Eur J Cancer Care (Engl) 2010; 20:475-82. [PMID: 20646036 DOI: 10.1111/j.1365-2354.2010.01209.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to investigate the factors related to screening intention in a population-based screening programme for colorectal cancer. The data were taken from the 2008 Korean National Cancer Screening Survey. We conducted a nationwide survey with trained interviewers using a questionnaire. A total of 2038 participants agreed to answer the survey. There were 955 study subjects aged ≥ 50 years in the target age group for colorectal cancer screening. Colorectal cancer screening behaviour and demographic characteristics were collected to evaluate intention for colorectal cancer screening and related factors. Descriptive statistics and multiple logistic regression were used in the analysis. The lifetime screening rate was 50.4% (50.9% for men and 49.8% for women). The screening rate with recommendation was 39.7% (39.3% for men and 40.1% of women). The odds ratios of intention to be screened increased significantly in younger subjects and those screened with double-contrast barium enema or colonoscopy. 'Without any symptoms' was reported as the most frequent reason for non-attendance or no intention to be screened. Age and recent screening methods were important factors related to intention to be screened for colorectal cancer. Further research is needed to identify remaining barriers to screening.
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Affiliation(s)
- M A Han
- National Cancer Control Research Institute, National Cancer Centre, Goyang, Korea
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Predictors of colorectal cancer knowledge and screening among church-attending African Americans and Whites in the Deep South. J Community Health 2009; 34:90-7. [PMID: 18941876 DOI: 10.1007/s10900-008-9128-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined colorectal cancer (CRC) knowledge and the relationship between knowledge, risk factors and screening behaviors among African Americans and Whites in the Deep South. One hundred and twenty three African Americans and Whites age-eligible for CRC screening were interviewed by telephone survey as part of a church-based CRC educational intervention. CRC knowledge was lower among those with less education, unemployed, Medicaid, Medicare, and less family income. Generally, participants who had more CRC knowledge were more likely to have engaged in screening behaviors. Participants who had a family history of CRC were more likely to have had a fecal occult blood test (OR = 2.55, 0.99-6.60) or barium enema (OR = 3.84, 1.44-10.24) than those without. Whites were more likely to have had a flexible sigmoidoscopy (OR = 4.17, 1.09-16.67), colonoscopy (OR = 7.14, 1.72-25) or barium enema (OR = 6.25, 1.67-25) than African Americans. Church-based CRC screening intervention programs should target African Americans, those with no family history of CRC, and those with less education.
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Pignone M, Scott TL, Schild LA, Lewis C, Vázquez R, Glanz K. Yield of claims data and surveys for determining colon cancer screening among health plan members. Cancer Epidemiol Biomarkers Prev 2009; 18:726-31. [PMID: 19273480 DOI: 10.1158/1055-9965.epi-08-0751] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Screening can reduce incidence and mortality from colorectal cancer but has been underutilized. Efforts to increase screening depend on accurate data about screening status. We sought to evaluate the independent and combined yield of claims and direct survey for identifying colorectal cancer screening among average-risk health plan beneficiaries. Participants were Aetna members ages between 52 and 80 years from 32 primary care practices in Florida and Georgia participating in the Communicating Health Options through Information and Cancer Education study. Main outcomes were the proportion of average-risk patients who were up-to-date with colorectal cancer screening based on claims data and the estimated additional yield of survey data for patients with no evidence of screening in their claims history. Of 4,020 average-risk members identified, claims data indicated that 1,066 (27%) had recent colorectal cancer screening. Among the 1,269 average-risk members with no evidence of screening by claims data who returned surveys, 498 (39%) reported being up-to-date with screening. Combining claims data and survey data and accounting for survey nonresponse, we estimate that 47% to 59% of member patients were actually up-to-date with screening, an additional yield of 20 to 32 percentage points. We conclude that, among health plan members, the combination of claims data and survey information had substantially higher yield than claims data alone for identifying colorectal cancer screening.
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Affiliation(s)
- Michael Pignone
- University of North Carolina Division of General Internal Medicine and Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Burgess DJ, Powell AA, Griffin JM, Partin MR. Race and the validity of self-reported cancer screening behaviors: development of a conceptual model. Prev Med 2009; 48:99-107. [PMID: 19118570 DOI: 10.1016/j.ypmed.2008.11.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 11/19/2008] [Accepted: 11/24/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Many estimates of cancer screening are based on self-reported screening behavior. There is growing concern that self-reported screening measures may be less accurate among members of racial and ethnic minority groups. This would have considerable implications for research on racial and ethnic disparities in cancer screening. OBJECTIVES To review the literature on the relationship between race/ethnicity and the accuracy of self-reported cancer screening behavior and develop a conceptual framework that would provide a deeper understanding of factors underlying this relationship. METHODS We developed a conceptual framework drawing from diverse literatures including validation studies examining the accuracy of self-reported cancer screening behaviors and articles on survey response bias. RESULTS AND CONCLUSIONS Evidence suggests that racial and ethnic minorities may be less likely to provide accurate reports of their cancer screening behavior and that overreporting may be particularly problematic. Research conducted in other areas suggests that these sources of measurement error may stem from cognitive and motivational processes and that they can be moderated by question wording and data collection characteristics. At this point, however, the quality of the evidence is not strong and more research is needed before definitive conclusions can be drawn.
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Affiliation(s)
- Diana J Burgess
- Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, MN 55417, USA.
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Eisinger F, Cals L, Calazel-Benque A, Blay JY, Coscas Y, Dolbeault S, Namer M, Pivot X, Rixe O, Serin D, Roussel C, Morère JF. Impact of organised programs on colorectal cancer screening. BMC Cancer 2008; 8:104. [PMID: 18412950 PMCID: PMC2373301 DOI: 10.1186/1471-2407-8-104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Accepted: 04/15/2008] [Indexed: 11/14/2022] Open
Abstract
Purpose Colorectal cancer (CRC) screening has been shown to decrease CRC mortality. Organised mass screening programs are being implemented in France. Its perception in the general population and by general practitioners is not well known. Methods Two nationwide observational telephone surveys were conducted in early 2005. First among a representative sample of subjects living in France and aged between 50 and 74 years that covered both geographical departments with and without implemented screening services. Second among General Practionners (Gps). Descriptive and multiple logistic regression was carried out. Results Twenty-five percent of the persons(N = 1509) reported having undergone at least one CRC screening, 18% of the 600 interviewed GPs reported recommending a screening test for CRC systematically to their patients aged 50–74 years. The odds ratio (OR) of having undergone a screening test using FOBT was 3.91 (95% CI: 2.49–6.16) for those living in organised departments (referent group living in departments without organised screening), almost twice as high as impact educational level (OR = 2.03; 95% CI: 1.19–3.47). Conclusion CRC screening is improved in geographical departments where it is organised by health authorities. In France, an organised screening programs decrease inequalities for CRC screening.
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Affiliation(s)
- François Eisinger
- Paoli Calmettes Institute; INSERM UMR599 232 Bd, St Marguerite, 13009 Marseille, France.
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Rauscher GH, Johnson TP, Cho YI, Walk JA. Accuracy of self-reported cancer-screening histories: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2008; 17:748-57. [PMID: 18381468 DOI: 10.1158/1055-9965.epi-07-2629] [Citation(s) in RCA: 392] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Survey data used to study trends in cancer screening may overestimate screening utilization while potentially underestimating existing disparities in use. METHODS We did a literature review and meta-analysis of validation studies examining the accuracy of self-reported cancer-screening histories. We calculated summary random-effects estimates for sensitivity and specificity, separately for mammography, clinical breast exam (CBE), Pap smear, prostate-specific antigen testing (PSA), digital rectal exam, fecal occult blood testing, and colorectal endoscopy. RESULTS Sensitivity was highest for mammogram, CBE, and Pap smear (0.95, 0.94, and 0.93, respectively) and lowest for PSA and digital rectal exam histories (0.71 and 0.75). Specificity was highest for endoscopy, fecal occult blood testing, and PSA (0.90, 0.78, and 0.73, respectively) and lowest for CBE, Pap smear, and mammogram histories (0.26, 0.48, and 0.61, respectively). Sensitivity and specificity summary estimates tended to be lower in predominantly Black and Hispanic samples compared with predominantly White samples. When estimates of self-report accuracy from this meta-analysis were applied to cancer-screening prevalence estimates from the National Health Interview Survey, results suggested that prevalence estimates are artificially increased and disparities in prevalence are artificially decreased by inaccurate self-reports. CONCLUSIONS National survey data are overestimating cancer-screening utilization for several common procedures and may be masking disparities in screening due to racial/ethnic differences in reporting accuracy.
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Affiliation(s)
- Garth H Rauscher
- School of Public Health, Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Schenck AP, Klabunde CN, Warren JL, Peacock S, Davis WW, Hawley ST, Pignone M, Ransohoff DF. Evaluation of claims, medical records, and self-report for measuring fecal occult blood testing among medicare enrollees in fee for service. Cancer Epidemiol Biomarkers Prev 2008; 17:799-804. [PMID: 18381471 DOI: 10.1158/1055-9965.epi-07-2620] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is no agreement on the best data source for measuring colorectal cancer (CRC) screening. Medicare claims have been used to measure CRC testing but the validity of using claims to measure fecal occult blood tests (FOBT) has not been established. METHODS We compared ascertainment of FOBT among three data sources: self-reports, Medicare claims, and medical records. Data were collected on FOBT use during the study window (1/1/1998 - 12/31/2002). Our study was conducted with North Carolina Medicare enrollees (N = 561) who had previously responded to a telephone survey on CRC tests. FOBT information was abstracted from respondents' physician office medical records and compared with self-reported FOBT use and Medicare claims for FOBT. Data sources were assessed for accuracy and completeness of FOBT reporting using sensitivity, specificity, positive predictive value, negative predictive value, and agreement. RESULTS Reporting of FOBT use in the prior year in medical records and Medicare claims agreed 82% of the time [95% confidence interval (95% CI), 79-85%]. FOBT 1-year use rates from self-report agreed with test use found in medical records 70% of the time (95% CI, 66-74%). The lowest agreement was between self-reported 1-year FOBT use and Medicare claims, which agreed 67% of the time (95% CI, 63-71%). CONCLUSIONS No data source could be established as providing complete and valid information about FOBT use among Medicare enrollees, showing the difficulty of ascertaining test use rates for noninvasive, low-cost procedures conducted in multiple settings. Caution should be used when attempting to measure FOBT use with self-report, Medicare claims, or medical records.
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Affiliation(s)
- Anna P Schenck
- The Carolinas Center for Medical Excellence, Cary, NC 27511-8598, USA.
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Jones RM, Mongin SJ, Lazovich D, Church TR, Yeazel MW. Validity of four self-reported colorectal cancer screening modalities in a general population: differences over time and by intervention assignment. Cancer Epidemiol Biomarkers Prev 2008; 17:777-84. [PMID: 18381476 DOI: 10.1158/1055-9965.epi-07-0441] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Little is known about the validity of self-reported colorectal cancer screening. To date, few published studies have validated all four screening modalities per recommended guidelines or included a general population-based sample, and none has assessed validity over time and by intervention condition. To estimate the validity of self-reported screening, a random sample of 200 adults, ages > or =50 years, was selected from those completing annual surveys on screening behavior as part of an intervention study. Approximately 60% of the validation sample authorized medical record review. Sensitivity, specificity, and positive and negative predictive values were calculated for baseline and year 1 follow-up reports for each test and for overall screening adherence. Sensitivity at baseline ranged from 86.9% (flexible sigmoidoscopy) to 100% (colonoscopy). Sensitivity at follow-up was slightly lower. Adjusting for validity measures, the sample overreported screening prevalence at baseline for each of the four modalities. At follow-up, overreporting was greatest for fecal occult blood test (13.0%). Overreporting across intervention conditions was highest for fecal occult blood test (10.8% for control; 24.8% for the most intense intervention) and overall screening adherence (10.9% for control; 14.3% for the most intense intervention). Sensitivity and specificity of self-reported colorectal cancer screening compared with medical records were high; however, adjusting self-reported screening rates based on relative error rates reduced screening prevalence estimates. Those exposed to more intense interventions to modify screening behavior seemed more likely to overestimate their screening rates compared with those who were not exposed.
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Affiliation(s)
- Resa M Jones
- Department of Epidemiology and Community Health, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Vernon SW, Tiro JA, Vojvodic RW, Coan S, Diamond PM, Greisinger A, Fernandez ME. Reliability and validity of a questionnaire to measure colorectal cancer screening behaviors: does mode of survey administration matter? Cancer Epidemiol Biomarkers Prev 2008; 17:758-67. [PMID: 18381467 DOI: 10.1158/1055-9965.epi-07-2855] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Valid and reliable self-report measures of cancer screening behaviors are important for evaluating efforts to improve adherence to guidelines. We evaluated test-retest reliability and validity of self-report of the fecal occult blood test (FOBT), sigmoidoscopy (SIG), colonoscopy (COL), and barium enema (BE) using the National Cancer Institute colorectal cancer screening (CRCS) questionnaire. A secondary objective was to evaluate reliability and validity by mail, telephone, and face-to-face survey administration modes. Consenting men and women, 51 to 74 years old, receiving care at a multispecialty clinic for at least 5 years who had not been diagnosed with colorectal cancer were stratified by prior CRCS status and randomized to survey mode (n = 857). Within survey mode, respondents were randomized to complete a second survey at 2 weeks, 3 months, or 6 months. Comparing self-report with administrative and medical records, concordance estimates were 0.91 for COL, 0.85 for FOBT, 0.85 for SIG, and 0.92 for BE. Overall sensitivity estimates were 0.91 for COL, 0.82 for FOBT, 0.76 for SIG, and 0.56 for BE. Specificity estimates were 0.91 for COL, 0.86 for FOBT, 0.89 for SIG, and 0.97 for BE. Sensitivity and specificity varied little by survey mode for any test. Report-to-records ratio showed overreporting for SIG (1.1), COL (1.15), and FOBT (1.57), and underreporting for BE (0.82). Reliability at all time intervals was highest for COL; there was no consistent pattern according to survey mode. This study provides evidence to support the use of the National Cancer Institute CRCS questionnaire to assess self-report with any of the three survey modes.
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Affiliation(s)
- Sally W Vernon
- University of Texas-Houston School of Public Health, Division of Health Promotion and Behavioral Sciences, Houston, TX 77030, USA.
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Bastani R, Glenn BA, Maxwell AE, Ganz PA, Mojica CM, Chang LC. Validation of self-reported colorectal cancer (CRC) screening in a study of ethnically diverse first-degree relatives of CRC cases. Cancer Epidemiol Biomarkers Prev 2008; 17:791-8. [PMID: 18381469 DOI: 10.1158/1055-9965.epi-07-2625] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Evidence about the accuracy of self-reports of colorectal cancer (CRC) screening is lacking. We conducted a validation protocol in a randomized trial to increase CRC screening among high-risk individuals. METHODS First-degree relatives (n = 1,280) of CRC cases who were due for CRC screening were included in the parent trial. All subjects who completed the follow-up interview (n = 948) were asked to participate in validation activities. Self-reports of receipt of CRC screening during the 12-month study period were verified via physicians. RESULTS Although 60% (n = 567) verbally agreed, only 171 subjects (18% of original sample) returned the signed validation form with the physician name and contact information and a medical information release statement. The signed forms were mailed to physicians with a $10 incentive and the request to list the dates of recent CRC screening tests. One hundred twenty-three physicians (72% of physicians contacted, 13% of original sample) returned completed validation forms. Rates of agreement were low across all three screening types with physicians verifying self-reported screening for 29% of fecal occult blood testing, 56% of sigmoidoscopy, 55% of colonoscopy, and 57% of any screening test. CONCLUSION Validation of self-report using the type of protocol we used for subjects receiving medical care in many community settings may be unfeasible and cost inefficient. Given the overall low participation rate in validation activities and considerable challenges in collecting high quality data, conclusions about the accuracy of self-reported CRC screening are difficult to make based on the results of this study.
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Affiliation(s)
- Roshan Bastani
- School of Public Health and Jonsson Comprehensive Cancer Center, University of California at Los Angeles School of Public Health, Los Angeles, CA 90095-6900, USA.
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Partin MR, Grill J, Noorbaloochi S, Powell AA, Burgess DJ, Vernon SW, Halek K, Griffin JM, van Ryn M, Fisher DA. Validation of self-reported colorectal cancer screening behavior from a mixed-mode survey of veterans. Cancer Epidemiol Biomarkers Prev 2008; 17:768-76. [PMID: 18381474 DOI: 10.1158/1055-9965.epi-07-0759] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The aim of the study was to validate self-reported colorectal cancer (CRC) screening using the National Cancer Institute Colorectal Cancer Screening questionnaire. MATERIALS AND METHODS 890 patients, ages 50 to 75 years, from the Minneapolis Veterans Affairs (VA) Medical Center were surveyed by mail. Phone administration was attempted with mail nonresponders. VA and non-VA records were combined for the reference standard. Sensitivity, specificity, concordance, and report-to-records ratio (R2R) were estimated for overall and test-specific CRC adherence among respondents providing complete medical records. Secondary analyses examined variation in estimates by patient characteristics, treatment of missing and uncertain responses, and whether a strict or liberal time interval was used for assessing concordance. RESULTS Complete medical records were available for 345 of the 686 survey responders. For overall adherence, sensitivity was 0.98, specificity was 0.59, concordance was 0.88, and R2R was 1.14. Sensitivity was 0.82 for fecal occult blood test (FOBT), 0.75 for sigmoidoscopy, 0.97 for colonoscopy, and 0.63 for double-contrast barium enema (DCBE). Specificity was 0.89 for FOBT, 0.76 for sigmoidoscopy, 0.72 for colonoscopy, and 0.85 for DCBE. Concordance was >0.80 for all tests other than sigmoidoscopy (0.76). R2R was 1.31 for FOBT, 1.33 for sigmoidoscopy, 1.42 for colonoscopy, and 6.13 for DCBE. The R2R was lower for a combined sigmoidoscopy and colonoscopy measure. Overreporting was more pronounced for older, less-educated individuals with no family history of CRC. Sensitivity and R2R improved using a liberal interval and treating uncertain responses as nonadherent (versus missing), but differences were not statistically significant. CONCLUSIONS Self-reported CRC screening validity is generally acceptable and robust across definitional decisions, but varies by screening test and patient characteristics.
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Affiliation(s)
- Melissa R Partin
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417, USA.
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Palmer RC, Emmons KM, Fletcher RH, Lobb R, Miroshnik I, Kemp JA, Bauer M. Familial risk and colorectal cancer screening health beliefs and attitudes in an insured population. Prev Med 2007; 45:336-41. [PMID: 17804048 DOI: 10.1016/j.ypmed.2007.07.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Revised: 07/14/2007] [Accepted: 07/19/2007] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine the relationship between health beliefs and attitudes toward colorectal cancer screening, strength of family history risk, and being appropriately screened for colorectal cancer. METHODS In February 2004, 7000 randomly selected members of a multi-specialty group practice located in Boston, MA were mailed a brief survey that was used to ascertain colorectal cancer family history. A follow-up survey that contained questions representing selected constructs of the Health Belief Model, Theory of Planned Behavior, and healthcare experiences was then mailed to all 355 individuals who reported a family history in the initial survey and 710 randomly selected participants with no colorectal cancer family history. RESULTS Participants who were appropriately screened had higher mean scores for perceived cancer risk, subjective norms, and perceived benefits and lower scores for perceived barriers. Multivariate findings indicate that having high perceptions of risk for colorectal cancer was a significant correlate of being screened appropriately among individuals with a strong family history. CONCLUSIONS For those at greatest colorectal cancer risk due to family history, ensuring that these individuals understand their personal risk might lead to increased colorectal cancer screening participation. Future intervention research is warranted to examine if raising perceptions of risk can increase screening behaviors in individuals with colorectal cancer risk due to family history.
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Affiliation(s)
- Richard C Palmer
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA 02115, USA.
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Fletcher RH, Lobb R, Bauer MR, Kemp JA, Palmer RC, Kleinman KP, Miroshnik I, Emmons KM. Screening patients with a family history of colorectal cancer. J Gen Intern Med 2007; 22:508-13. [PMID: 17372801 PMCID: PMC1829437 DOI: 10.1007/s11606-007-0135-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To compare screening practices and beliefs in patients with and without a clinically important family history. DESIGN We mailed a brief questionnaire asking about family history and a second, longer survey asking about knowledge of and beliefs about colorectal cancer to all respondents with a family history and a random sample of respondents without a family history of colorectal cancer. We reviewed electronic medical records for screening examinations and recording of family history. PARTICIPANTS One thousand eight hundred seventy of 6,807 randomly selected patients ages 35-55 years who had been continuously enrolled in a large multispecialty group practice for at least 5 years. MEASUREMENTS Recognition of increased risk, screening practices, and beliefs-all according to strength of family history and patient's age. RESULTS Nineteen percent of respondents reported a family history of colorectal cancer. In 11%, this history was strong enough to warrant screening before age 50 years. However, only 39% (95% CI 36, 42) of respondents under the age of 50 years said they had been asked about family history and only 45% of those with a strong family history of colorectal cancer had been screened appropriately. Forty-six percent of patients with a strong family history did not know that they should be screened at a younger age than average risk people. Medical records mentioned family history of colorectal cancer in 59% of patients reporting a family history. CONCLUSIONS More efforts are needed to translate information about family history of colorectal cancer into the care of patients.
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Affiliation(s)
- Robert H Fletcher
- Department of Ambulatory Care and Prevention, Harvard Medical School, Harvard Pilgrim Health Care, and Harvard Vanguard Medical Associates, Boston, MA, USA.
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Schenck AP, Klabunde CN, Davis WW. Racial differences in colorectal cancer test use by Medicare consumers. Am J Prev Med 2006; 30:320-6. [PMID: 16530619 DOI: 10.1016/j.amepre.2005.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Revised: 10/31/2005] [Accepted: 11/29/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lower use of colorectal cancer (CRC) screening has been suggested as a factor in higher rates of CRC incidence and mortality among African Americans. Racial differences in colorectal cancer test use are not well understood. METHODS The study sample included respondents aged 50 to 80 to a 2001 telephone survey of Medicare consumers from two states. The analyses, initiated in 2004, were limited to respondents with no history of CRC (n = 1901). Three CRC tests were examined: fecal occult blood tests (FOBTs), sigmoidoscopy, and colonoscopy. Type of testing and testing according to Medicare coverage intervals by race were compared. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from unadjusted and adjusted models to assess the independent associations between race and test use. RESULTS Adherence to the Medicare-covered intervals for CRC tests was low (56.8% for whites, 39.1% for African Americans), and did not significantly differ by race after adjustment. African Americans were, however, significantly less likely to have ever been tested (OR = 0.48, 95% CI = 0.33-0.70) and more likely to have had an endoscopic test than an FOBT (OR = 3.06, 95% CI = 1.70-5.51). CONCLUSIONS The type of test used to screen for colorectal cancer has important implications for compliance with recommended screening intervals. Understanding reasons for racial differences in CRC test use may help identify approaches to increasing test use in the Medicare population.
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Affiliation(s)
- Anna P Schenck
- Medical Review of North Carolina, Cary, North Carolina 27511-8598, USA.
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Greiner KA, James AS, Born W, Hall S, Engelman KK, Okuyemi KS, Ahluwalia JS. Predictors of fecal occult blood test (FOBT) completion among low-income adults. Prev Med 2005; 41:676-84. [PMID: 15917068 DOI: 10.1016/j.ypmed.2004.12.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Revised: 11/29/2004] [Accepted: 12/29/2004] [Indexed: 01/27/2023]
Abstract
BACKGROUND Fecal occult blood testing (FOBT) can reduce colorectal cancer (CRC) mortality. Unfortunately, CRC screening is underutilized. Sociocultural mediators of FOBT adherence have not been extensively studied in lower income, minority populations. This study prospectively studied FOBT return in a low-income, multiethnic population. METHODS Participants (N = 298), aged > or =40 years, were surveyed and given FOBT kits with instructions. Those not returning kits within 30 days received a reminder telephone call. Bivariate and multivariate analyses assessed predictors of FOBT card return at 90 days. RESULTS Participants (median age = 48) were predominately African American (69%), without private insurance (88%), and of low income. The largest group of participants preferred FOBT alone (46%), followed by whatever my doctor recommends (19%), endoscopy + annual FOBT (16%), endoscopy alone (14%), and no screening (5%). In multivariate analyses, FOBT return was predicted by age (OR = 1.05) and lack of reported FOBT barriers (OR = 3.81). Among those > or =50 and not up-to-date with screening, FOBT return was predicted by cancer fatalism (OR = 0.83). FOBT barriers were associated with age (OR = 0.96), less than high school education (OR = 2.05), and less physician trust (OR = 2.12). Endoscopy barriers were associated with age (OR = 0.93), less physician trust (OR = 1.95), and female gender (OR = 3.45). CONCLUSIONS Younger individuals and those with less education, less trust in health care providers, and more fatalistic beliefs are at risk for CRC screening non-adherence. Strategies addressing common misconceptions should improve CRC screening rates in low-income, multiethnic populations.
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Affiliation(s)
- K Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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