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Scaglioni G, Guidetti M, Cavazza N. The role of disgust as an emotional barrier to colorectal cancer screening participation: a systematic review and meta-analysis. Psychol Health 2023; 38:389-408. [PMID: 34433347 DOI: 10.1080/08870446.2021.1967351] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Worldwide colorectal cancer (CRC) screening rates are suboptimal. This systematic review and meta-analysis examine the role of disgust in CRC screening avoidance. DESIGN A systematic literature search was conducted. In all, 46 studies were included in the review. Among these, 16 studies were compared with a meta-analytical approach in order to 1) estimate the effect size of state disgust on screening intention and attendance; 2) examine whether methodological characteristics moderate the effect of state disgust on screening behaviour; 3) estimate the effect sizes of trait disgust and type of exam kit on state disgust. RESULTS In the reviewed studies, state disgust was often associated with CRC screening and especially with CRC screening avoidance. The meta-analysis confirmed low-to-moderate negative effects of state disgust on screening intention and attendance. Population sampling strategy was the only significant moderator of the effect of state disgust on screening attendance, i.e. studies that used convenience (versus random/representative) samples found a significantly lower effect size. Trait disgust and type of exam kit exerted a large and a moderate-to-large positive effect, respectively, on state disgust. CONCLUSIONS Disgust can boost CRC screening avoidance. Further studies and interventions must be designed to help patients in overcoming this emotional barrier.
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Affiliation(s)
- Giulia Scaglioni
- Department of Humanities, Social Sciences, and Cultural Industries, University of Parma, Parma, Italy
| | - Margherita Guidetti
- Department of Communication and Economics, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Nicoletta Cavazza
- Department of Communication and Economics, University of Modena and Reggio Emilia, Reggio Emilia, Italy
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2
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Wang CW, Mclean I R, Cheng YW, Kim S, Terdiman J, Kathpalia P, Beck KR. Racial Disparities in Endoscopy Cancellations During the COVID-19 Pandemic. Dig Dis Sci 2023; 68:729-735. [PMID: 35732970 PMCID: PMC9216287 DOI: 10.1007/s10620-022-07575-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/20/2022] [Indexed: 12/09/2022]
Abstract
INTRODUCTION The coronavirus disease 19 (COVID-19) pandemic has disrupted healthcare delivery including elective endoscopy. We aimed to determine the prevalence of endoscopy cancellations in the COVID-19 era and identify patient characteristics associated with cancellation due to the pandemic. METHODS Medical charts were reviewed for adults who cancelled an outpatient endoscopic procedure from 5/2020 to 8/2020. The association of patient characteristics with cancellation of endoscopy due to COVID-19 was assessed using logistic regression. RESULTS There were 652 endoscopy cancelations with 211 (32%) due to COVID-19, 384 (59%) due to non-COVID reasons, and 57 (9%) undetermined. Among COVID-19 related cancellations, 75 (36%) were COVID-19 testing logistics related, 121 (57%) were COVID-19 fear related, and 15 (7%) were other. On adjusted analysis, the odds of cancellation due to COVID-19 was significantly higher for black patients (OR 2.04, 95% CI 1.07-3.88, p = 0.03), while patients undergoing EGD (OR 0.56, 95% CI 0.31-0.99, p = 0.05) or advanced endoscopy (OR 0.18, 95% CI 0.07-0.49, p = 0.001) had lower odds of cancellation. The odds of cancelling due to COVID-19 testing logistics was significantly higher among black patients (OR 3.12, 95% CI 1.03-9.46, p = 0.05) and patients with Medi-Cal insurance (OR 2.89, 95% CI 1.21-6.89, p = 0.02). CONCLUSION Black race is associated with an increased risk of COVID-19 related cancellation. Specifically, black patients and those with Medi-Cal are at increased risk of cancellation related to logistics of obtaining pre-endoscopy COVID-19 testing. Racial and socioeconomic disparities in access to endoscopy may be further amplified by the COVID-19 pandemic and warrant further study.
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Affiliation(s)
- Connie W. Wang
- grid.266102.10000 0001 2297 6811Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143 USA
| | - Richard Mclean I
- grid.266102.10000 0001 2297 6811Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143 USA
| | - Yao-Wen Cheng
- grid.266102.10000 0001 2297 6811Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143 USA
| | - Stephanie Kim
- grid.266102.10000 0001 2297 6811University of California San Francisco School of Medicine, San Francisco, CA USA
| | - Jonathan Terdiman
- grid.266102.10000 0001 2297 6811Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143 USA
| | - Priya Kathpalia
- grid.266102.10000 0001 2297 6811Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143 USA
| | - Kendall R. Beck
- grid.266102.10000 0001 2297 6811Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143 USA
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Barberan Parraga C, Singh R, Lin R, Tamariz L, Palacio A. Colorectal Cancer Screening Disparities Among Race: A Zip Code Level Analysis. Clin Colorectal Cancer 2023; 22:183-189. [PMID: 36842869 DOI: 10.1016/j.clcc.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) screening can prevent disease by early identification. Existing disparities in CRC screening have been associated with factors including race, socioeconomic status, insurance, and even geography. Our study takes a deeper look into how social determinants related to zip code tabulation areas affect CRC screenings. MATERIALS AND METHODS We conducted a retrospective cross-sectional study of CRC screenings by race at a zip code level, evaluating for impactful social determinant factors such as the social deprivation index (SDI). We used publicly available data from CDC 500 Cities Project (2016-2019), PLACES Project (2020), and the American Community Survey (2019). We conducted multivariate and confirmatory factor analyses among race, income, health insurance, check-up visits, and SDI. RESULTS Increasing the tertile of SDI was associated with a higher likelihood of being Black or Hispanic, as well as decreased median household income (P < .01). Lower rates of regular checkup visits were found in the third tertile of SDI (P < .01). The multivariate analysis showed that being Black, Hispanic, lower income, being uninsured, lack of regular check-ups, and increased SDI were related to decreased CRC screening. In the confirmatory factor analysis, we found that SDI and access to insurance were the variables most related to decreased CRC screening. CONCLUSION Our results reveal the top 2 factors that impact a locality's CRC screening rates are the social deprivation index and access to health care. This data may help implement interventions targeting social barriers to further promote CRC screenings within disadvantaged communities and decrease overall mortality via early screening.
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Affiliation(s)
- Carla Barberan Parraga
- Department of Medicine and Epidemiology Universidad Catolica Santiago de Guayaquil, Guayaquil, Ecuador.
| | - Roshni Singh
- Miller School of Medicine, University of Miami, Miami, FL
| | - Rachel Lin
- Miller School of Medicine, University of Miami, Miami, FL
| | | | - Ana Palacio
- Miami Veterans Affairs Medical Center, Miami, FL
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Cataneo JL, Kim TD, Park JJ, Marecik S, Kochar K. Disparities in Screening for Colorectal Cancer Based on Limited Language Proficiency. Am Surg 2022; 88:2737-2744. [PMID: 35642266 DOI: 10.1177/00031348221105596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study analyzes the association between limited language proficiency and screening for colorectal cancer. METHODS This is a retrospective cohort study from the 2015 sample of the National Health Interview Survey database utilizing univariate and multivariate regression analysis. The study population includes subjects between 50 and 75 years of age. The main outcome analyzed was rates of screening colonoscopies between limited English-language proficiency (LEP) subjects and those fluent in English. Secondary outcomes included analysis of baseline, socioeconomic, access to health care variables, and other modalities for colorectal cancer screening between the groups. RESULTS Incidence of limited language proficiency was 4.8% (n = 1978, count = 4 453 599). They reported lower rates of screening colonoscopies (61% vs 34%, P < .001), less physician recommendation for a colonoscopy (87 vs 60%, P < .001), fewer polyps removed in the previous 3 years (24% vs 9.1%; P < .001), and fewer fecal occult blood samples overall (P < .001). Additionally, Hispanic non-LEP subjects have higher rates of colonoscopies compared to those with language barriers (50% vs 33%, P < .001). On multivariate analysis, LEP was associated with a lower likelihood to have a screening colonoscopy (OR .67 95% CI .49-.91). A second regression model with "Spanish language" and "other language" variables included, associated Spanish speakers with a lower likelihood for a screening colonoscopy (OR .71 95% CI .52-.97) when controlling for baseline, socioeconomic, and access to health care covariates. DISCUSSION Patients with limited English-language proficiency are associated with lower rates of screening for colorectal cancer, in particular the Spanish speaking subgroup.
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Affiliation(s)
- Jose L Cataneo
- 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Tae David Kim
- 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - John J Park
- 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | | | - Kunal Kochar
- 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
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Stephens K, Fahy BN. Adherence to surveillance colonoscopy guidelines in patients following curative-intent colorectal cancer resection. Cancer Treat Res Commun 2021; 29:100479. [PMID: 34710850 DOI: 10.1016/j.ctarc.2021.100479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Current guidelines recommend that patients who have undergone curative-intent resection for colorectal cancer (CRC) should undergo colonoscopy one year following their surgery or at six months post-operatively if a pre-operative colonoscopy was not performed due to an obstructing lesion. We sought to determine adherence to postoperative surveillance colonoscopy guidelines in our National Cancer Institute designated comprehensive cancer center and potentially identify factors associated with non-adherence. MATERIALS AND METHODS A retrospective review of 100 patients who underwent curative-intent CRC resection was performed between 2013 and 2019. Patients were divided into two groups based upon adherence to surveillance colonoscopy guidelines. Demographic, tumor, and postoperative variables were analyzed. RESULTS The median age of all patients was 62. Fifty-seven percent of patients were male. Thirty-eight patients underwent surveillance colonoscopy in accordance with current guidelines. Sixty-two patients did not undergo surveillance colonoscopy postoperatively or did so outside of the National Comprehensive Cancer Network guidelines. Factors associated with non-adherence to surveillance colonoscopy included presence of comorbidities, albumin less than 3.5, and performance of a pre-operative colonoscopy. CONCLUSIONS Adherence to surveillance colonoscopy guidelines was low among our patients. Efforts should be directed toward patients at increased risk for non-adherence to surveillance colonoscopy guidelines.
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Affiliation(s)
- Kyle Stephens
- University of New Mexico, School of Medicine United States
| | - Bridget N Fahy
- University of New Mexico, Department of Surgery, Division of Surgical Oncology 1 University of New Mexico, MS 07-4025 Albuquerque, NM 87131 United States.
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Scaglioni G, Cavazza N. Emotional Barriers to Bowel Screening in Italy: Scale psychometric properties and effects on screening attendance. Psychooncology 2021; 31:78-85. [PMID: 34331357 DOI: 10.1002/pon.5781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess a three-factor version of the Emotional Barriers to Bowel Screening (EBBS) scale; analyze the scale's psychometric properties; and investigate the associations of fecal disgust, embarrassment, and fear with colorectal cancer (CRC) screening avoidance. METHODS Retrospective design: We asked participants to rate negative emotions associated with CRC screenings as well as whether they had ever attended a fecal occult blood test. SAMPLE 268 Italian adults aged 45-74 years. MEASURES negative emotions, screening knowledge, CRC risk perception, demographic and background data, and hypothetical medical help-seeking. ANALYSES Confirmatory factor analyses, correlations, logistic regressions. RESULTS The EBBS scale is a multidimensional instrument and, at least where fecal tests are of interest, can be used without the insertion disgust subscale. The analyzed negative emotions were negatively correlated with screening attendance and positively correlated with intention to delay seeking medical help. However, logistic regression models showed that, of the three analyzed emotions, fear about outcome was the only significant predictor of screening behavior and delaying medical care. CONCLUSIONS Further studies can adopt the version of the EBBS scale that is most suitable for their research contexts. Interventions must be designed to reassure patients.
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Affiliation(s)
- Giulia Scaglioni
- Department of Humanities, Social Sciences, and Cultural Industries, University of Parma, Parma, Italy
| | - Nicoletta Cavazza
- Department of Communication and Economics, University of Modena and Reggio Emilia, Reggio Emilia, Italy
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Kelly TA, Kim S, Jemmott LS, Jemmott JB. Predictors of Colorectal Cancer Screening Among African American Men Living with HIV. J Community Health 2021; 46:1099-1106. [PMID: 33963984 DOI: 10.1007/s10900-021-00997-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 01/22/2023]
Abstract
African American men living with HIV are at high risk of colorectal cancer (CRC). Screening to detect CRC is associated with a reduced risk of CRC mortality. However, little is known about CRC screening predictors in this population. This study examined the relation of self-efficacy, a potential mediator of screening that interventions could target, to CRC screening. It also investigated several variables that might identify subpopulations of African American men non-adherent to CRC screening recommendations. We report a secondary analysis on baseline data from a randomized controlled trial of a health promotion intervention for African American men living with HIV. Before their intervention, they completed measures of CRC screening, self-efficacy, marital status, age, education, and adherence to physical activity guidelines and were assessed for obesity. A total of 270 African American men aged 45 to 88 (Mean = 55.07; SD = 6.46) living with HIV participated. About 30% reported CRC screening in the past six months. Multiple logistic regression revealed greater CRC screening self-efficacy and meeting physical activity guidelines were associated with receiving CRC screening. Obese men and men reporting higher education were less likely to report screening. Age and marital status were unrelated to screening. The results of this study suggest CRC screening rates may be low among African American men living with HIV, and interventions targeting self-efficacy may improve their screening uptake. Moreover, public-health efforts to increase screening should prioritize interventions with subpopulations of African American men living with HIV who are physically inactive and obese.
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Affiliation(s)
- Terri-Ann Kelly
- Rutgers University-Camden School of Nursing, 530 Federal Street, Office 448, Camden, NJ, 08102, USA.
| | | | - Loretta S Jemmott
- Drexel University College of Nursing and Health Professions, Philadelphia, USA
| | - John B Jemmott
- University Pennsylvania Annenberg School of Communication, Philadelphia, USA
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Oh A, Gaysynsky A, Knott CL, Nock NL, Erwin DO, Vinson CA. Customer discovery as a tool for moving behavioral interventions into the marketplace: insights from the NCI SPRINT program. Transl Behav Med 2019; 9:1139-1150. [PMID: 31313817 PMCID: PMC7184906 DOI: 10.1093/tbm/ibz103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The National Cancer Institute established a dissemination and implementation accelerator program called Speeding Research-tested INTerventions (SPRINT) in order to expedite the translation of behavioral research into practice. The goal of SPRINT is to introduce researchers to a new method for moving their research into practice in order to increase the real-world impact of their evidence-based interventions. The goal of this article is to present case studies on three teams that have completed the SPRINT program to date. Each case study provides a description of the intervention the team came into the program with, the team's motivation for participating in the SPRINT program, the team's experience in the program, lessons learned from "customer discovery" interviews conducted by the team during the course, and the team's future plans for their intervention. The case studies suggest that by focusing on behavioral researchers, SPRINT addresses an unmet need in the commercialization training space; that the definition of "success" can vary across SPRINT projects; that identifying and engaging "payors" for behavioral interventions is an ongoing challenge; and that there are potential "misalignments" between the research process and market demands. Overall, these examples show that customer discovery is a potentially useful method for making interventions more responsive to the needs of stakeholders, and that researchers can benefit from learning the "language" of business and working with individuals who have business experience before trying to move their research from the lab to the real world.
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Affiliation(s)
- April Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Anna Gaysynsky
- Engagement and Transformation, ICF Next, Rockville, MD, USA
| | - Cheryl L Knott
- Department of Behavioral and Community Health, University of Maryland, College Park, MD, USA
| | - Nora L Nock
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Deborah O Erwin
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Cynthia A Vinson
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Cardoso R, Niedermaier T, Chen C, Hoffmeister M, Brenner H. Colonoscopy and Sigmoidoscopy Use among the Average-Risk Population for Colorectal Cancer: A Systematic Review and Trend Analysis. Cancer Prev Res (Phila) 2019; 12:617-630. [PMID: 31289028 DOI: 10.1158/1940-6207.capr-19-0202] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/11/2019] [Accepted: 07/03/2019] [Indexed: 12/24/2022]
Abstract
Monitoring population-level colonoscopy and sigmoidoscopy use is crucial to estimate the future burden of colorectal cancer and guide screening efforts. We conducted a systematic literature search on colonoscopy and sigmoidoscopy use, published between November 2016 and December 2018 in the databases PubMed and Web of Science to update previous reviews and analyze time trends for various countries. In addition, we used data from the German and European Health Interview Surveys and the National Health Interview Survey to explore recent time trends for Germany and the US, respectively. The literature search yielded 23 new articles: fourteen from the US and nine from Australia, Canada, England, Germany, Saudi Arabia, and South Korea. Colonoscopy use within 10 years was highest and, apart from the youngest age groups eligible for colorectal cancer screening, kept increasing to levels close to 60% in the US and Germany. A recent steep increase was also observed for South Korea. Limited data were available on sigmoidoscopy use; regional studies from the US suggest that sigmoidoscopy has become rarely used. Despite high uptake and ongoing increase in the US, Germany, and South Korea, use of colonoscopy and sigmoidoscopy has either remained low or essentially unknown for the majority of countries.
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Affiliation(s)
- Rafael Cardoso
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Tobias Niedermaier
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Chen Chen
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany. .,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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