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Coury J, Coronado GD, Myers E, Patzel M, Thompson J, Whidden-Rivera C, Davis MM. Engaging with Rural Communities for Colorectal Cancer Screening Outreach Using Modified Boot Camp Translation. Prog Community Health Partnersh 2024; 18:47-59. [PMID: 38661826 PMCID: PMC11047025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) incidence and mortality are disproportionately high among rural residents and Medicaid enrollees. OBJECTIVES To address disparities, we used a modified community engagement approach, Boot Camp Translation (BCT). Research partners, an advisory board, and the rural community informed messaging about CRC outreach and a mailed fecal immunochemical test program. METHODS Eligible rural patients (English-speaking and ages 50-74) and clinic staff involved in patient outreach participated in a BCT conducted virtually over two months. We applied qualitative analysis to BCT transcripts and field notes. RESULTS Key themes included: the importance of directly communicating about the seriousness of cancer, leveraging close clinic-patient relationships, and communicating the test safety, ease, and low cost. CONCLUSIONS Using a modified version of BCT delivered in a virtual format, we were able to successfully capture community input to adapt a CRC outreach program for use in rural settings. Program materials will be tested during a pragmatic trial to address rural CRC screening disparities.
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Katz ML, Stump TE, Monahan PO, Emerson B, Baltic R, Young GS, Madison Hyer J, Paskett ED, Champion VL, Rawl SM. Factors associated with the accurate self-report of cancer screening behaviors among women living in the rural Midwest region of the United States. Prev Med Rep 2022; 30:102063. [PMID: 36531105 PMCID: PMC9747628 DOI: 10.1016/j.pmedr.2022.102063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/07/2022] [Accepted: 11/20/2022] [Indexed: 11/22/2022] Open
Abstract
This study examines the accuracy of the self-report of up-to-date cancer screening behaviors (Mammography, Papanicolaou (Pap)/Human Papillomavirus (HPV) tests, Fecal Occult Blood Test (FOBT)/Fecal Immunochemical Test (FIT), Colonoscopy) compared to medical record documentation prior to eligibility determination and enrollment in a randomized controlled trial of an intervention to increase cancer screening among women living in rural counties of Indiana and Ohio. Women (n = 1,641) completed surveys and returned a medical record release form from November 2016-June 2019. We compared self-report to medical records for up-to-date cancer screening behaviors to determine the validity of self-report. Logistic regression models identified variables associated with accurate reporting. Women were up-to-date for mammography (75 %), Pap/HPV test (54 %), colonoscopy (53 %), and FOBT/FIT (6 %) by medical record. Although 39.6 % of women reported being up-to-date for all three anatomic sites (breast, cervix, and colon), only 31.8 % were up to date by medical records. Correlates of accurate reporting of up-to-date cancer screening varied by screening test. Approximately-one-third of women in rural counties in the Midwest are up-to-date for all three anatomic sites and correlates of the accurate reporting of screening varied by test. Although most investigators use medical records to verify completion of cancer screening behaviors as the primary outcome of intervention trials, they do not usually use medical records for the routine verification of study eligibility. Study results suggest that future research should use medical record documentation of cancer screening behaviors to determine eligibility for trials evaluating interventions to increase cancer screening.
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Affiliation(s)
- Mira L. Katz
- College of Public Health, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Timothy E. Stump
- Department of Biostatistics, School of Medicine, Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN, United States
| | - Patrick O. Monahan
- Indiana University, Simon Comprehensive Cancer Center, Indianapolis, IN, United States
| | - Brent Emerson
- College of Public Health, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
- College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Ryan Baltic
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Gregory S. Young
- Center for Biostatistics, The Ohio State University, Columbus, OH, United States
| | - J. Madison Hyer
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Electra D. Paskett
- College of Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Victoria L. Champion
- School of Nursing, Indiana University, Simon Comprehensive Cancer Center, Indianapolis, IN, United States
| | - Susan M. Rawl
- School of Nursing, Indiana University, Simon Comprehensive Cancer Center, Indianapolis, IN, United States
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Shapiro JA, Soman AV, Berkowitz Z, Fedewa SA, Sabatino SA, de Moor JS, Clarke TC, Doria-Rose VP, Breslau ES, Jemal A, Nadel MR. Screening for Colorectal Cancer in the United States: Correlates and Time Trends by Type of Test. Cancer Epidemiol Biomarkers Prev 2021; 30:1554-1565. [PMID: 34088751 DOI: 10.1158/1055-9965.epi-20-1809] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/19/2021] [Accepted: 05/21/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND It is strongly recommended that adults aged 50-75 years be screened for colorectal cancer. Recommended screening options include colonoscopy, sigmoidoscopy, CT colonography, guaiac fecal occult blood testing (FOBT), fecal immunochemical testing (FIT), or the more recently introduced FIT-DNA (FIT in combination with a stool DNA test). Colorectal cancer screening programs can benefit from knowledge of patterns of use by test type and within population subgroups. METHODS Using 2018 National Health Interview Survey (NHIS) data, we examined colorectal cancer screening test use for adults aged 50-75 years (N = 10,595). We also examined time trends in colorectal cancer screening test use from 2010-2018. RESULTS In 2018, an estimated 66.9% of U.S. adults aged 50-75 years had a colorectal cancer screening test within recommended time intervals. However, the prevalence was less than 50% among those aged 50-54 years, those without a usual source of health care, those with no doctor visits in the past year, and those who were uninsured. The test types most commonly used within recommended time intervals were colonoscopy within 10 years (61.1%), FOBT or FIT in the past year (8.8%), and FIT-DNA within 3 years (2.7%). After age-standardization to the 2010 census population, the percentage up-to-date with CRC screening increased from 61.2% in 2015 to 65.3% in 2018, driven by increased use of stool testing, including FIT-DNA. CONCLUSIONS These results show some progress, driven by a modest increase in stool testing. However, colorectal cancer testing remains low in many population subgroups. IMPACT These results can inform efforts to achieve population colorectal cancer screening goals.
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Affiliation(s)
- Jean A Shapiro
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Ashwini V Soman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zahava Berkowitz
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stacey A Fedewa
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Tainya C Clarke
- Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Erica S Breslau
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Ahmedin Jemal
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Marion R Nadel
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Impact of organized colorectal cancer screening programs on screening uptake and screening inequalities: A study of systematic- and patient-reliant programs in Canada. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2020.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Warren Andersen S, Blot WJ, Lipworth L, Steinwandel M, Murff HJ, Zheng W. Association of Race and Socioeconomic Status With Colorectal Cancer Screening, Colorectal Cancer Risk, and Mortality in Southern US Adults. JAMA Netw Open 2019; 2:e1917995. [PMID: 31860105 PMCID: PMC6991213 DOI: 10.1001/jamanetworkopen.2019.17995] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Colorectal cancer (CRC) screening is rarely studied in populations who may face additional barriers to participate in cancer screening, such as African American individuals and individuals with low socioeconomic status (SES). OBJECTIVE To examine the associations of CRC screening and modalities with CRC incidence and mortality by race and SES. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Southern Community Cohort Study, which enrolled more than 85 000 participants from community health centers or stratified random sampling of the general population in 12 states in the southeastern United States. The present study included data from cohort members who were eligible for CRC screening as recommended by expert organizations based on age and family history. Participants completed questionnaires from 2002 to 2009 and were contacted again from 2008 to 2012. Linkages to state cancer registries and the National Death Index as of December 31, 2016, identified incident CRC and vital status. Data analysis was performed from January 1, 2018, to October 30, 2019. MAIN OUTCOMES AND MEASURES Incident CRC (n = 632) and mortality (n = 10 003). Cox proportional hazards regression models evaluated associations between screening modalities and CRC risk and mortality. Information on fecal occult blood test use was only obtained on the follow-up questionnaire. Self-identified race was measured as African American/black, white, or other, and SES was defined by household income. RESULTS This study included 47 596 participants (median baseline age, 54 years [interquartile range, 10 years]; 32 185 [67.6%] African American; 28 884 [60.7%] female; and 26 075 [54.8%] with household income <$15 000). A total of 24 432 participants (63.9%) had never undergone CRC testing at baseline. The CRC testing assessed at baseline and follow-up interviews was associated with significant CRC risk reduction (hazard ratio [HR], 0.55; 95% CI, 0.44-0.70 for ever colonoscopy at baseline). Results were similar in analyses stratified by race (African American: HR, 0.65; 95% CI, 0.50-0.85; white: HR, 0.44; 95% CI, 0.27-0.70) and household income (<$15 000: HR, 0.63; 95% CI, 0.46-0.86, ≥$15 000: HR, 0.49; 95% CI, 0.35-0.69). Ever sigmoidoscopy at baseline was associated with CRC risk reduction (HR, 0.66; 95% CI, 0.51-0.87), and undergoing fecal occult blood test in the interval between baseline and follow-up interview was associated with CRC risk reduction (HR, 0.75; 95% CI, 0.57-0.98). Inverse associations were also observed between CRC mortality and receipt of colonoscopy (HR for women, 0.39; 95% CI, 0.21-0.73; HR for men, 0.69; 95% CI, 0.40-1.18) and sigmoidoscopy (HR for women, 0.37; 95% CI, 0.16-0.85; HR for men, 0.82; 95% CI, 0.46-1.47); however, the association did not extend to fecal occult blood test (HR for women, 1.02; 95% CI, 0.62-1.70; HR for men, 1.03; 95% CI, 0.55-1.93). CONCLUSIONS AND RELEVANCE In this study, CRC test rates were low among African American individuals and those with low SES. The findings suggest that screening, particularly with colonoscopy, is significantly associated with reduced risk of CRC and mortality. The CRC disparities experienced by individuals with low SES and African American individuals may be lessened by improving access to and uptake of CRC screening.
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Affiliation(s)
- Shaneda Warren Andersen
- Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
- University of Wisconsin Carbone Cancer Center, Madison
| | - William J. Blot
- Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee
| | - Loren Lipworth
- Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Mark Steinwandel
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee
| | - Harvey J. Murff
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wei Zheng
- Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
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Carey RN, El-Zaemey S. Lifestyle and occupational factors associated with participation in colorectal cancer screening among men and women in Australia. Prev Med 2019; 126:105777. [PMID: 31319115 DOI: 10.1016/j.ypmed.2019.105777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/04/2019] [Accepted: 07/14/2019] [Indexed: 11/16/2022]
Abstract
This study explores the associations between lifestyle and occupational factors and participation in colorectal cancer (CRC) screening among men and women aged 50 and over and living in Australia. We used weighted data from the Australian National Health Survey 2014-15 to produce population estimates. Lifestyle variables investigated were smoking, physical activity, alcohol consumption, fruit and vegetable consumption, and body mass index, while the occupational variables were labour force status, occupation, and participation in shift work. Using weighted data, 1,990,287 men (55%) and 1,898,232 women (49%) reported ever-screening for CRC. Female current smokers were less likely to report ever-screening for CRC (adjusted RR = 0.78, 95% CI 0.64-0.96), as were men who were less physically active (aRR = 0.87, 95% CI 0.78-0.97), reported no alcohol consumption (aRR = 0.73, 95% CI 0.59-0.91), and reported eating more vegetables (aRR = 0.84, 95% CI 0.72-0.99). When lifestyle behaviours were combined into a healthy lifestyle index score, a significant trend was observed for both men and women, whereby those who reported engaging in more healthy behaviours were more likely to have ever-screened for CRC (p = .027 men; p < .001 women). No associations were observed between CRC screening and occupational variables. This is the first comprehensive assessment of the lifestyle and occupational factors associated with participation in CRC screening among men and women in Australia. Participation in CRC screening was greater among those engaging in more healthy behaviours, suggesting that an individual's pattern of lifestyle behaviours may be important in determining screening participation. These results have important implications for public health strategies on improving CRC screening participation.
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Affiliation(s)
- Renee N Carey
- School of Public Health, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia.
| | - Sonia El-Zaemey
- School of Public Health, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia
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Blair A, Gauvin L, Ouédraogo S, Datta GD. Area-level income disparities in colorectal screening in Canada: evidence to inform future surveillance. ACTA ACUST UNITED AC 2019; 26:e128-e137. [PMID: 31043818 DOI: 10.3747/co.26.4279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Participation in colorectal screening remains low even in countries with universal health coverage. Area-level determinants of low screening participation in Canada remain poorly understood. Methods We assessed the association between area-level income and two indicators of colorectal screening (having never been screened, having not been screened recently) by linking census-derived local area-level income data with self-reported screening data from urban-dwelling respondents to the Canadian Community Health Survey (50-75 years of age, cycles 2005 and 2007, n = 18,362) who reported no known risk factors for colorectal cancer. Generalized estimating equation Poisson models estimated the prevalence ratios and differences for having never been screened and having not been screened recently, adjusting for individual-level income, education, marital status, having a regular physician, age, and sex. Results About 53% of the study population had never been screened. Among individuals who had ever been screened, 35% had been screened recently. Adjusting for covariates, lower area-level income was associated with having never been screened [covariate-adjusted prevalence ratios: 1.24 for quartile 1; 95% confidence limits (cl): 1.16, 1.34; 1.25 for quartile 2; 95% cl: 1.15, 1.33; 1.15 for quartile 3; 95% cl: 1.08, 1.23]. Among individuals who had been screened in their lifetime, area-level income was not associated with having not been screened recently. Conclusions Lower area-level income is associated with having never been screened for colorectal cancer even after adjusting for individual socioeconomic factors. Those findings highlight the potential importance of socioeconomic contexts for colorectal screening initiation and merit attention in both future research and surveillance efforts.
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Affiliation(s)
- A Blair
- Department of Social and Preventive Medicine, École de Santé Publique de l'Université de Montréal Montreal, QC.,Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | - L Gauvin
- Department of Social and Preventive Medicine, École de Santé Publique de l'Université de Montréal Montreal, QC.,Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | - S Ouédraogo
- Department of Social and Preventive Medicine, École de Santé Publique de l'Université de Montréal Montreal, QC.,Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | - G D Datta
- Department of Social and Preventive Medicine, École de Santé Publique de l'Université de Montréal Montreal, QC.,Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC
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Petrik AF, Green BB, Vollmer WM, Le T, Bachman B, Keast E, Rivelli J, Coronado GD. The validation of electronic health records in accurately identifying patients eligible for colorectal cancer screening in safety net clinics. Fam Pract 2016; 33:639-643. [PMID: 27471224 PMCID: PMC5161488 DOI: 10.1093/fampra/cmw065] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND While electronic health records (EHRs) play a key role in increasing colorectal cancer (CRC) screening by identifying individuals who are overdue, important shortfalls remain. OBJECTIVES As part of the Strategies and Opportunities to STOP Colon Cancer (STOP CRC) study, we assessed the accuracy of EHR codes in identifying patients eligible for CRC screening. METHODS We selected a stratified random sample of 800 study participants from 26 participating clinics, in the Pacific Northwest region of the USA. We compared data obtained through codes in the EHR to conduct a manual chart audit. A trained chart abstractor completed the abstraction of eligible and ineligible patients. RESULTS Of 520 individuals in need of CRC screening, identified via the EHR, 459 were confirmed through chart review (positive predictive value = 88%). Of 280 individuals flagged as up-to-date in their screening per EHR data, 269 were confirmed through chart review (negative predictive value = 96%). Among the 61 patients incorrectly classified as eligible, 83.6% of disagreements were due to evidence of a prior colonoscopy or referral that was not captured in recognizable fields in the EHR. CONCLUSIONS Our findings highlight importance of better capture of past screening events in the EHR. While the need for better population-based data is not unique to CRC screening, it provides an important example of the use of population-based data not only for tracking care, but also for delivering interventions.
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Affiliation(s)
- Amanda F Petrik
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR,
| | | | - William M Vollmer
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Barbara Bachman
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Erin Keast
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Jennifer Rivelli
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Gloria D Coronado
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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Shokar NK, Byrd T, Salaiz R, Flores S, Chaparro M, Calderon-Mora J, Reininger B, Dwivedi A. Against colorectal cancer in our neighborhoods (ACCION): A comprehensive community-wide colorectal cancer screening intervention for the uninsured in a predominantly Hispanic community. Prev Med 2016; 91:273-280. [PMID: 27575314 DOI: 10.1016/j.ypmed.2016.08.039] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/17/2016] [Accepted: 08/25/2016] [Indexed: 12/14/2022]
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer deaths in the USA. Screening is widely recommended but underutilized, particularly among the low income, the uninsured, recent immigrants and Hispanics. The study objective was to determine the effectiveness of a comprehensive community-wide, bilingual, CRC screening intervention among uninsured predominantly Hispanic individuals. This prospective study was embedded in a CRC screening program and utilized a quasi-experimental design. Recruitment occurred from Community and clinic sites. Inclusion criteria were aged 50-75years, uninsured, due for CRC screening, Texas address and exclusions were a history of CRC, or recent rectal bleeding. Eligible subjects were randomized to either promotora (P), video (V), or combined promotora and video (PV) education, and also received no-cost screening with fecal immunochemical testing or colonoscopy and navigation. The non-randomly allocated controls recruited from a similar county, received no intervention. The main outcome was 6month self-reported CRC screening. Per protocol and worst case scenario analyses, and logistic regression with covariate adjustment were performed. 784 subjects (467 in intervention group, 317 controls) were recruited; mean age was 56.8years; 78.4% were female, 98.7% were Hispanic and 90.0% were born in Mexico. In the worst case scenario analysis (n=784) screening uptake was 80.5% in the intervention group and 17.0% in the control group [relative risk 4.73, 95% CI: 3.69-6.05, P<0.001]. No educational group differences were observed. Covariate adjustment did not significantly alter the effect. A multicomponent community-wide, bilingual, CRC screening intervention significantly increased CRC screening in an uninsured predominantly Hispanic population.
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Affiliation(s)
- Navkiran K Shokar
- Department of Family and Community Medicine and Biomedical Sciences, Texas Tech University Health Sciences Center-El Paso, 9849 Kenworthy Street, El Paso, TX 79924, United States.
| | - Theresa Byrd
- Department of Public Health, Texas Tech University Health Sciences Center, 3601 4th Street STOP 9430, Lubbock, TX 79430-9430, United States.
| | - Rebekah Salaiz
- Department of Family and Community Medicine and Biomedical Sciences, Texas Tech University Health Sciences Center-El Paso, 9849 Kenworthy Street, El Paso, TX 79924, United States.
| | - Silvia Flores
- Department of Family and Community Medicine and Biomedical Sciences, Texas Tech University Health Sciences Center-El Paso, 9849 Kenworthy Street, El Paso, TX 79924, United States.
| | - Maria Chaparro
- Department of Family and Community Medicine and Biomedical Sciences, Texas Tech University Health Sciences Center-El Paso, 9849 Kenworthy Street, El Paso, TX 79924, United States.
| | - Jessica Calderon-Mora
- Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, Office of Diversity Affairs, 5001 El Paso Drive, El Paso, TX 79905, United States
| | - Belinda Reininger
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Regional Brownsville Campus, 80 Fort Brown, Brownsville, TX 78520, United States.
| | - Alok Dwivedi
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, 5001 El Paso Drive, El Paso, TX 79905, United States
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Manning M, Burnett J, Chapman R. Predicting Incongruence between Self-reported and Documented Colorectal Cancer Screening in a Sample of African American Medicare Recipients. Behav Med 2016; 42:238-47. [PMID: 25961362 PMCID: PMC4641836 DOI: 10.1080/08964289.2015.1011600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Assessments of colorectal cancer (CRC) screening rates typically rely on self-reported screening data, which are often incongruent with medical records. We used multilevel models to examine health-related, socio-demographic and psychological predictors of incongruent self-reports for CRC screening among Medicare-insured African Americans (N = 3,740). Results indicated that living alone decreased, and income increased, the odds of congruently self-reporting endoscopic CRC screening. Being male and having greater number of comorbidities decreased, and having less than a high school education increased, the odds of congruently self-reported fecal occult blood tests. Living alone, age and income had the most robust effects across classifications into one of four mutually exclusive categories defined by screening status (screened/unscreened) and congruence of self-reports. The results underscore the clinical importance of gathering socio-demographic data via patient interviews, and the relevance of these data for judging the veracity of self-reported CRC screenings behaviors.
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Affiliation(s)
- Mark Manning
- Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, 4100 John R - MM03CB, Detroit, MI 48201
| | - Janice Burnett
- Josephine Ford Cancer Institute, Division of Hematology and Medical Oncology, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202
| | - Robert Chapman
- Josephine Ford Cancer Institute, Division of Hematology and Medical Oncology, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202
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Katz ML, Reiter PL, Young GS, Pennell ML, Tatum CM, Paskett ED. Adherence to Multiple Cancer Screening Tests among Women Living in Appalachia Ohio. Cancer Epidemiol Biomarkers Prev 2015; 24:1489-94. [PMID: 26282630 DOI: 10.1158/1055-9965.epi-15-0369] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/28/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is a lack of information about the correlates of completing all three cancer screening tests among women living in Appalachia. METHODS Cross-sectional telephone interviews were conducted (April-September 2013) among women (n = 637) ages 51 to 75 years from 12 Appalachia Ohio counties. Outcomes of within screening guidelines were verified by medical records. Multivariable logistic regression models identified correlates of being within guidelines for all three cancer screening tests. RESULTS Screening rates included mammography (32.1%), Pap test (36.1%), and a colorectal cancer test (30.1%). Only 8.6% of women were within guidelines for all tests. Having had a check-up in the past 2 years and having received a screening recommendation were significantly related to being within guidelines for all three tests (P < 0.01). Participants with higher annual household incomes [$60,000+; OR, 3.53; 95% confidence interval (CI), 1.49-8.33] and conditions requiring regular medical visits (OR, 3.16; 95% CI, 1.29-7.74) were more likely to be within guidelines for all three screening tests. CONCLUSION Less than 10% of women had completed screening within guidelines for all three screening tests. Regular contact with the health care system and higher incomes were significant predictors of being within guidelines. IMPACT Within guidelines rates for the three recommended cancer screening tests are low among women in Appalachia Ohio. This finding illustrates the need for innovative interventions to improve rates of multiple cancer screening tests.
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Affiliation(s)
- Mira L Katz
- College of Public Health, The Ohio State University, Columbus, Ohio. Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio. College of Medicine, The Ohio State University, Columbus, Ohio.
| | - Paul L Reiter
- College of Public Health, The Ohio State University, Columbus, Ohio. Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio. College of Medicine, The Ohio State University, Columbus, Ohio
| | - Gregory S Young
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Michael L Pennell
- College of Public Health, The Ohio State University, Columbus, Ohio. Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Cathy M Tatum
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Electra D Paskett
- College of Public Health, The Ohio State University, Columbus, Ohio. Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio. College of Medicine, The Ohio State University, Columbus, Ohio
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Shokar NK, Byrd T, Lairson DR, Salaiz R, Kim J, Calderon-Mora J, Nguyen N, Ortiz M. Against Colorectal Cancer in Our Neighborhoods, a Community-Based Colorectal Cancer Screening Program Targeting Low-Income Hispanics. Health Promot Pract 2015; 16:656-66. [DOI: 10.1177/1524839915587265] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background. Colorectal cancer is the second leading cause of cancer-related death in the United States. Despite universal screening recommendations, screening rates in the United States remain suboptimal, especially among the poor, the uninsured, recent immigrants, and Hispanics. This article describes the development of a large community-based colorectal cancer screening program designed to address these disparities. Method. The Against Colorectal Cancer in our Neighborhoods program is a bilingual, evidence-based, theory-guided, multicomponent community screening intervention, targeting the uninsured and developed using a systematic planning process. It combines community health worker–led outreach, bilingual and culturally tailored community education, and no-cost screening with provision of the fecal immunochemical test or colonoscopy and navigation services. A detailed process and outcome evaluation is planned. Program development cost calculated prospectively (in 2011 dollars) using a societal perspective and micro-costing methods was $243,278, of which $180,344 was direct cost. Discussion. The detailed description of the development processes and costs of this health promotion program targeting low-income Hispanics will inform health program decision makers about the resource requirements for planning and developing new programs to reduce disease burden in communities.
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Affiliation(s)
| | - Theresa Byrd
- Texas Tech University Health Sciences Center, El Paso, TX, USA
| | | | - Rebekah Salaiz
- Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Junghyun Kim
- University of Texas Health Science Center at Houston, TX, USA
| | | | | | - Melchor Ortiz
- Texas Tech University Health Sciences Center, El Paso, 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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14
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Kepka D, Smith A, Zeruto C, Yabroff KR. Is provider type associated with cancer screening and prevention: advanced practice registered nurses, physician assistants, and physicians. BMC Cancer 2014; 14:233. [PMID: 24685149 PMCID: PMC4230633 DOI: 10.1186/1471-2407-14-233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 03/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physician recommendations for cancer screening and prevention are associated with patient compliance. However, time constraints may limit physicians' ability to provide all recommended preventive services, especially with increasing demand from the Affordable Care Act in the United States. Team-based practice that includes advanced practice registered nurses and physician assistants (APRN/PA) may help meet this demand. This study investigates the relationship between an APRN/PA visit and receipt of guideline-consistent cancer screening and prevention recommendations. METHODS Data from the 2010 National Health Interview Survey were analyzed with multivariate logistic regression to assess provider type seen and receipt of guideline-consistent cancer screening and prevention recommendations (n = 26,716). RESULTS In adjusted analyses, women who saw a primary care physician (PCP) and an APRN/PA or a PCP without an APRN/PA in the past 12 months were more likely to be compliant with cervical and breast cancer screening guidelines than women who did not see a PCP or APRN/PA (all p < 0.0001 for provider type). Women and men who saw a PCP and an APRN/PA or a PCP without an APRN/PA were also more likely to receive guideline consistent colorectal cancer screening and advice to quit smoking and participate in physical activity than women and men who did not see a PCP or APRN/PA (all p < 0.01 for provider type). CONCLUSIONS Seeing a PCP alone, or in conjunction with an APRN/PA is associated with patient receipt of guideline-consistent cancer prevention and screening recommendations. Integrating APRN/PA into primary care may assist with the delivery of cancer prevention and screening services. More intervention research efforts are needed to explore how APRN/PA will be best able to increase cancer screening, HPV vaccination, and receipt of behavioral counseling, especially during this era of healthcare reform.
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Affiliation(s)
- Deanna Kepka
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | | | - K Robin Yabroff
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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Oldach BR, Katz ML. Health literacy and cancer screening: a systematic review. PATIENT EDUCATION AND COUNSELING 2014; 94:149-57. [PMID: 24207115 PMCID: PMC3946869 DOI: 10.1016/j.pec.2013.10.001] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 08/12/2013] [Accepted: 10/05/2013] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To evaluate published evidence about health literacy and cancer screening. METHODS Seven databases were searched for English language articles measuring health literacy and cancer screening published in 1990-2011. Articles meeting inclusion criteria were independently reviewed by two investigators using a standardized data abstraction form. Abstracts (n=932) were reviewed and full text retrieved for 83 articles. Ten articles with 14 comparisons of health literacy and cancer screening according to recommended medical guidelines were included in the analysis. RESULTS Most articles measured health literacy using the S-TOFHLA instrument and documented cancer screening by self-report. There is a trend for an association of inadequate health literacy and lower cancer screening rates, however, the evidence is mixed and limited by study design and measurement issues. CONCLUSION A patient's health literacy may be a contributing factor to being within recommended cancer screening guidelines. PRACTICE IMPLICATIONS Future research should: be conducted using validated health literacy instruments; describe the population included in the study; document cancer screening test completion according to recommended guidelines; verify the completion of cancer screening tests by medical record review; adjust for confounding factors; and report effect size of the association of health literacy and cancer screening.
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Affiliation(s)
- Benjamin R Oldach
- Comprehensive Cancer Center, The Ohio State University, Columbus, USA
| | - Mira L Katz
- Comprehensive Cancer Center, The Ohio State University, Columbus, USA; Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, USA.
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16
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Pisu M, Holt CL, Brown-Galvan A, Fairley T, Smith JL, White A, Hall IJ, Oster RA, Martin MY. Surveillance instructions and knowledge among African American colorectal cancer survivors. J Oncol Pract 2014; 10:e45-50. [PMID: 24385336 DOI: 10.1200/jop.2013.001203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION African Americans are less likely than other racial/ethnic groups to receive appropriate surveillance, an important component of care to achieve better long-term outcomes and well-being after colorectal cancer (CRC) treatment. This study explored survivors' understanding of surveillance instructions and purpose. PATIENTS AND METHODS Interviews with 60 African American CRC survivors were recorded and transcribed. Compliance with surveillance guidelines was defined by disease stage and self-reported tests. Four coders (blind to compliance status) independently reviewed transcripts. Frequency of themes was reported by compliance status. RESULTS Survivors (4 to 6 years postdiagnosis; women, 57%; age ≥ 65 years, 60%; rural location, 57%; early-stage disease, 62%) were 48% noncompliant. Most survivors reported receiving surveillance instructions from providers (compliant, 80%; noncompliant, 76%). There was variation in recommended frequency of procedures (eg, every 3 or 12 months) and in importance of surveillance stressed by physicians. Most survivors understood the need for follow-up (compliant, 87%; noncompliant, 79%). Lack of knowledge of/interest in surveillance was more common among noncompliant individuals (compliant, 32%; noncompliant, 52%). CONCLUSION Patients' limited understanding about the importance of CRC surveillance and procedures may negatively affect compliance with recommendations in African American CRC survivors. Clear and enhanced communications about post-treatment recommendations in this population are warranted.
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Affiliation(s)
- Maria Pisu
- University of Alabama at Birmingham, Birmingham, AL; University of Maryland, College Park, MD; and Centers for Disease Control and Prevention, Atlanta, GA
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Perencevich M, Ojha RP, Steyerberg EW, Syngal S. Racial and ethnic variations in the effects of family history of colorectal cancer on screening compliance. Gastroenterology 2013; 145:775-81.e2. [PMID: 23796457 PMCID: PMC3783551 DOI: 10.1053/j.gastro.2013.06.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 06/13/2013] [Accepted: 06/18/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Individuals with a family history of colorectal cancer (CRC) have a higher risk of developing CRC than the general population, and studies have shown that they are more likely to undergo CRC screening. We assessed the overall and race- and ethnicity-specific effects of a family history of CRC on screening. METHODS We analyzed data from the 2009 California Health Interview Survey to estimate overall and race- and ethnicity-specific odds ratios (ORs) for the association between family history of CRC and CRC screening. RESULTS The unweighted and weighted sample sizes were 23,837 and 8,851,003, respectively. Individuals with a family history of CRC were more likely to participate in any form of screening (OR, 2.3; 95% confidence limit [CL], 1.7, 3.1) and in colonoscopy screening (OR, 2.7; 95% CL, 2.2, 3.4) than those without a family history, but this association varied among racial and ethnic groups. The magnitude of the association between family history and colonoscopy screening was highest among Asians (OR, 6.1; 95% CL, 3.1, 11.9), lowest among Hispanics (OR, 1.4; 95% CL, 0.67, 2.8), and comparable between non-Hispanic whites (OR, 3.1; 95% CL, 2.6, 3.8) and non-Hispanic blacks (OR 2.6; 95% CL, 1.2, 5.7) (P for interaction < .001). CONCLUSIONS The effects of family history of CRC on participation in screening vary among racial and ethnic groups, and have the lowest effects on Hispanics, compared with other groups. Consequently, interventions to promote CRC screening among Hispanics with a family history should be considered.
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Affiliation(s)
- Molly Perencevich
- Division of Gastroenterology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Rohit P. Ojha
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ewout W. Steyerberg
- Center for Medical Decision Making, Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sapna Syngal
- Division of Gastroenterology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
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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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Greene P, Mehta P, Yeary KHCK, Bursac Z, Zhang J, Goldsmith G, Henry-Tillman R. Using population data to reduce disparities in colorectal cancer screening, Arkansas, 2006. Prev Chronic Dis 2012; 9:E138. [PMID: 22898236 PMCID: PMC3475514 DOI: 10.5888/pcd9.110256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Colorectal cancer is a common disease, and incidence and death rates are higher in medically underserved populations. The colorectal cancer death rate in Arkansas exceeds the national rate. The objective of this study was to examine population characteristics relevant to the design and implementation of a state-sponsored colorectal cancer screening program that is responsive to medically underserved populations. Methods Trained interviewers in 2006 conducted a random-digit–dialed telephone survey comprising items selected from the Health Information National Trends Survey to characterize demographic factors, health care variables, and colorectal screening history in a sample (n = 2,021) representative of the Arkansas population. Univariate and multivariate analyses identified associations among population characteristics and screening status. Results Participants who were aged 50 to 64, who did not have health insurance, or who had an annual household income of $15,000 or less were significantly less likely than their counterparts to be in compliance with screening guidelines. Those who reported having a health care provider, having 5 or more health care visits during the past year, and receiving physician advice for colorectal screening were more likely to be in compliance with screening guidelines. Although a larger percentage of white participants were in compliance with screening guidelines, blacks had higher screening rates than whites when we controlled for screening advice. Conclusion Survey results informed efforts to decrease disparities in colorectal cancer screening in Arkansas. Efforts should focus on reimbursing providers and patients for screening costs, encouraging the use of physicians as a point of entry to screening programs, and promoting a balanced approach (ie, multiple options) to screening recommendations. Our methods established a model for developing screening programs for medically underserved populations.
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Affiliation(s)
- Paul Greene
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham no. 820, Little Rock, AR 72205, USA.
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Abstract
BACKGROUND Physician recommendation is one of the strongest, most consistent predictors of colorectal cancer (CRC) screening. Little is known regarding characteristics associated with patient adherence to physician recommendations in community and academic based primary care settings. METHODS Data were analyzed from 975 patients, aged ≥50 years, recruited from 25 primary care practices in New Jersey. Chi-square and generalized estimate equation analyses determined independent correlates of receipt of and adherence to physician recommendation for CRC. RESULTS Patients reported high screening rates for CRC (59%). More than three fourths of patients reported either screening or having received a screening recommendation (82%). Men (P = .0425), nonsmokers (P = .0029), and patients who were highly educated (P = .0311) were more likely to receive a CRC screening recommendation. Patients more adhere to CRC screening recommendations were older adults (P < .0001), nonsmokers (P = .0005), those who were more highly educated (P = .0365), Hispanics (P = .0325), and those who were married (P < .0001). CONCLUSIONS Community and academic primary care clinicians appropriately recommended screening to high-risk patients with familial risk factors. However, they less frequently recommended screening to others (ie, women and smokers) also likely to benefit. To further increase CRC screening, clinicians must systematically recommend screening to all patients who may benefit.
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Shapiro JA, Klabunde CN, Thompson TD, Nadel MR, Seeff LC, White A. Patterns of colorectal cancer test use, including CT colonography, in the 2010 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev 2012; 21:895-904. [PMID: 22490320 DOI: 10.1158/1055-9965.epi-12-0192] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Recommended colorectal cancer (CRC) screening tests for adults ages 50 to 75 years include home fecal occult blood tests (FOBT), sigmoidoscopy with FOBT, and colonoscopy. A newer test, computed tomographic (CT) colonography, has been recommended by some, but not all, national organizations. METHODS We analyzed 2010 National Health Interview Survey data, including new CT colonography questions, from respondents ages 50 to 75 years (N = 8,952). We (i) assessed prevalence of CRC test use overall, by test type, and by sociodemographic and health care access factors and (ii) assessed reported reasons for not having a CRC test. RESULTS The age-standardized percentage of respondents reporting FOBT, sigmoidoscopy, or colonoscopy within recommended time intervals was 58.3% [95% confidence interval (CI), 57.0-59.6]. Colonoscopy was the most commonly reported test [within past 10 years: 54.6% (95% CI, 53.2-55.9)]. Home FOBT and sigmoidoscopy with FOBT were less frequently used [FOBT within past year: 8.8% (95% CI, 8.1-9.6); sigmoidoscopy within past 5 years with FOBT within past 3 years: 1.3% (95% CI, 1.0-1.6)]. CT colonography was rare: 1.3% (95% CI, 1.0-1.7). Increasing age, education, income, having health care insurance, and having a usual source of health care were associated with higher CRC test use. Test use within recommended time intervals was particularly low among individuals ages 50 to 64 years without health care insurance [21.2% (95% CI, 18.3-24.4)]. The most common reason for nonuse was "no reason or never thought about it." CONCLUSIONS About 40% of Americans ages 50 to 75 years do not meet the recommendations for having CRC screening tests. IMPACT Expanded health care coverage and greater awareness of CRC screening are needed to further decrease CRC mortality.
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Affiliation(s)
- Jean A Shapiro
- Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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