1
|
Beydoun HA, Tsai J. Lifetime prevalence and correlates of colorectal cancer screening among low-income U.S. Veterans. Cancer Causes Control 2024; 35:1215-1231. [PMID: 38714606 DOI: 10.1007/s10552-024-01881-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 04/10/2024] [Indexed: 05/10/2024]
Abstract
PURPOSE The Veterans Health Administration (VHA) is the largest integrated healthcare system in the U.S. While preventive healthcare services are high priority in the VHA, low-income U.S. Veterans experience adverse life circumstances that may negatively impact their access to these services. This study examined lifetime prevalence as well as demographic, socioeconomic, military-specific, and clinical correlates of colorectal cancer (CRC) screening among low-income U.S. Veterans ≥ 50 years of age. METHODS Cross-sectional data on 862 participants were analyzed from the 2021-2022 National Veteran Homeless and Other Poverty Experiences study. RESULTS Overall, 55.3% (95% confidence interval [CI] 51.3-59.3%) reported ever-receiving CRC-screening services. In a multivariable logistic regression model, never-receivers of CRC screening were twice as likely to reside outside of the Northeast, and more likely to be married (odds ratio [OR] = 1.86, 95% CI 1.02, 3.37), have BMI < 25 kg/m2 [vs. 25- < 30 kg/m2] (OR = 1.75, 95% CI 1.19, 2.58), or ≥ 1 chronic condition (OR = 1.46, 95% CI 1.06, 2.02). Never-receivers of CRC screening were less likely to be female (OR = 0.53, 95% CI 0.29, 0.96), aged 65-79y [vs. ≥ 80y] (OR = 0.61, 95% CI 0.40, 0.92), live in 5 + member households (OR = 0.33, 95% CI 0.13, 0.86), disabled (OR = 0.45, 0.22, 0.92), with purchased health insurance (OR = 0.56, 95% CI 0.33, 0.98), or report alcohol-use disorder (OR = 0.10, 95% CI 0.02, 0.49) and/or HIV/AIDS (OR = 0.28, 95% CI 0.12, 0.68). CONCLUSION Nearly 55% of low-income U.S. Veterans reported ever screening for CRC. Variations in CRC-screening behaviors according to veteran characteristics highlight potential disparities as well as opportunities for targeted behavioral interventions.
Collapse
Affiliation(s)
- Hind A Beydoun
- National Center on Homelessness Among Veterans (NCHAV), Veterans Health Administration, 810 Vermont Avenue, NW, Washington, DC, 20420, USA.
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Jack Tsai
- National Center on Homelessness Among Veterans (NCHAV), Veterans Health Administration, 810 Vermont Avenue, NW, Washington, DC, 20420, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
2
|
Li R, Li C, Liu L, Chen W, Bai Y. Factors affecting colonoscopy screening among first-degree relatives of colorectal cancer patients: A mixed-method systematic review. Worldviews Evid Based Nurs 2024; 21:245-252. [PMID: 37950436 DOI: 10.1111/wvn.12689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND First-degree relatives (FDRs) of colorectal cancer (CRC) patients have a higher risk of developing CRC than the general population. Ensuring that these at-risk populations receive colonoscopy screening is an effective strategy for reducing the increased risk, but the rates remain low. Colonoscopy screening behavior is influenced by factors at multiple levels. However, most previous reviews failed to review them and their interactions systematically. AIMS To explore factors influencing FDRs' colonoscopy screening behavior according to the ecological model. METHOD A mixed-method systematic review was performed in accordance with The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. A comprehensive literature search was conducted using eight bibliographic databases (Medline, EMBASE, PubMed, the Cochrane Library, Scopus, China National Knowledge Infrastructure, Wan Fang Data, and China Biology Medicine) for the period from January 1995 to February 2023. The Joanna Briggs Institute critical appraisal checklists were applied to assess studies qualities. A convergent integrated approach was used for data synthesis and integration. RESULTS In total, 24 articles reporting on 23 studies were included. Only one study was rated low quality, and the other 22 studies were rated moderate to high quality. The findings revealed that certain factors and their interactions affected FDRs' colonoscopy screening behaviors according to the ecological model, including misconceptions about CRC and colonoscopy, concerns about the procedure, perceived susceptibility to developing CRC, health motivation, fear of CRC, fatalism, the recommendation from CRC patients, and recommendations from physicians, colonoscopy schedules, cancer taboo, health insurance and cost of colonoscopy. LINK EVIDENCE TO ACTION Family communication-centered multilevel interventions are recommended to promote colonoscopy screening behavior among FDRs of CRC patients.
Collapse
Affiliation(s)
- Rujin Li
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Caixia Li
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Li Liu
- School of Nursing, Central South University, Changsha, China
| | - Weicong Chen
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yang Bai
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| |
Collapse
|
3
|
Elshami M, Albandak M, Alser M, Al-Slaibi I, Ayyad M, Dwikat MF, Naji SA, Mohamad BM, Isleem WS, Shurrab A, Yaghi B, Qabaja YA, Hamdan FK, Sweity RR, Jneed RT, Assaf KA, Hmaid MM, Awwad II, Alhabil BK, Alarda MN, Alsattari AS, Aboyousef MS, Aljbour OA, AlSharif R, Giacaman CT, Alnaga AY, Abu Nemer RM, Almadhoun NM, Skaik SM, Albarqi SI, Abu-El-Noor N, Bottcher B. Screening Perspectives: The Role of Colorectal Cancer Awareness in Shaping Attitudes Toward Colonoscopy in Palestine. JCO Glob Oncol 2024; 10:e2300470. [PMID: 38386956 PMCID: PMC10898669 DOI: 10.1200/go.23.00470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/05/2024] [Indexed: 02/24/2024] Open
Abstract
PURPOSE To assess colorectal cancer (CRC) awareness and its influence on attitudes toward colonoscopy in Palestine. MATERIALS AND METHODS Convenience sampling was used to recruit Palestinian adults from hospitals, primary health care centers, and public spaces across 11 governorates. To evaluate the awareness of CRC signs/symptoms, risk factors, and mythical causes, the Bowel Cancer Awareness Measure and Cancer Awareness Measure-Mythical Causes Scale were used after translation into Arabic. For each correctly recognized item, one point was given. The total awareness score of each domain was calculated and categorized into tertiles; the top tertile was considered high awareness, and the other two tertiles were considered low awareness. RESULTS A total of 4,623 questionnaires were included. Only 1,849 participants (40.0%) exhibited high awareness of CRC signs/symptoms. High awareness of CRC symptoms was associated with higher likelihood of showing positive attitudes toward colonoscopy (odds ratio [OR], 1.21 [95% CI, 1.07 to 1.37]). A total of 1,840 participants (38.9%) demonstrated high awareness of CRC risk factors. Participants with high awareness of CRC risk factors were more likely to display positive attitudes toward colonoscopy (OR, 1.20 [95% CI, 1.07 to 1.37]). Only 219 participants (4.7%) demonstrated high awareness of CRC causation myths. There was no association between awareness of CRC causation myths and positive attitudes toward colonoscopy. CONCLUSION Awareness of CRC was poor with less than half of the study participants demonstrating high awareness of CRC signs/symptoms and risk factors, and a minority (<5%) displaying high awareness of CRC causation myths. High awareness of CRC signs/symptoms and risk factors was associated with greater likelihood of demonstrating positive attitudes toward colonoscopy. Educational initiatives are needed to address knowledge gaps and dispel misconceptions surrounding CRC.
Collapse
Affiliation(s)
- Mohamedraed Elshami
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
- Ministry of Health, Gaza, Palestine
| | - Maram Albandak
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Mohammed Alser
- The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Gaza, Palestine
| | | | - Mohammed Ayyad
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Shoruq A. Naji
- Faculty of Pharmacy, Al-Azhar University of Gaza, Gaza, Palestine
| | | | - Wejdan S. Isleem
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Bashar Yaghi
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Fatma K. Hamdan
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Remah T. Jneed
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Khayria A. Assaf
- Faculty of Medicine, An-Najah National University, Nablus, Palestine
| | | | - Iyas I. Awwad
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Marah N. Alarda
- Faculty of Dentistry, Arab American University, Jenin, Palestine
| | | | | | - Omar A. Aljbour
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Rinad AlSharif
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Ali Y. Alnaga
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Ranin M. Abu Nemer
- Faculty of Allied Medical Sciences, Arab American University, Jenin, Palestine
| | | | | | | | | | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| |
Collapse
|
4
|
Biederman E, Baltic R, Katz ML, Rawl S, Vachon E, Monahan PO, Stump TE, Kettler C, Carter L, Young G, Xu W, Paskett ED, Champion V. Increasing breast, cervical, and colorectal cancer screening among rural women: Baseline characteristics of a randomized control trial. Contemp Clin Trials 2022; 123:106986. [PMID: 36328234 DOI: 10.1016/j.cct.2022.106986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/22/2022] [Accepted: 10/26/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Rural women suffer disproportionately from breast, cervical, and colorectal cancer mortality compared to those in urban areas. Screening behaviors for these three cancers share many similar beliefs and barriers. Unfortunately, published interventions have not attempted to simultaneously bring women up to date with screening for three cancers (breast, cervical, and colorectal) even though multiple behavior change interventions are effective. The aim of this randomized controlled study was to compare the effectiveness of a mailed interactive and tailored DVD vs. DVD plus telephonic patient navigation (DVD + PN) vs. Usual Care (UC) to increase the percentage of rural women (aged 50-74) up to date for breast, cervical, and colorectal cancer screening. METHODS Nine hundred eighty-three participants needing one, two, or three cancer screening tests were consented and randomized to one of three groups. Prior to randomization, women were assessed for baseline characteristics including sociodemographics, health status, and cancer screening test beliefs. Screening status was assessed by medical record review. RESULTS At baseline, the average age of participants was 58.6 years. Nineteen percent of the sample was not up to date with screenings for all three cancers. Colorectal cancer had the highest percentage of women (69%) who were not up to date with screening followed by cervical (57%) and then breast cancer (41%). Sixty percent of women reported receiving a reminder for mammography; 30%, for cervical cancer screening; 15% for colonoscopy; and 6% for FOBT/FIT. DISCUSSION Increasing adherence to colorectal cancer screening may be the most urgent need among all screening tests. This clinical trial is registered at clinicaltrials.gov with identifier NCT02795104.
Collapse
Affiliation(s)
- Erika Biederman
- The Ohio State University (OSU) Comprehensive Cancer Center, Suite 525, 1590 North High Street, Columbus, OH 43201, United States of America.
| | - Ryan Baltic
- The OSU Comprehensive Cancer Center, Suite 525, 1590 North High Street, Columbus, OH 43201, United States of America.
| | - Mira L Katz
- College of Public Health and the OSU Comprehensive Cancer Center, Suite 525, 1590 North High Street, Columbus, OH 43201, United States of America.
| | - Susan Rawl
- Indiana School of Nursing and the Indiana University Simon Comprehensive Cancer Center, 600 Barnhill Drive, NU345E Indianapolis, IN, United States of America.
| | - Eric Vachon
- Indiana University School of Nursing and Center for Health Services Research, Regenstrief Institute, 600 Barnhill Drive, NUW427 Indianapolis, IN, United States of America.
| | - Patrick O Monahan
- Department of Biostatistics and Health Data Science, School of Medicine & Fairbanks School of Public Health, Biostatistics and Data Management Core, Indiana University Simon Comprehensive Cancer Center, 410 W. 10(th) St., Suite 3000, Indianapolis, IN 46202, United States of America.
| | - Timothy E Stump
- Department of Biostatistics and Health Data Science, School of Medicine, 410 W. 10(th) St, Suite 3000, Indianapolis, IN 46202, United States of America.
| | - Carla Kettler
- Department of Biostatistics and Health Data Science, 410 W. 10(th) St., Suite 3000, Indianapolis, IN 46202, United States of America.
| | - Lisa Carter
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7(th) Floor, New York, NY 10022, United States of America.
| | - Gregory Young
- The Ohio State University, College of Medicine, Department of Biomedical Informatics, 1800 Cannon Dr., Columbus, OH 43210, United States of America
| | - Wendy Xu
- College of Public Health and The OSU Comprehensive Cancer Center, 1841 Neil Ave, Columbus, OH 43210, United States of America.
| | - Electra D Paskett
- College of Medicine and The Ohio State University (OSU) Comprehensive Cancer Center, Suite 525, 1590 North High Street, Columbus, OH 43201, United States of America.
| | - Victoria Champion
- Indiana School of Nursing and IU Comprehensive Cancer Center, 600 Barnhill Drive, NU317 Indianapolis, IN, United States of America.
| |
Collapse
|
5
|
Vachon E, Robb BW, Haggstrom DA. Impact of a Personal Health Record Intervention Upon Surveillance Among Colorectal Cancer Survivors: Feasibility Study. JMIR Cancer 2022; 8:e34851. [PMID: 35969424 PMCID: PMC9412760 DOI: 10.2196/34851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/07/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are currently an estimated 1.5 million individuals living in the United States with colorectal cancer (CRC), and although the 5-year survival rate has increased, survivors are at risk for recurrence, particularly within the first 2-3 years after treatment. National guidelines recommend continued surveillance after resection to identify recurrence early on. Adherence among survivors ranges from 23% to 94%. Novel interventions are needed to increase CRC survivors' knowledge and confidence in managing their cancer and thus to increase adherence to follow-up surveillance. OBJECTIVE The objective of this study is to develop and test the feasibility and efficacy of a stand-alone, web-based personal health record (PHR) to increase surveillance adherence among CRC survivors, with patient beliefs about surveillance as secondary outcomes. METHODS A pre- and postintervention feasibility trial was conducted testing the efficacy of the colorectal cancer survivor (CRCS)-PHR, which had been previously developed using an iterative, user-centered design approach. RESULTS The average age of the sample was 58 (SD 9.9) years, with 57% (16/28) male and the majority married (20/28, 71%) and employed full-time (15/28, 54%). We observed a significant increase in adherence to colonoscopy (before: 11/21, 52% vs after: 18/21, 86%; P=.005) and CEA (14/21, 67% vs 20/21, 95%; P=.01), as well as a slight increase in CT scans (14/21, 67% vs 18/21, 86%; P=.10). The only significant impact on secondary outcome (patient beliefs) was benefits of CEA test (P=.04), as most of the beliefs were high at baseline. CONCLUSIONS This feasibility study lays the groundwork for continued development of the CRCS-PHR to increase CRC surveillance. Patient-centered technologies, such as the CRCS-PHR, represent an important potential approach to improving the receipt of guideline-concordant care and follow-up surveillance, and not just for CRC survivors. Researchers should continue to develop patient-centered health technologies with clinician implementation in mind to increase patient self-efficacy and surveillance adherence.
Collapse
Affiliation(s)
- Eric Vachon
- School of Nursing, Indiana University, Indianapolis, IN, United States
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
| | - Bruce W Robb
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - David A Haggstrom
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
- Division of General Internal Medicine and Geriatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
| |
Collapse
|
6
|
Fatima H, Wajid M, Krier C, Champion V, Carter-Harris L, Shedd-Steele R, Imperiale TF, Schwartz P, Strom S, Magnarella M, Rawl SM. Development of a Computer-Tailored Intervention/Decision Aid To Increase Colorectal Cancer Screening in Health Systems. Cureus 2022; 14:e23372. [PMID: 35475065 PMCID: PMC9020808 DOI: 10.7759/cureus.23372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 12/09/2022] Open
|
7
|
Alduraywish SA, Altamimi LA, Almajed AA, Kokandi BA, Alqahtani RS, Alghaihb SG, Aldakheel FM. Barriers of colorectal cancer screening test among adults in the Saudi Population: A Cross-Sectional study. Prev Med Rep 2020; 20:101235. [PMID: 33194537 PMCID: PMC7645071 DOI: 10.1016/j.pmedr.2020.101235] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 12/22/2022] Open
Abstract
Lack of physician recommendation was commonly reported barrier to CRC screening. Barriers to CRC screening were observed more in females. Barriers to CRC screening were seen more in those who had not performed CRC screening.
Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer death worldwide. CRC can be completely cured if detected at an early stage with screening. However, many barriers to screening have been reported. This study aimed to identify the potential barriers to CRC screening among the Saudi population aged ≥45 years. A cross-sectional study of randomly selected adults (aged ≥45 years) attending primary care clinics at KKUH in Saudi Arabia was conducted. A self-administered questionnaire was used to collect data. A total of 448 participants were included. In general, the most commonly reported barrier to CRC screening was a lack of physician recommendation (77.1%). Moreover, fear of painful colonoscopy procedures and a lack of knowledge regarding the availability of the fecal occult blood test (FOBT) were reported by 51.6% and 57.8% of patients, respectively. Significant gender differences were observed, with females reporting more barriers to CRC screening than males (general barriers [p < 0.001] and colonoscopy-specific barriers [p = 0.003]). Participants who had not undergone any previous CRC screening reported significantly more barriers compared to those who had undergone a previous CRC screening (general barriers [p = 0.015], colonoscopy-specific barriers [p = 0.006], and FOBT specific barriers [p = 0.024]). Because a lack of physician recommendation was the most commonly reported general barrier, we recommend that physicians emphasize the need for CRC screening, particularly to high-risk patients. Extensive campaigns and programs must be launched to raise awareness about the importance of screening for CRC. Additionally, gender-specific strategies need to be formulated to promote CRC screening in females.
Collapse
Affiliation(s)
- Shatha A. Alduraywish
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Prince Sattam Research Chair for Epidemiology and Public Health, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Corresponding author at: Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | | | | | | | | | | | - Fahad M. Aldakheel
- Prince Sattam Research Chair for Epidemiology and Public Health, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
8
|
Travis E, Ashley L, Pownall M, O'Connor DB. Barriers to flexible sigmoidoscopy colorectal cancer screening in low uptake socio-demographic groups: A systematic review. Psychooncology 2020; 29:1237-1247. [PMID: 32539187 DOI: 10.1002/pon.5443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To synthesise qualitative evidence related to barriers and facilitators of flexible sigmoidoscopy screening (FSS) intention and uptake, particularly within low socio-demographic uptake groups. FSS uptake is lower amongst women, lower socio-economic status (SES), and Asian ethnic groups within the United Kingdom (UK) and United States of America. METHODS A total of 12 168 articles were identified from searches of four databases: EMBASE, MEDLINE, PsycINFO and Web of Science. Eligibility criteria included: individuals eligible to attend FSS and empirical peer-reviewed studies that analysed qualitative data. The Critical Appraisal Skills Program tool evaluated the methodological quality of included studies, and thematic synthesis was used to analyse the data. RESULTS Ten qualitative studies met the inclusion criteria. Key barriers to FSS intention and uptake centred upon procedural anxieties. Women, including UK Asian women, reported shame and embarrassment, anticipated pain, perforation risk, and test preparation difficulties to elevate anxiety levels. Religious and cultural-influenced health beliefs amongst UK Asian groups were reported to inhibit FSS intention and uptake. Competing priorities, such as caring commitments, particularly impeded women's ability to attend certain FSS appointments. The review identified a knowledge gap concerning factors especially associated with FSS participation amongst lower SES groups. CONCLUSIONS Studies mostly focussed on barriers and facilitators of intention to participate in FSS, particularly within UK Asian groups. To determine the barriers associated with FSS uptake, and further understand how screening intention translates to behaviour, it is important that future qualitative research is equally directed towards factors associated with screening behaviour.
Collapse
Affiliation(s)
| | - Laura Ashley
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
| | | | | |
Collapse
|
9
|
Temucin E, Nahcivan NO. The Effects of the Nurse Navigation Program in Promoting Colorectal Cancer Screening Behaviors: a Randomized Controlled Trial. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:112-124. [PMID: 30470978 DOI: 10.1007/s13187-018-1448-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although screening programs are known and recommended for the early detection of colorectal cancer (CRC), the screening rates for the fecal occult blood test (FOBT) and colonoscopy are very low among adult individuals. Navigation programs, also known as individualized counseling, have recently begun to be used for increasing screening rates. The purpose of this study was to compare the efficacy of the Nurse Navigation Program versus usual care on CRC screening participation and movement in stage of adoption for CRC screening and to examine perceived benefits of and barriers to CRC screening. This study was designed in line with a pre- and posttest two-group methodology. A total of 110 participants (55 nurse-navigated and 55 non-navigated patients) were studied. Data were collected using the following three tools: a sociodemographic information form, the Harvard Colorectal Cancer Risk Assessment Tool, and Instruments to Measure Colorectal Cancer Screening Benefits and Barriers. Following the Nurse Navigation Program, the FOBT (82 and 84%, respectively) and colonoscopy completion rates (15 and 22%, respectively) were significantly higher in the nurse-navigated group than in the non-navigated group at 3 and 6 months follow-up. Following the program, the benefit perceptions of the nurse-navigated group about CRC screening were improved, and their barrier perceptions were reduced. The results showed that the Nurse Navigation Program had significant effects on CRC screening behavior and health-related beliefs concerning CRC screening. Further assessment of the Nurse Navigation Program in different groups should be performed to observe its effects.
Collapse
Affiliation(s)
- Elif Temucin
- Nursing Faculty, Oncology Nursing Department, University of Health Sciences, Istanbul, Turkey.
| | - Nursen O Nahcivan
- Florence Nightingale Nursing Faculty, Public Health Nursing Department, Istanbul University, Istanbul, Turkey
| |
Collapse
|
10
|
Tsoh JY, Tong EK, Sy AU, Stewart SL, Gildengorin GL, Nguyen TT. Knowledge of colorectal cancer screening guidelines and intention to obtain screening among nonadherent Filipino, Hmong, and Korean Americans. Cancer 2019; 124 Suppl 7:1560-1567. [PMID: 29578604 DOI: 10.1002/cncr.31097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/10/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Nonadherence to colorectal cancer (CRC) screening among Asian Americans is high but not well understood. This study examined correlates of screening intention among Filipino, Hmong, and Korean Americans who were nonadherent to CRC screening. METHODS Using cross-sectional, preintervention survey data from 504 Asian Americans (115 Filipinos, 185 Hmong, and 204 Koreans) aged 50-75 years who were enrolled in a multisite cluster randomized controlled trial of lay health educator intervention, we analyzed correlates of self-reported CRC screening nonadherence, which was defined as not being up-to-date for fecal occult blood test, sigmoidoscopy, or colonoscopy. RESULTS Only 26.8% of participants indicated intention to obtain screening within 6 months (Hmong: 12.4%; Korean: 30.8%; and Filipino: 42.6%; P < .001). Only one third of participants had undergone a prior screening, and a majority did not know that screening is a method of CRC prevention method (61.3%) or had any knowledge of CRC screening guidelines (53.4%). Multivariable analyses revealed that patient-provider ethnicity concordance, provider's recommendation of screening, participants' prior CRC screening, perceived severity and susceptibility of CRC, and knowledge of guidelines were positively associated with screening intention. Specifically, knowing one or more screening guidelines doubled the odds of screening intention (adjusted odds ratio, 2.38; 95% confidence interval, 1.32-4.28). Hmong were less likely to have screening intention than Filipinos, which was unexplained by socio-demographics, health care factors, perceived needs for CRC screening, or knowledge of screening guidelines. CONCLUSION CRC screening intention among nonadherent Filipino, Hmong, and Korean Americans was low. Targeting knowledge of CRC screening guidelines may be effective strategies for increasing CRC screening intention among nonadherent Asian Americans. Cancer 2018;124:1560-7. © 2018 American Cancer Society.
Collapse
Affiliation(s)
- Janice Y Tsoh
- Department of Psychiatry, University of California San Francisco, San Francisco, California.,Asian American Research Center on Health, San Francisco, California
| | - Elisa K Tong
- Asian American Research Center on Health, San Francisco, California.,Department of Internal Medicine, University of California Davis, Davis, California
| | - Angela U Sy
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Susan L Stewart
- Department of Public Health Sciences, University of California Davis, Davis, California
| | - Ginny L Gildengorin
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California
| | - Tung T Nguyen
- Asian American Research Center on Health, San Francisco, California.,Division of General Internal Medicine, University of California San Francisco, San Francisco, California
| |
Collapse
|
11
|
McGarragle KM, Hare C, Holter S, Facey DA, McShane K, Gallinger S, Hart TL. Examining intrafamilial communication of colorectal cancer risk status to family members and kin responses to colonoscopy: a qualitative study. Hered Cancer Clin Pract 2019; 17:16. [PMID: 31391872 PMCID: PMC6595615 DOI: 10.1186/s13053-019-0114-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 06/03/2019] [Indexed: 01/21/2023] Open
Abstract
Background First-degree relatives (FDRs) of probands with colorectal cancer (CRC) may be at increased risk of CRC and require colonoscopy. Proband disclosure about this risk and need for colonoscopy is essential for FDRs to take appropriate action. Low colonoscopy rates are reported among FDRs and little is known about the proband disclosure process. A better understanding of the barriers surrounding colonoscopy and disclosure is needed. Methods CRC probands (n = 16) and FDRs (n = 9), recruited from a Canadian CRC Consortium, completed interviews to determine barriers to disclosure and colonoscopy, respectively. Interviews were analyzed using thematic analysis and participants’ motivation to disclose to FDRs or undertake colonoscopy was categorized into Stages of Change (i.e., Precontemplation, Contemplation, Preparation, Action, or Maintenance) using the transtheoretical model. Results 25% of probands had not disclosed to any first-degree kin and were categorized in the Precontemplation or Contemplation Stage of Change. Barriers to disclosure included lack of information, negative expectations about familial reaction, assuming FDRs were aware of risk or already being screened, dysfunctional family dynamics, and cultural barriers. 75% of FDRs were categorized in the Precontemplation or Contemplation Stage of Change. Barriers included negative perceptions about colonoscopy, health-care provider related factors, practical concerns, and lack of information about CRC, risk, and colonoscopy. Conclusions In the absence of barriers such as cost and accessibility, this Canadian sample still reported several challenges to disclosure and colonoscopy adherence. Future research should explore interventions such as motivational interviewing to improve proband disclosure and to increase FDR adherence to colonoscopy.
Collapse
Affiliation(s)
| | - Crystal Hare
- 1Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada
| | - Spring Holter
- 2Zane Cohen Centre for Digestive Diseases, Sinai Health System, Box 24-60 Murray Street, Toronto, ON M5T 3L9 Canada
| | - Dorian Anglin Facey
- 2Zane Cohen Centre for Digestive Diseases, Sinai Health System, Box 24-60 Murray Street, Toronto, ON M5T 3L9 Canada
| | - Kelly McShane
- 1Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada
| | - Steven Gallinger
- 2Zane Cohen Centre for Digestive Diseases, Sinai Health System, Box 24-60 Murray Street, Toronto, ON M5T 3L9 Canada.,3Department of General Surgery, Toronto General Hospital, 200 Elizabeth St., 10EN, Room 206, Toronto, ON M5G 2C4 Canada
| | - Tae L Hart
- 1Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada.,2Zane Cohen Centre for Digestive Diseases, Sinai Health System, Box 24-60 Murray Street, Toronto, ON M5T 3L9 Canada.,4Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8 Canada
| |
Collapse
|
12
|
Rapid review of factors associated with flexible sigmoidoscopy screening use. Prev Med 2019; 120:8-18. [PMID: 30597228 DOI: 10.1016/j.ypmed.2018.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/04/2018] [Accepted: 12/24/2018] [Indexed: 01/19/2023]
Abstract
Flexible sigmoidoscopy (FS) screening has been shown to reduce colorectal cancer (CRC) incidence and mortality among screened adults. The aim of this review was to identify patient-related factors associated with the screening test's use. We searched PubMed for studies that examined the association between FS screening use and one or more factors. To determine the eligibility of studies, we first reviewed titles, then abstracts, and finally the full paper. We started with a narrow search, which we expanded successively (by adding 'OR' terms) until the number of new publications eligible after abstract review was <1% of the total number of publications. We then abstracted factors from eligible papers and reported the number of times each was found to be positively or negatively associated with FS screening use. We identified 42 papers, most of which reported studies conducted in the United States of America (n = 21, 50%) and the United Kingdom (n = 13, 31%). Across studies, a wide range of factors were examined (n = 123), almost half of which were found to be associated with FS screening use at least once (n = 60). Sociodemographic and health and lifestyle factors that were frequently positively associated with FS screening use included: male gender, higher socioeconomic status and a family history of CRC. Frequently positively associated psychosocial factors included low perceived barriers and high perceived benefits. Findings suggest that future research should focus on developing a theoretical framework of cancer screening behaviour to allow a greater level of consistency and specificity in measuring key constructs.
Collapse
|
13
|
Redwood DG, Blake ID, Provost EM, Kisiel JB, Sacco FD, Ahlquist DA. Alaska Native Patient and Provider Perspectives on the Multitarget Stool DNA Test Compared With Colonoscopy for Colorectal Cancer Screening. J Prim Care Community Health 2019; 10:2150132719884295. [PMID: 31646933 PMCID: PMC6820167 DOI: 10.1177/2150132719884295] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: Alaska Native (AN) people have among the world's highest rate of colorectal cancer (CRC). We assessed perceptions of AN people and their health care providers of a new take-home multitarget stool DNA test (MT-sDNA; Cologuard) relative to colonoscopy. Methods: Cross-sectional surveys of AN people aged 40 to 75 years (mailed) and providers (online). Results: Participants included 1616 AN patients (19% response rate) and 87 providers (26% response rate; 57% AN people). Over half (58%) of patients preferred colonoscopy for CRC screening, while 36% preferred MT-sDNA. Unscreened patients were significantly more likely to state a preference for MT-sDNA than previously screened patients (42% vs 31%, P < .05) as were younger patients (<60 years old) compared with older patients (40% vs 30%, P < .05). Most providers thought that MT-sDNA would improve screening rates (69%), would recommend if available (79%), and be implementable (79%). Perceived barriers differed substantially between patients and providers in both type and magnitude. Leading colonoscopy barriers reported by patients were travel (44%) and bowel preparation (40%), while providers thought that fear of pain (92%) and invasiveness of the test (87%) were the primary barriers. For MT-sDNA, patients' belief that colonoscopy was better (56%) and not knowing how to do the test (40%) were primary barriers, while providers thought stool collection (67%) and having a stool sample in their home (63%) were leading barriers. Conclusions: This study found that MT-sDNA has potential acceptability among AN people and their health care providers. Both groups reported a willingness to use MT-sDNA and did not perceive major barriers to its use. This preference was especially true of unscreened and younger patients. The majority of providers indicated they would use MT-sDNA if available and that it would improve CRC screening rates. In this population, where colonoscopy access is limited, MT-sDNA has the potential to improve CRC screening adherence.
Collapse
Affiliation(s)
| | - Ian D. Blake
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | | | - Frank D. Sacco
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | |
Collapse
|
14
|
Gholampour Y, Jaderipour A, Khani Jeihooni A, Kashfi SM, Afzali Harsini P. The Effect of Educational Intervention Based on Health Belief Model and Social Support on the Rate of Participation of Individuals in Performing Fecal Occult Blood Test for Colorectal Cancer Screening. ASIAN PACIFIC JOURNAL OF CANCER PREVENTION : APJCP 2018; 19:2777-2787. [PMID: 30360606 PMCID: PMC6291048 DOI: 10.22034/apjcp.2018.19.10.2777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background and Aim: Among the screening tests for colorectal cancer, fecal occult blood test (FOBT) is important in comparison other methods due to its ease of use and low cost.The aim of this study is to survey the effect of educational intervention based on health belief model and social support on the rate of participation of individuals in performing fecal occult blood test for colorectal cancer screening among men who referred to the health centers in FasaCity, Fars province, Iran. Materials and Methods: In this quasi-experimental study, 200 men (100 in experimental group and 100 in control group) in FasaCity, Fars province, Iranwere selected in 2017. A questionnaire consisting of demographic information, knowledge, HBM constructs (perceived susceptibility, severity, benefits, barriers, self- efficacy and cues to action) and social support was used to measure the rate of participation of individuals in performing Fecal Occult Blood Test for colorectal cancer screening before and three months after the intervention. Data were analyzed using SPSS22 viadescriptive and inferential statistics, paired t-test, Mann-Whitney, Chi-square, and independent t-test at a significance level of 0.5. Results: The mean age of the men was 63.18 ± 8.25 years in the experimental group and 65.11 ± 7.66 years in the control group. Three months after the intervention, the experimental group showed a significant increase in the knowledge, perceived susceptibility, perceived severity, perceived benefits, Self-efficacy, cues to action, social support and the level of referrals (participation) of subjects for FOBTcompared to the control group. Conclusion: This study showed the effectiveness of HBM constructs and social support in adoption of the level of participation of subjects for FOBTin men. Hence, these models can act as a framework for designing and implementing educational interventions for undergoing FOBT.
Collapse
Affiliation(s)
- Yousef Gholampour
- Department of Internal Medicine, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran.
| | | | | | | | | |
Collapse
|
15
|
Carter-Harris L, Davis LL, Rawl SM. Lung Cancer Screening Participation: Developing a Conceptual Model to Guide Research. Res Theory Nurs Pract 2018; 30:333-352. [PMID: 28304262 DOI: 10.1891/1541-6577.30.4.333] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To describe the development of a conceptual model to guide research focused on lung cancer screening participation from the perspective of the individual in the decision-making process. METHODS Based on a comprehensive review of empirical and theoretical literature, a conceptual model was developed linking key psychological variables (stigma, medical mistrust, fatalism, worry, and fear) to the health belief model and precaution adoption process model. RESULTS Proposed model concepts have been examined in prior research of either lung or other cancer screening behavior. To date, a few studies have explored a limited number of variables that influence screening behavior in lung cancer specifically. Therefore, relationships among concepts in the model have been proposed and future research directions presented. CONCLUSION This proposed model is an initial step to support theoretically based research. As lung cancer screening becomes more widely implemented, it is critical to theoretically guide research to understand variables that may be associated with lung cancer screening participation. Findings from future research guided by the proposed conceptual model can be used to refine the model and inform tailored intervention development.
Collapse
|
16
|
Intervention Mediators in a Randomized Controlled Trial to Increase Colonoscopy Uptake Among Individuals at Increased Risk of Familial Colorectal Cancer. Ann Behav Med 2018; 51:694-706. [PMID: 28236077 DOI: 10.1007/s12160-017-9893-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Understanding the pathways by which interventions achieve behavioral change is important for optimizing intervention strategies. PURPOSE We examined mediators of behavior change in a tailored-risk communication intervention that increased guideline-based colorectal cancer screening among individuals at increased familial risk. METHODS Participants at increased familial risk for colorectal cancer (N = 481) were randomized to one of two arms: (1) a remote, tailored-risk communication intervention (Tele-Cancer Risk Assessment and Evaluation (TeleCARE)) or (2) a mailed educational brochure intervention. RESULTS Structural equation modeling showed that participants in TeleCARE were more likely to get a colonoscopy. The effect was partially mediated through perceived threat (β = 0.12, p < 0.05), efficacy beliefs (β = 0.12, p < 0.05), emotions (β = 0.22, p < 0.001), and behavioral intentions (β = 0.24, p < 0.001). Model fit was very good: comparative fit index = 0.95, root-mean-square error of approximation = 0.05, and standardized root-mean-square residual = 0.08. CONCLUSION Evaluating mediating variables between an intervention (TeleCARE) and a primary outcome (colonoscopy) contributes to our understanding of underlying mechanisms that lead to health behavior change, thus leading to better informed and designed future interventions. TRIAL REGISTRATION NUMBER ClinicalTrials.gov , NCT01274143.
Collapse
|
17
|
Bulduk S, Dinçer Y, Usta E. Identification of Colorectal Cancer Risks of Individuals Aged over Fifty and Their Beliefs towards Having Fecal Occult Blood Test. KONURALP TIP DERGISI 2017. [DOI: 10.18521/ktd.306651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
18
|
Carter-Harris L, Brandzel S, Wernli KJ, Roth JA, Buist DSM. A qualitative study exploring why individuals opt out of lung cancer screening. Fam Pract 2017; 34:239-244. [PMID: 28122849 PMCID: PMC6279209 DOI: 10.1093/fampra/cmw146] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Lung cancer screening with annual low-dose computed tomography is relatively new for long-term smokers in the USA supported by a US Preventive Services Task Force Grade B recommendation. As screening programs are more widely implemented nationally and providers engage patients about lung cancer screening, it is critical to understand behaviour among high-risk smokers who opt out to improve shared decision-making processes for lung cancer screening. OBJECTIVE The purpose of this study was to explore the reasons for screening-eligible patients' decisions to opt out of screening after receiving a provider recommendation. METHODS Semi-structured qualitative telephone interviews were performed with 18 participants who met lung cancer screening criteria for age, smoking and pack-year history in Washington State from November 2015 to January 2016. Two researchers with cancer screening and qualitative methodology expertise conducted data analysis using thematic content analytic procedures from audio-recorded interviews. RESULTS Five primary themes emerged for reasons of opting out of lung cancer screening: (i) Knowledge Avoidance; (ii) Perceived Low Value; (iii) False-Positive Worry; (iv) Practical Barriers; and (v) Patient Misunderstanding. CONCLUSION The participants in our study provided insight into why some patients make the decision to opt out of low-dose computed tomography screening, which provides knowledge that can inform intervention development to enhance shared decision-making processes between long-term smokers and their providers and decrease decisional conflict about screening.
Collapse
Affiliation(s)
- Lisa Carter-Harris
- Indiana University School of Nursing, Science of Nursing Care Department, Indianapolis, IN, USA
| | | | | | - Joshua A Roth
- Fred Hutchinson Cancer Research Center, Hutchinson Institute for Cancer Outcomes Research, Seattle, WA, USA
| | | |
Collapse
|
19
|
Abstract
OBJECTIVE To present an overview of current practices in the screening and early detection of gastrointestinal cancers. DATA SOURCES Literature reviews. CONCLUSION Screening for gastrointestinal cancers is less than desirable, particularly in underserved populations. There are inadequate methods of screening for early detection of esophageal and gastric cancers. IMPLICATIONS FOR NURSING PRACTICE Education of patients is needed to reinforce the importance of screening for gastrointestinal cancers.
Collapse
|
20
|
Brenner AT, Gupta S, Ko LK, Janz N, Inadomi JM. Development of a Practical Model for Targeting Patient Decision Support Interventions to Promote Colorectal Cancer Screening in Vulnerable Populations. J Health Care Poor Underserved 2016; 27:465-78. [PMID: 27180689 DOI: 10.1353/hpu.2016.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We sought to develop a practical model for predicting probability of colorectal cancer (CRC) screening completion in a diverse safety-net population and a subsequent framework for targeting screening promotion interventions. Data used to construct the models was prospectively collected from a CRC screening intervention. Models were cross-validated by randomly splitting the data into training and validation samples. The predicted probabilities of screening completion from the final model were trichotomized into framework groups and cross-validated by defining cut-points in the training sample, applying them to the validation sample, and comparing across samples for homogeneity. The final model included demographic and simple psychosocial measures and predicted screening behavior adequately (AUROC=0.63). The framework groups (cut-points 0.62 (low), 0.74 (medium), and 1.0 (high)) were homogeneous across the two samples. The model and framework may be useful for designing and delivering targeted interventions to promote CRC screening. Future research should validate the framework groups.
Collapse
|
21
|
Predictors of stage of adoption for colorectal cancer screening among African American primary care patients. Cancer Nurs 2015; 37:241-51. [PMID: 24145250 DOI: 10.1097/ncc.0b013e3182a40d8d] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Compared with other racial groups, African Americans have the highest colorectal cancer (CRC) incidence and mortality rates coupled with lower screening rates. OBJECTIVE Our study examined the predictors of stage of adoption for fecal occult blood testing (FOBT) and colonoscopy among African American primary care patients who were nonadherent to published screening guidelines. METHODS Baseline data (N = 815) in a randomized clinical trial were analyzed. Participants were categorized into precontemplation, contemplation, and preparation stages for FOBT and colonoscopy. Predictor variables were demographics, clinical variables, CRC health beliefs and knowledge, and social support. Hierarchical modeling was to identify significant predictors of stage of adoption. RESULTS Older, male, Veterans Affairs participants and those with higher perceived self-efficacy, family/friend encouragement, and a provider recommendation had higher odds of being at a more advanced stage of adoption for FOBT. Patients with a history of cancer and higher perceived barriers had higher odds of being at an earlier stage of adoption for FOBT. Predictors of more advanced stage of adoption for colonoscopy included higher perceived benefits, higher perceived self-efficacy, family/friend encouragement, and a provider recommendation for colonoscopy. Higher income (>30 000 vs <15 000) was predictive of earlier stage of adoption for colonoscopy. CONCLUSIONS Enhancing self-efficacy, encouragement from family and friends, and provider recommendations are important components of interventions to promote CRC screening. IMPLICATIONS FOR PRACTICE Nurses can use knowledge of the characteristics associated with stage of adoption to educate and motivate their African American primary care patients to complete CRC screening tests.
Collapse
|
22
|
Homan SG, Yun S, Stewart BR, Armer JM. Breast Cancer Survivorship Care: Targeting a Colorectal Cancer Education Intervention. J Pers Med 2015; 5:296-310. [PMID: 26258794 PMCID: PMC4600149 DOI: 10.3390/jpm5030296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/27/2015] [Accepted: 07/31/2015] [Indexed: 11/25/2022] Open
Abstract
Breast cancer survivors are at risk of developing a second primary cancer. Colorectal cancer (CRC) is one of the leading second primary cancers, and it is often preventable. We developed a multi-component educational tool to inform and encourage women breast cancer survivors to engage in CRC screening. To assess the strengths and weakness of the tool and to improve the relevancy to the target audience, we convened four focus groups of women breast cancer survivors in Missouri. We also assessed the potential impact of the tool on the knowledge, attitudes, and beliefs regarding CRC and collected information on the barriers to CRC screening through pre- and post-focus groups' questionnaires. A total of 43 women breast cancer survivors participated and provided very valuable suggestions on design and content to update the tool. Through the process and comparing pre- and post-focus group assessments, a significantly higher proportion of breast cancer survivors strongly agreed or agreed that CRC is preventable (78.6% vs. 96.9%, p = 0.02) and became aware that they were at a slightly increased risk for CRC (18.6% vs. 51.7%, p = 0.003). The most cited barrier was the complexity of preparation for colonoscopy.
Collapse
Affiliation(s)
- Sherri G Homan
- Public Health Epidemiologist, Missouri Department of Health and Senior Services, Division of Community and Public Health, Office of Epidemiology, 920 Wildwood Drive, Jefferson City, MO 65109, USA.
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
| | - Shumei Yun
- Chronic Disease and Nutrition Epidemiology Team, Missouri Department of Health and Senior Services, Division of Community and Public Health, Office of Epidemiology, 920 Wildwood Drive, Jefferson City, MO 65109, USA.
- School of Medicine, University of Missouri-Columbia, MO 65212, USA.
| | - Bob R Stewart
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
- College of Education, University of Missouri, Columbia, MO 65211, USA.
| | - Jane M Armer
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
| |
Collapse
|
23
|
Redwood D, Provost E, Lopez EDS, Skewes M, Johnson R, Christensen C, Sacco F, Haverkamp D. A Process Evaluation of the Alaska Native Colorectal Cancer Family Outreach Program. HEALTH EDUCATION & BEHAVIOR 2015; 43:35-42. [PMID: 26157041 DOI: 10.1177/1090198115590781] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This article presents the results of a process evaluation of the Alaska Native (AN) Colorectal Cancer (CRC) Family Outreach Program, which encourages CRC screening among AN first-degree relatives (i.e., parents, siblings, adult children; hereafter referred to as relatives) of CRC patients. Among AN people incidence and death rates from CRC are the highest of any ethnic/racial group in the United States. Relatives of CRC patients are at increased risk; however, CRC can be prevented and detected early through screening. The evaluation included key informant interviews (August to November 2012) with AN and non-AN stakeholders and program document review. Five key process evaluation components were identified: program formation, evolution, outreach responses, strengths, and barriers and challenges. Key themes included an incremental approach that led to a fully formed program and the need for dedicated, culturally competent patient navigation. Challenges included differing relatives' responses to screening outreach, health system data access and coordination, and the program impact of reliance on grant funding. This program evaluation indicated a need for more research into motivating patient screening behaviors, electronic medical records systems quality improvement projects, improved data-sharing protocols, and program sustainability planning to continue the dedicated efforts to promote screening in this increased risk population.
Collapse
Affiliation(s)
- Diana Redwood
- Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Ellen Provost
- Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | | | | | - Claudia Christensen
- Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Frank Sacco
- Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Donald Haverkamp
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, NM, USA
| |
Collapse
|
24
|
Wilson CJ, Flight IH, Turnbull D, Gregory T, Cole SR, Young GP, Zajac IT. A randomised controlled trial of personalised decision support delivered via the internet for bowel cancer screening with a faecal occult blood test: the effects of tailoring of messages according to social cognitive variables on participation. BMC Med Inform Decis Mak 2015; 15:25. [PMID: 25886492 PMCID: PMC4403749 DOI: 10.1186/s12911-015-0147-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 03/17/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In Australia, bowel cancer screening participation using faecal occult blood testing (FOBT) is low. Decision support tailored to psychological predictors of participation may increase screening. The study compared tailored computerised decision support to non-tailored computer or paper information. The primary outcome was FOBT return within 12 weeks. Additional analyses were conducted on movement in decision to screen and change on psychological variables. METHODS A parallel, randomised controlled, trial invited 25,511 people aged 50-74 years to complete an eligibility questionnaire. Eligible respondents (n = 3,408) were assigned to Tailored Personalised Decision Support (TPDS), Non-Tailored PDS (NTPDS), or Control (CG) (intention-to-treat, ITT sample). TPDS and NTPDS groups completed an on-line baseline survey (BS) and accessed generic information. The TPDS group additionally received a tailored intervention. CG participants completed a paper BS only. Those completing the BS (n = 2270) were mailed an FOBT and requested to complete an endpoint survey (ES) that re-measured BS variables (per-protocol, PP sample). RESULTS FOBT return: In the ITT sample, there was no significant difference between any group (χ (2)(2) = 2.57, p = .26; TPDS, 32.5%; NTPDS, 33%; and CG, 34.5%). In the PP sample, FOBT return in the internet groups was significantly higher than the paper group (χ (2)(2) = 17.01, p < .001; TPDS, 80%; NTPDS, 83%; and CG, 74%). FOBT completion by TPDS and NTPDS did not differ (χ (2)(1) = 2.23, p = .13). Age was positively associated with kit return. Decision to screen: 2227/2270 of the PP sample provided complete BS data. Participants not wanting to screen at baseline (1083/2227) and allocated to TPDS and NTPDS were significantly more likely to decide to screen and return an FOBT than those assigned to the CG. FOBT return by TPDS and NTPDS did not differ from one another (OR = 1.16, p = .42). Change on psychosocial predictors: Analysis of change indicated that salience and coherence of screening and self-efficacy were improved and faecal aversion decreased by tailored messaging. CONCLUSIONS Online information resources may have a role in encouraging internet-enabled people who are uncommitted to screening to change their attitudes, perceptions and behaviour. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12610000095066.
Collapse
Affiliation(s)
- Carlene J Wilson
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia. .,Cancer Council South Australia, Eastwood, South Australia, Australia.
| | - Ingrid Hk Flight
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia.,Cancer Council South Australia, Eastwood, South Australia, Australia.,Commonwealth Industrial Research Organisation, Food and Nutrition Flagship, Adelaide, South Australia, Australia
| | - Deborah Turnbull
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Tess Gregory
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,School of Population Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen R Cole
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Ian T Zajac
- Commonwealth Industrial Research Organisation, Food and Nutrition Flagship, Adelaide, South Australia, Australia
| |
Collapse
|
25
|
Taniguchi T, Hirai K, Harada K, Ishikawa Y, Nagatsuka M, Fukuyoshi J, Arai H, Mizota Y, Yamamoto S, Saito H, Shibuya D. The relationship between obtaining fecal occult blood test and beliefs regarding testing among Japanese. Health Psychol Behav Med 2015. [DOI: 10.1080/21642850.2015.1084473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
26
|
Gupta S, Brenner AT, Ratanawongsa N, Inadomi JM. Patient trust in physician influences colorectal cancer screening in low-income patients. Am J Prev Med 2014; 47:417-23. [PMID: 25084682 PMCID: PMC4171139 DOI: 10.1016/j.amepre.2014.04.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 03/28/2014] [Accepted: 04/24/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) screening is effective but underutilized. Although physician recommendation is an important predictor of screening, considerable variation in CRC screening completion remains. PURPOSE To characterize the influence of patient trust in care providers on CRC screening behavior. METHODS Data were collected as part of a cluster-randomized CRC screening intervention trial performed in the San Francisco Community Health Network from March 2007 to January 2012 (analysis, Spring 2012). All study participants received a recommendation to complete CRC screening from their primary care provider (PCP). Included participants were aged 50-79 years, not current with screening, and completed the Wake Forest Trust Scale (WFTS) measuring trust in PCPs and doctors in general. Primary outcome was CRC screening completion (colonoscopy or fecal occult blood testing) within 12 months following enrollment. Multivariable association adjusted for race/ethnicity, language, and other sociodemographics was estimated using generalized estimating equations with logit link and binomial distribution. RESULTS WFTS response was 70.3% (701). Most participants (83%) were Latino, Asian, or black. Most had income <$30,000 (96%) and public health insurance (86%). Higher trust in PCP was associated with screening completion (OR=1.11, 95% CI=1.03, 1.17), but trust in doctors was not (OR=1.02, 95% CI=0.82, 1.28). Race, language, and other sociodemographic factors were not significant in multivariable analysis. CONCLUSIONS After controlling for traditional factors, trust in PCP remained the only significant driver of CRC screening completion in low-income patients. Interventions to promote CRC screening may be improved by including efforts to enhance patient trust in PCP.
Collapse
Affiliation(s)
- Shivani Gupta
- Emory University School of Medicine, Atlanta, Georgia
| | - Alison T Brenner
- Department of Health Services, University of Washington School of Public Health and Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington
| | - Neda Ratanawongsa
- Division of General Internal Medicine and Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California
| | - John M Inadomi
- Department of Health Services, University of Washington School of Public Health and Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington.
| |
Collapse
|
27
|
Lee-Lin F, Menon U, Leo MC, Pedhiwala N. Feasibility of a targeted breast health education intervention for Chinese American immigrant women. Oncol Nurs Forum 2014; 40:361-72. [PMID: 23803269 DOI: 10.1188/13.onf.361-372] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To assess the feasibility and acceptability of a targeted educational intervention to increase mammography screening among Chinese American women. DESIGN One-group pre- and post-test quasiexperimental design. SETTING Metropolitan areas of Portland, OR. SAMPLE 44 foreign-born Chinese American women aged 40 years and older. METHODS Participants who had not had a mammogram within the past 12 months were recruited and enrolled to a targeted breast health educational program. Before starting the group session, participants completed a baseline survey, which was administered again 12 weeks postintervention. MAIN RESEARCH VARIABLES Completion of mammography screening test, movement in stage of readiness, mammography and breast cancer knowledge, perceived susceptibility, perceived benefits, and perceived common and cultural barriers. FINDINGS The study response rate was high (71%). Of the 42 women who completed the study, 21 (50%) had a mammogram postintervention. The top three reasons for not completing a mammogram at the end of the study were no need or no symptom, busy, and reliance on family for assistance. Mean breast cancer susceptibility scores increased significantly at post-test as theorized (t[40] = -2.88, p < 0.01). Participants were more likely to obtain a mammogram when they had been in the United States for 3-15 years. CONCLUSIONS A targeted program that aims to increase breast health knowledge, improve access, and remove barriers may promote mammography screening among Chinese American immigrant women. IMPLICATIONS FOR NURSING This promising intervention now being tested under a randomized, controlled design can be adapted to other Asian subgroups. KNOWLEDGE TRANSLATION Targeted breast health intervention is feasible for improving mammography screening among Chinese immigrant women. Educating these women about early detection is important, as the first sign of breast cancer usually shows on a woman's mammogram before it can be felt or any other symptoms are present. Immigrant women may be too busy to dedicate proper time to self-care behaviors; therefore, making it easier and faster for them to obtain a mammogram may improve the screening rate.
Collapse
Affiliation(s)
- Frances Lee-Lin
- School of Nursing, Oregon Health and Science University, Portland, USA.
| | | | | | | |
Collapse
|
28
|
Christy SM, Mosher CE, Rawl SM. Integrating men's health and masculinity theories to explain colorectal cancer screening behavior. Am J Mens Health 2014; 8:54-65. [PMID: 23813927 PMCID: PMC3849215 DOI: 10.1177/1557988313492171] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Colorectal cancer (CRC) is the third most common cause of cancer deaths among men in the United States. Although CRC screening has been found to reduce CRC incidence and mortality, current screening rates among men are suboptimal due to various practical and psychosocial barriers. One potential barrier to CRC screening identified in qualitative studies with men is the threat to masculinity that endoscopic screening methods pose. Indeed, beliefs about masculinity have been predictive of other preventive health behaviors among men. In this review article, we propose a novel conceptual framework to explain men's CRC screening behavior that integrates masculinity norms, gender role conflict, men's health care experiences, behaviors, and beliefs, and social and background variables. This framework has the potential to guide future research on men's CRC screening behaviors and other health behaviors and may inform gender-sensitive interventions that target masculinity beliefs to increase preventive health behaviors.
Collapse
Affiliation(s)
- Shannon M Christy
- 1Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | | | | |
Collapse
|
29
|
Public health and cooperative group partnership: a colorectal cancer intervention. Semin Oncol Nurs 2013; 30:61-73. [PMID: 24559782 DOI: 10.1016/j.soncn.2013.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe the development of a multi-component colorectal cancer educational tool for female breast cancer survivors through a cooperative group and public health partnership. DATA SOURCES PubMed, World Wide Web, guidelines from professional organizations, surveys and focus groups with breast cancer survivors. CONCLUSION Collaboration is at the core of cooperative group and public health research. This partnership led to the development of a colorectal cancer educational tool for breast cancer survivors. Focus groups revealed that female breast cancer survivors were receptive to education on colorectal cancer screening. IMPLICATIONS FOR NURSING PRACTICE Nurses are instrumental in research collaborations between cooperative groups and public health. The colorectal educational intervention for breast cancer survivors serves as an exemplar of partnerships leading to innovative research planning and implementation outcomes.
Collapse
|
30
|
Bronner K, Mesters I, Weiss-Meilik A, Geva R, Rozner G, Strul H, Inbar M, Halpern Z, Kariv R. Determinants of adherence to screening by colonoscopy in individuals with a family history of colorectal cancer. PATIENT EDUCATION AND COUNSELING 2013; 93:272-281. [PMID: 23916675 DOI: 10.1016/j.pec.2013.06.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 06/19/2013] [Accepted: 06/29/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Although first-degree relatives (FDRs) of colorectal cancer (CRC) patients, as a high-risk population, have the most to gain from colonoscopy screening, their adherence is suboptimal. Thus, an assessment of the determinants of adherence to screening is of potential importance. METHODS A cross-sectional study was conducted among 318 FDRs of 164 CRC patients treated at Tel-Aviv Sourasky Medical Center. Interviews were conducted with a questionnaire using I-Change Model. RESULTS Adherence to interval colonoscopy was low with only 73 FDRs (23.0%). Greater adherence was associated with socio-demographic variables (older age, siblings, having spouse, higher level of education and income) and behavioral variables (healthier lifestyle, utilization of preventive health services). Family physicians and kin were identified as the most influential figures on uptake. Intention, affective barriers, positive attitudes, social support, cues to action, age, and health maintenance were the strongest determinants of participation in CRC screening. CONCLUSION Adherence to colonoscopy is determined by multiple variables. Medical staff can play a key role in increasing adherence to colonoscopy. PRACTICE IMPLICATIONS Future interventions should focus on fostering positive attitudes, overcoming barriers, enhancing social support and providing a medical recommendation. Special efforts should be invested in young FDRs, those of low socio-economic status and those who underutilize preventive medicine.
Collapse
Affiliation(s)
- Karen Bronner
- The Department of Gastroenterology and Liver Diseases, The Tel Aviv Sourasky Medical Center, Israel.
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Bae N, Park S, Lim S. Factors associated with adherence to fecal occult blood testing for colorectal cancer screening among adults in the Republic of Korea. Eur J Oncol Nurs 2013; 18:72-7. [PMID: 24183583 DOI: 10.1016/j.ejon.2013.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 08/23/2013] [Accepted: 09/03/2013] [Indexed: 12/24/2022]
Abstract
PURPOSE Repeated participation in fecal occult blood testing (FOBT) is one of the major factors affecting the long-term success of population-based colorectal cancer screening programs. The aim of this study is to explore strong factors linked to repeated participation in FOBT in the prior decade (2002-2011) among adults using the Health Belief Model (HBM) after controlling for other covariates. METHODS Data were obtained from South Korean adults, aged 50 years and over, who visited a national health screening center within a magnet hospital (N = 237). A pilot test was conducted to investigate the internal consistency of the HBM instruments and the clarity of survey questions. Sample characteristics and rates of adherence to FOBT screening were examined using means and frequencies. Important factors associated with adherence to FOBT were examined using multivariate logistic regression analysis. RESULTS About 44% of the respondents were adherent to FOBT screening over the prior decade. Four out of the six HBM-driven factors (perceived susceptibility, severity, and barriers, and health motivation) were statistically significant. Those with greater levels of susceptibility and health motivation and lower levels of severity and barriers were more likely to adhere to FOBT. CONCLUSIONS Health professionals should focus more on the four modifiable HBM-related factors to encourage adults to adhere to FOBT. Intervention programs, which lower perceived severity and barriers and increase susceptibility and health motivation, should be developed and implemented.
Collapse
Affiliation(s)
- Nayoung Bae
- Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
| | - Sunhee Park
- College of Nursing Science, East-West Nursing Research Institute, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul 130-071, Republic of Korea.
| | - Sungwon Lim
- National Evidence-based Health Care Collaborating Agency, Seoul, Republic of Korea.
| |
Collapse
|
32
|
Al-Dubai SAR, Ganasegeran K, Alabsi AM, Shah SA, Razali FMM, Arokiasamy JT. Exploration of risk taking behaviors and perceived susceptibility of colorectal cancer among Malaysian adults: a community based cross-sectional study. BMC Public Health 2013; 13:930. [PMID: 24093502 PMCID: PMC3851727 DOI: 10.1186/1471-2458-13-930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 10/02/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Perceived susceptibility to an illness has been shown to affect Health-risk behavior. The objective of the present study was to determine the risk taking behaviors and the demographic predictors of perceived susceptibility to colorectal cancer in a population-based sample. METHODS A cross-sectional study was carried out among 305 Malaysian adults in six major districts, selected from urban, semi-urban, and rural settings in one state in Malaysia. A self-administered questionnaire was used in this study. It was comprised of socio-demographics, risk-taking behaviors, and validated domains of the Health Belief Model (HBM). RESULTS The mean (± SD) age of the respondents was 34.5 (± 9.6) and the majority (59.0%) of them were 30 years or older. Almost 20.7% of the respondents felt they were susceptible to colorectal cancer. Self-reported perceived susceptibility mirrored unsatisfactory screening behaviors owing to the lack of doctors' recommendation, ignorance of screening modalities, procrastination, and the perception that screening was unnecessary. Factors significantly associated with perceived susceptibility to colorectal cancer were gender (OR = 1.8, 95% CI 1.0-3.3), age (OR = 2. 2, 95% CI 1.2-4.0), ethnicity (OR = 0. 3, 95% CI 0.2-0.6), family history of colorectal cancer (OR = 3. 2, 95% CI 1.4-7.4) and alcohol intake (OR = 3.9, 95% CI 2.1-7.5). CONCLUSION The present study revealed that screening behavior among respondents was unsatisfactory. Hence, awareness of the importance of screening to prevent colorectal cancers is imperative.
Collapse
Affiliation(s)
- Sami AR Al-Dubai
- Department of Community Medicine, International Medical University (IMU), No. 126, Jln Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Kurubaran Ganasegeran
- International Medical School, Management and Science University (MSU), University Drive, Off Persiaran Olahraga, Section 13, 40100 Shah Alam, Selangor, Malaysia
| | - Aied M Alabsi
- Oral Cancer Research And Coordinating Center, Faculty of Dentistry, University of Malaya (UM), Kuala Lumpur 50603 Malaysia
| | - Shamsul A Shah
- Department of Community Health, UKM Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Farid MM Razali
- Perdana University Graduate School of Medicine, Perdana University, Maeps Building, Mardi Complex, 43400 Serdang, SelangorMalaysia
| | - John T Arokiasamy
- Department of Community Medicine, International Medical University (IMU), No. 126, Jln Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| |
Collapse
|
33
|
Korean Americans' Beliefs about Colorectal Cancer Screening. Asian Nurs Res (Korean Soc Nurs Sci) 2013; 7:45-52. [DOI: 10.1016/j.anr.2012.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 09/07/2012] [Accepted: 09/29/2012] [Indexed: 11/19/2022] Open
|
34
|
Christy SM, Rawl SM. Shared decision-making about colorectal cancer screening: a conceptual framework to guide research. PATIENT EDUCATION AND COUNSELING 2013; 91:310-7. [PMID: 23419327 PMCID: PMC3756595 DOI: 10.1016/j.pec.2013.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 12/27/2012] [Accepted: 01/11/2013] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To develop a conceptual framework to guide research on shared decision-making about colorectal cancer (CRC) screening among persons at average risk and their providers. METHODS Based upon a comprehensive review of empirical literature and relevant theories, a conceptual framework was developed that incorporated patient characteristics, cultural beliefs, provider/health care system variables, health belief/knowledge/stage of adoption variables, and shared decision-making between patients and providers that may predict behavior. Relationships among concepts in the framework, shared decision-making process and outcomes, and CRC screening behavior were proposed. Directions for future research were presented. RESULTS Many of the concepts in the proposed framework have been examined in prior research. However, these elements have not been combined previously to explain shared decision-making about CRC screening. CONCLUSION Research is needed to test the proposed relationships and hypotheses and to refine the framework. PRACTICE IMPLICATIONS Findings from future research guided by the proposed framework may inform clinical practice to facilitate shared decision-making about CRC screening.
Collapse
Affiliation(s)
- Shannon M Christy
- Purdue School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, USA.
| | | |
Collapse
|
35
|
Do individuals with a family history of colorectal cancer adhere to medical recommendations for the prevention of colorectal cancer? Fam Cancer 2013; 12:629-37. [DOI: 10.1007/s10689-013-9627-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
36
|
Milà N, García M, Binefa G, Borràs JM, Espinàs JA, Moreno V. [Adherence to a population-based colorectal cancer screening program in Catalonia (Spain), 2000-2008]. GACETA SANITARIA 2012; 26:217-22. [PMID: 22361637 DOI: 10.1016/j.gaceta.2011.10.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/26/2011] [Accepted: 10/19/2011] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To analyze correlates of adherence to colorectal cancer screening with biennial fecal occult blood testing in asymptomatic individuals aged 50 to 69 years. METHODS A cross-sectional telephone survey was conducted among people (n = 1,193) invited to participate in at least two successive rounds of a population-based colorectal cancer screening program in L'Hospitalet de Llobregat (Barcelona, Spain). Subjects were classified according to their adherence to colorectal cancer screening guidelines (non-adherent, irregular adherent and totally adherent). Independent variables were sociodemographic variables, self-perceived health, attitudes and beliefs regarding colorectal cancer and preventive activities. Binary and politomous logistic regression models were performed. RESULTS Of the individuals invited to participate in the screening program, 14.4% were adherent to screening recommendations and 18.4% were occasionally adherent. Significant differences were found in beliefs and attitudes regarding colorectal cancer and its early detection among adherent and non-adherent individuals. Sharing the decision to participate in screening with a family member increased adherence by nine- and tweve-fold. A positive perception of the screening process was a facilitator to adherence. CONCLUSIONS Attitudes and beliefs regarding colorectal cancer and its early detection, as well as familial support, are associated with initial participation in colorectal cancer screening but do not affect the persistence of preventive behavior over time.
Collapse
Affiliation(s)
- Núria Milà
- Grupo de Prevención y Control del Cáncer, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | | | | | | | | | | |
Collapse
|
37
|
McLachlan SA, Clements A, Austoker J. Patients' experiences and reported barriers to colonoscopy in the screening context--a systematic review of the literature. PATIENT EDUCATION AND COUNSELING 2012; 86:137-46. [PMID: 21640543 DOI: 10.1016/j.pec.2011.04.010] [Citation(s) in RCA: 182] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 03/07/2011] [Accepted: 04/08/2011] [Indexed: 05/15/2023]
Abstract
OBJECTIVE A systematic review of the literature was conducted to characterise patients' own experience of colonoscopy in the screening context. METHODS A search strategy was applied in MEDLINE, EMBASE and PSYCHinfo (1996-2009). Thematic analysis and narrative summary techniques were used. RESULTS Fifty-six studies met eligibility criteria and were included in the analysis. Seven studies examined patients' views after having colonoscopy. Forty-seven studies addressed patient-reported barriers to an anticipated primary colonoscopy. Most patients perceived the laxative bowel preparation to be the most burdensome part of colonoscopy. Other reported difficulties included anxiety, anticipation of pain, feelings of embarrassment and vulnerability. Inadequate knowledge and fear of finding cancer were identified as obstacles to the uptake of screening colonoscopy. Physician endorsement, having a family history, knowing someone with cancer, and perceived accuracy of the test were incentives to having a colonoscopy. Two studies focused on colonoscopy after faecal occult blood screening. Similar procedural, personal, and practical concerns were reported. CONCLUSIONS Bowel preparation, lack of awareness of the importance of screening, and feelings of vulnerability in women are all significant barriers to screening colonoscopy. PRACTICE IMPLICATIONS Patient reported obstacles and barriers to screening colonoscopy needs to be addressed to improve adherence.
Collapse
|
38
|
Kiviniemi MT, Bennett A, Zaiter M, Marshall JR. Individual-level factors in colorectal cancer screening: a review of the literature on the relation of individual-level health behavior constructs and screening behavior. Psychooncology 2011; 20:1023-33. [PMID: 21954045 PMCID: PMC3038178 DOI: 10.1002/pon.1865] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 09/10/2010] [Accepted: 09/16/2010] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Compliance with colorectal cancer screening recommendations requires considerable conscious effort on the part of the individual patient, making an individual's decisions about engagement in screening an important contributor to compliance or noncompliance. The objective of this paper was to examine the effectiveness of individual-level behavior theories and their associated constructs in accounting for engagement in colorectal cancer screening behavior. METHODS We reviewed the literature examining constructs from formal models of individual-level health behavior as factors associated with compliance with screening for colorectal cancer. All published studies examining one or more constructs from the health belief model, theory of planned behavior, transtheoretical model, or social cognitive theory and their relation to screening behavior or behavioral intentions were included in the analysis. RESULTS By and large, results of studies supported the theory-based predictions for the influence of constructs on cancer screening behavior. However, the evidence base for many of these relations, especially for models other than the health belief model, is quite limited. CONCLUSIONS Suggestions are made for future research on individual-level determinants of colorectal cancer screening.
Collapse
Affiliation(s)
- Marc T Kiviniemi
- Department of Health Behavior, University at Buffalo, New York 14124, USA.
| | | | | | | |
Collapse
|
39
|
Smith ML, Hochhalter AK, Ahn S, Wernicke MM, Ory MG. Utilization of screening mammography among middle-aged and older women. J Womens Health (Larchmt) 2011; 20:1619-26. [PMID: 21780914 DOI: 10.1089/jwh.2010.2168] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS This study examines patterns of screening mammogram use, investigating the relationship of screening with demographic, health status, and healthcare factors. METHODS Data from 1242 women aged ?41 were obtained from a random sample of mailed surveys to community households in an eight-county region in Central Texas in 2010. The dependent variable was the timing of the participants' most recent screening mammography (in the past 12 months, between 1 and 2 years, or >2 years). Predictor variables included demographic, health status, and healthcare access factors. Multinomial logistic regression identified variables associated with screening mammography practices. RESULTS The majority of women reported having at least one mammogram during their lifetime (93.0%) and having a mammography within the past 2 years (76.2%). Participants who reported not having a routine checkup in the past 12 months (odds ratio [OR] 0.12, p<0.001), having a lapse of insurance in the past 3 years (OR 2.95, p<0.05), and living in a health provider shortage area (OR 1.42, p<0.05) were less likely to be screened within the past 2 years. CONCLUSIONS Routine healthcare plays a major role in preventive screening, which indicates screening mammography practices can be enhanced by improving participation in routine checkups with medical providers, continuity of insurance coverage, and women's access to healthcare. Interventions to encourage screening mammography may be particularly needed for women who have experienced a lapse in insurance or have not had a checkup in the past year.
Collapse
Affiliation(s)
- Matthew Lee Smith
- College of Public Health, University of Georgia, 330 River Road, Athens, GA 30602-6522, USA.
| | | | | | | | | |
Collapse
|
40
|
Vincent J, Hochhalter AK, Broglio K, Avots-Avotins AE. Survey respondents planning to have screening colonoscopy report unique barriers. Perm J 2011; 15:4-11. [PMID: 21505611 DOI: 10.7812/tpp/10-089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Tailoring colorectal cancer screening interventions to address the needs of individuals for whom screening is recommended requires accurate identification of the barriers experienced by each targeted group. The primary purpose of this survey study was to test differences in the barriers to undergoing screening colonoscopy reported by men and women. In addition, we were interested in differences in barriers reported by 1) 50-year-olds versus those age 51 to 80 years, 2) persons reporting readiness for colonoscopy versus those not reporting readiness, and 3) persons who had had a primary care encounter in the preceding 12 months versus those who had not. Four thousand members of a health maintenance organization (Scott & White Health Plan) were surveyed. Response rate overall was 30.85%. No differences in barriers to screening colonoscopy were identified for men versus women. We did identify differences in barriers reported by persons reporting readiness versus those not reporting readiness. Findings suggest that interventions to increase rates of screening colonoscopy require addressing different sets of barriers depending on whether persons report readiness to have a colonoscopy within 6 months.
Collapse
|
41
|
Mitchell KA, Rawl SM, Champion VL, Jeffries PR, Welch JL. Development and Psychometric Testing of the Colonoscopy Embarrassment Scale. West J Nurs Res 2011; 34:548-64. [DOI: 10.1177/0193945911410328] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Colorectal cancer, the third leading cause of cancer-related death in the United States, could largely be prevented if more people had polyps removed via colonoscopies. Embarrassment is one important barrier to colonoscopy, but little is known about embarrassment in this context, and there were no reliable and valid measures of this construct. The purpose of this study was to develop a reliable and valid instrument to measure colonoscopy-related embarrassment. Transtheoretical Model of Behavior Change and Health Belief Model provided the theoretical basis for this study. Participants were health maintenance organization members aged 50 to 65 years ( N = 234). Using a cross-sectional, descriptive research design, data were collected using a mailed survey. Internal consistency (Cronbach’s α = .96) and construct validity of the 13-item instrument were demonstrated. This unidimensional scale shows promise as a valid and reliable instrument to measure colonoscopy-related embarrassment and to inform development of interventions to reduce embarrassment, leading to higher colonoscopy completion rates and lower mortality.
Collapse
|
42
|
Abstract
BACKGROUND Colorectal cancer is a significant health problem; it is the most common malignancy of the gastrointestinal tract. Colorectal cancer is closely related to the clinical and pathological stage of the disease at diagnosis, which can be detected early through screening tests. OBJECTIVE This descriptive cross-sectional study was conducted to investigate the knowledge and beliefs of Jordanians toward colorectal cancer (CRC) screening using the Health Belief Model. METHODS One hundred sixty participants, 50 years and older, were identified in the outpatient clinics at the 2 largest Jordanian hospitals located in the north of the country; the King Abdullah University Hospital and the Princess Basma Hospital. RESULTS Data analyses revealed that most participants are not well informed about CRC and screening. Less than half perceived themselves as susceptible to developing CRC. Half comprehended the seriousness of CRC, the majority understood the benefits of CRC screening, and one-third realized the barriers of CRC screening. Moreover, most understood the importance of preventative medicine and was highly motivated. CONCLUSION Most Jordanians treated at outpatient clinics comprehend the benefits from CRC screening, understand the seriousness of CRC, and perceive barriers, and more than half of the patients perceive the general health motivation beliefs and outcomes. IMPLICATION FOR PRACTICE The healthcare system and the decision makers must develop strategies to increase the general population's awareness about CRC and the accompanying screening tests.
Collapse
|
43
|
McCann S, MacAuley D, Barnett Y, Bunting B, Bradley A, Jeffers L, Morrison PJ. Family communication, genetic testing and colonoscopy screening in hereditary non-polyposis colon cancer: a qualitative study. Psychooncology 2010; 18:1208-15. [PMID: 19177338 DOI: 10.1002/pon.1487] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Genetic testing and colonoscopy is recommended for people with a strong history of colorectal cancer (CRC). However, families must communicate so that all members are aware of the risk. The study aimed to explore the factors influencing family communication about genetic risk and colonoscopy among people with a strong family history of CRC who attended a genetic clinic with a view to having a genetic test for hereditary non-polyposis colon cancer (HNPCC). METHODS Interviews were held with 30 people with a high familial risk of colon cancer. The transcripts were transcribed verbatim and analysed using Interpretative Phenomenological Analysis. RESULTS The family context, family history and perceptions about family duties and responsibilities were important motivators for communication about risk, genetic testing and colonoscopy and influenced participation in genetic testing and screening programmes. Participants reported usually communicating openly with their relatives about genetic risk and colonoscopy. Individuals felt a duty towards affected relatives and to their own children. The influence of the spouse and other relatives, particularly those affected by CRC, was also important. Colonoscopy was perceived to be embarrassing, unpleasant and sometimes painful. While there was sometimes anxiety about the result of the colonoscopy the results were usually reassuring. CONCLUSIONS The family context and the experience of the family history can have an impact on communication, genetic testing and screening in HNPCC and this should be explored during counselling. Some individuals might benefit from support in communicating with relatives about genetic risk. Ways of improving the individual's experience of colonoscopy should also be examined.
Collapse
Affiliation(s)
- Siobhan McCann
- Psychology Research Institute, University of Ulster, Londonderry, Northern Ireland.
| | | | | | | | | | | | | |
Collapse
|
44
|
Wu TY, Hsieh HF, West BT. Stages of mammography adoption in Asian American women. HEALTH EDUCATION RESEARCH 2009; 24:748-759. [PMID: 19318524 DOI: 10.1093/her/cyp009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Asian American women have the lowest mammography screening rate and are often diagnosed at later stages of breast cancer compared with other ethnic groups. This study applied the Transtheoretical Model and examined the relationships between stages of mammography adoption and mammography-related beliefs while controlling for socio-demographic factors. The study consisted of a convenience sample of 315 participants from four populous Asian ethnic groups in Michigan (109 Asian Indians, 51 Chinese, 36 Koreans and 119 Filipinos). In this relatively small sample, Koreans appeared to be more likely to be at the pre-contemplation stage and less likely to be at the maintenance stage. Perceived barriers and decisional balance scores differed by stage, with pre-contemplators reporting highest barriers and lowest scores in decisional balance. In terms of specific barrier items, pre-contemplators also displayed significantly greater agreement for most of the barrier items. Participants in the action stage have less favorable decisional balance than those in two earlier stages (i.e. contemplation and relapse). Common barriers for this sample of Asian participants included the items related to access and modesty issues. Overall, the study supports the notion that assessing differences in mammography-related beliefs by stage of screening behavior may facilitate the development of stage-matched interventions for Asian ethnic groups.
Collapse
Affiliation(s)
- Tsu-Yin Wu
- School of Nursing, Eastern Michigan University, Ypsilanti, MI 48197, USA.
| | | | | |
Collapse
|
45
|
Manne SL, Coups EJ, Winkel G, Markowitz A, Meropol NJ, Lesko SM, Jacobsen PB, Haller D, Jandorf L, Peterson SK. Identifying cluster subtypes for intentions to have colorectal cancer screening among non-compliant intermediate-risk siblings of individuals with colorectal cancer. HEALTH EDUCATION RESEARCH 2009; 24:897-908. [PMID: 19654222 PMCID: PMC2738960 DOI: 10.1093/her/cyp043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 06/21/2009] [Indexed: 05/28/2023]
Abstract
Although first-degree relatives of colorectal cancer (CRC) patients diagnosed at an early age are at increased risk for CRC, their compliance with colorectal cancer screening (CRCS) is not high. Relatively little is known about why these intermediate-risk family members do not comply with CRCS. Study aims were to identify subgroups of siblings of individuals diagnosed with CRC prior to age 61 who were not compliant with CRCS using cluster analysis and to identify demographical, medical and attitudinal correlates of cluster membership. A total of 421 siblings completed measures of pros, cons, processes of change, CRCS knowledge, physician and family CRCS support, CRC risk, severity, preventability, curability, closeness with the affected sibling, distress about the sibling's cancer and screening intentions. Three clusters characterized as 'Positive about Screening', 'Uncertain about Screening' and 'Negative about Screening' were identified. External validation revealed that those in the Positive about Screening cluster reported significantly stronger CRCS intentions than those who are Uncertain about Screening and Negative about Screening clusters. Results provide an empirical typology for understanding motivations for CRCS among at-risk family members and may lead to the development of more effective interventions to improve screening uptake.
Collapse
|
46
|
Nichols C, Holt CL, Shipp M, Eloubeidi M, Fouad MN, Britt K. Physician knowledge, perceptions of barriers, and patient colorectal cancer screening practices. Am J Med Qual 2009; 24:116-22. [PMID: 19233946 DOI: 10.1177/1062860608328603] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Physician recommendation is a major determinant of colorectal cancer screening. The purpose of this study was to examine physician attitudes and self-reported colorectal cancer patient screening. In a physician survey, perceived patient barriers included preparation for the tests and patient dislike of the blood stool test. Physician semistructured interviews revealed that perception of patient barriers included cost, time off from work, and transportation. Most physicians reported low knowledge of insurance coverage for screening, and self-reported screening rates among physicians themselves were not optimal. Evidence-based interventions to increase physician recommendations for screening, such as reminder and tracking systems, may be of value. Interventions that target physician knowledge of insurance coverage and encourage physicians to adopt screening themselves could also be considered.
Collapse
Affiliation(s)
- Claretha Nichols
- University of Maryland, Department of Public and Community Health, College Park, Maryland, USA
| | | | | | | | | | | |
Collapse
|
47
|
Politi MC, Clark MA, Rogers ML, McGarry K, Sciamanna CN. Patient-provider communication and cancer screening among unmarried women. PATIENT EDUCATION AND COUNSELING 2008; 73:251-5. [PMID: 18723307 PMCID: PMC2648309 DOI: 10.1016/j.pec.2008.07.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 07/14/2008] [Accepted: 07/15/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Unmarried women are less likely than married women to receive recommended cancer screenings. Patient-provider communication is a consistent predictor of cancer screening among women. The purpose of this study was to investigate the relationship between patient and provider communication, barriers to cancer screening, and on-schedule breast and cervical cancer screening (BCCS) among unmarried women. METHODS Data were from the Cancer Screening Project for Women, a 2003-2005 survey examining cancer screening practices. We computed polytomous logistic regression models to examine the relationship between communication (communication about tests, communication about sexual and intimate relationships), barriers to screening, and on-schedule BCCS among unmarried women. RESULTS A total of 630 women were enrolled, and 605 women completed the baseline questionnaire. Overall, more than 60% reported on-schedule BCCS. More than half reported that their providers communicated about BCCS most or all of the time. Fewer than half communicated about sexual history and intimate relationships. Women who reported that their providers communicated about screening tests and their sexual and intimate relationships were more likely to be on-schedule for BCCS. CONCLUSION Patient-provider communication about multiple topics may encourage women to remain on-schedule for their recommended cancer screenings. Longitudinal research should be conducted to examine whether communication predicts BCCS, and to examine how patient and provider characteristics may influence communication in order to promote adherence to screening guidelines for unmarried women. PRACTICE IMPLICATIONS Comprehensive communication that goes beyond information about screening tests may impact adherence to cancer screening guidelines.
Collapse
Affiliation(s)
- Mary C Politi
- Warren Alpert Medical School of Brown University/The Miriam Hospital, Centers for Behavioral and Preventive Medicine, CORO Suite 500, One Hoppin Street, Providence, RI 02903, USA.
| | | | | | | | | |
Collapse
|
48
|
Tu SP, Yip MP, Chun A, Choe J, Bastani R, Taylor V. Development of intervention materials for individuals with limited English proficiency: lessons learned from "Colorectal Cancer Screening in Chinese Americans". Med Care 2008; 46:S51-61. [PMID: 18725834 DOI: 10.1097/mlr.0b013e31817f0cde] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND According to recent US census data, 52 million people reported speaking a language other than English at home, and almost 45% of this population reported limited English proficiency (LEP). Colorectal cancer (CRC) ranks among the top 3 most common cancers for several Asian ethnic groups, yet screening remains underutilized by Asian Americans. OBJECTIVES This article describes the development of culturally and linguistically appropriate intervention materials for individuals with LEP. We discuss lessons learned from this research and implications for the translation of research into practice. METHODS The Health Behavior Framework served as the conceptual model for this study, and qualitative findings guided the development of our intervention materials (a video and pamphlet). To recommend Western preventive behaviors, the research team bridged the gap between Western and Chinese values and beliefs by devoting particular attention to: (1) the target population's sociocultural values and health beliefs; and (2) unique linguistic features of the Chinese language. RESULTS Key lessons learned from this study include the importance of: (1) a conceptual framework to guide intervention development; (2) incorporating sociocultural values and health beliefs into the intervention; (3) addressing and capitalizing on complex linguistics issues; (4) using qualitative methodology in cross-cultural research; and (5) contributions from a multicultural and multilingual research team. Other lessons relate to the translation of research findings into practice. We surmise that lessons learned from this study may be pertinent to the promotion of CRC screening among other patient groups with LEP and applicable to additional cancer screening tests.
Collapse
Affiliation(s)
- Shin-Ping Tu
- Department of Medicine, University of Washington, Seattle, Washington, USA.
| | | | | | | | | | | |
Collapse
|
49
|
Lairson DR, DiCarlo M, Myers RE, Wolf T, Cocroft J, Sifri R, Rosenthal M, Vernon SW, Wender R. Cost-effectiveness of targeted and tailored interventions on colorectal cancer screening use. Cancer 2008; 112:779-88. [PMID: 18098272 DOI: 10.1002/cncr.23232] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) screening is cost-effective but underused. The objective of this study was to determine the cost-effectiveness of targeted and tailored behavioral interventions to increase CRC screening use by conducting an economic analysis associated with a randomized trial among patients in a large, racially and ethnically diverse, urban family practice in Philadelphia. METHODS The incremental costs per unit increase were measured in individuals who were screened during the 24 months after intervention. Percent increase in screening was adjusted for baseline differences in the study groups. Each intervention arm received a targeted screening invitation letter, stool blood test (SBT) cards, informational booklet, and reminder letter. Tailored interventions incrementally added tailored messages and reminder telephone calls. RESULTS Program costs of the targeted intervention were 42 dollars per participant. Additional costs of adding tailored print materials and of delivering a reminder telephone call were 150 dollars and 200 dollars per participant, respectively. The cost per additional individual screened was 319 dollars when comparing the no intervention group with the targeted intervention group. CONCLUSIONS The targeted intervention was more effective and less costly than the tailored intervention. Although tailoring plus reminder telephone call was the most effective strategy, it was very costly per additional individual screened. Mailed SBT cards significantly boosted CRC screening use. However, going beyond the targeted intervention to include tailoring or tailoring plus reminder calls in the manner used in this study did not appear to be an economically attractive strategy.
Collapse
Affiliation(s)
- David R Lairson
- Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Sciences Center at Houston, Houston, Texas 77030, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Myers RE, Sifri R, Hyslop T, Rosenthal M, Vernon SW, Cocroft J, Wolf T, Andrel J, Wender R. A randomized controlled trial of the impact of targeted and tailored interventions on colorectal cancer screening. Cancer 2007; 110:2083-91. [PMID: 17893869 DOI: 10.1002/cncr.23022] [Citation(s) in RCA: 177] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Colorectal cancer screening is underutilized. The objective of the current study was to determine whether targeted and tailored interventions can increase screening use. METHODS A total of 1546 primary care practice patients completed a baseline telephone survey and were randomized to 4 study groups: control (387 patients), Standard Intervention (SI) (387 patients), Tailored Intervention (TI) (386 patients), or Tailored Intervention plus Phone (TIP) (386 patients). The control group received usual care throughout the study. The SI group received a targeted intervention by mail (ie, screening invitation letter, informational booklet, stool blood test, and reminder letter). The TI group received the targeted intervention with tailored "message pages." The TIP group received the targeted intervention, tailored message pages, and a telephone reminder. Intervention group contacts were repeated 1 year later. Screening was assessed 24 months after randomization. RESULTS Screening rates in study groups were 33% in the control group, 46% in the SI group, 44% in the TI group, and 48% in the TIP group. Screening was found to be significantly higher in all 3 intervention groups compared with the control group (odds ratio [OR] of 1.7 [95% confidence interval (95% CI), 1.3-2.5], OR of 1.6 [95% CI, 1.2-2.1], and OR of 1.9 [95% CI, 1.4-2.6], respectively), but did not vary significantly across intervention groups. Multivariate analyses demonstrated that older age, education, past cancer screening, screening preference, response efficacy, social support and influence, and exposure to study interventions were positive predictors of screening. Having worries and concerns about screening was found to be a significant negative predictor. CONCLUSIONS Targeted and tailored interventions were found to increase colorectal cancer screening use. However, additional research is needed to determine how to increase the effect of such interventions in primary care.
Collapse
Affiliation(s)
- Ronald E Myers
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|