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Screening initiation with FIT or colonoscopy: Post-hoc analysis of a pragmatic, randomized trial. Prev Med 2019; 118:332-335. [PMID: 30508552 PMCID: PMC6362977 DOI: 10.1016/j.ypmed.2018.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/29/2018] [Accepted: 11/30/2018] [Indexed: 01/21/2023]
Abstract
Screening with FIT or colonoscopy can reduce CRC mortality. In our pragmatic, randomized trial of screening outreach over three years, patients annually received mailed FITs or colonoscopy invitations. We examined screening initiation after each mailing and crossover from the invited to other modality. Eligible patients (50-64 years, ≥1 primary-care visit before randomization, and no history of CRC) received mailed FIT kits (n = 2400) or colonoscopy invitations (n = 2400) from March 2013 through July 2016. Among those invited for colonoscopy, we used multinomial logistic regression to identify factors associated with screening initiation with colonoscopy vs. FIT vs. no screening after the first mailing. Most patients were female (61.8%) and Hispanic (48.9%) or non-Hispanic black (24.0%). Among those invited for FIT, 56.6% (n = 1359) initiated with FIT, whereas 3.3% (n = 78) crossed over to colonoscopy; 151 (15.7%) and 61 (7.7%) initiated with FIT after second and third mailings. Among those invited for colonoscopy, 25.5% (n = 613) initiated with colonoscopy whereas 18.8% (n = 452) crossed over to FIT; 112 (8.4%) and 48 (4.2%) initiated with colonoscopy after second and third mailings. Three or more primary-care visits prior to randomization were associated with initiating with colonoscopy (OR 1.49, 95% CI 1.17-1.91) and crossing over to FIT (OR 1.63, 95% CI 1.19-2.23). Although nearly half of patients initiated screening after the first mailing, few non-responders in either outreach group initiated after a second or third mailing. More patients invited to colonoscopy crossed over to FIT than those assigned to FIT crossed over to colonoscopy.
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Assessment of knowledge among patients of surgical wards regarding clinical symptoms and diagnostics of the most common malignant tumors. Contemp Oncol (Pozn) 2013; 16:557-62. [PMID: 23788944 PMCID: PMC3687468 DOI: 10.5114/wo.2012.32490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 07/02/2012] [Accepted: 08/07/2012] [Indexed: 11/24/2022] Open
Abstract
Aim of the study The aim of this work was to evaluate the knowledge of symptoms and prophylaxis among hospitalized patients. Material and methods The research was carried in the Provincial Hospital in Bydgoszcz (i.e. general surgery, gynecology and obstetrics, urology, breast surgery and thoracic surgery). 250 hospitalized patients took part in the tests, as well as 50 healthy people. The scientific method used was a specially designed questionnaire. The Bioethics Committee of Collegium Medicum of Mikołaj Kopernik University in Bydgoszcz approved these tests. Results Patients from the Breast Diseases Ward had better knowledge about cancers than the control group. Symptoms of lung cancer were known to both groups to the same extent. Patients from the Clinical Ward of Thoracic Surgery were very knowledgeable about lung cancer, but they did not know anything about other malignant types of cancer. Patients from Gynecology and Obstetrics wards are better than the control group only at knowledge about symptoms and screening of cervix cancer. Patients from the Urology Ward have the best knowledge about screening of prostate cancer and colon cancer. Those hospitalized at the Surgery Ward do not know symptoms of colon cancer, but they have knowledge about its screening. Conclusions Patients from the Clinical Ward of Thoracic and Cancer Surgery and the Clinical Surgery Ward had the least knowledge about malignant tumors. Patients from Urology, Gynecology and Obstetrics wards have better knowledge about malignant tumors treated there.
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Daly JM, Xu Y, Levy BT. Patients whose physicians recommend colonoscopy and those who follow through. J Prim Care Community Health 2012; 4:83-94. [PMID: 23799714 DOI: 10.1177/2150131912464887] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND More than half of eligible individuals are not up-to-date with colon cancer screening. PURPOSE To assess the characteristics of those who received a colonoscopy screening recommendation and those who followed the physician recommendation. METHODS Patient self-administered questionnaire and medical record review in 16 private family physician practices. RESULTS From 8372 patients invited to participate, 685 were enrolled and had a medical record review; 219 (32%) had a colonoscopy recommendation and 86 (39%) received a colonoscopy. Independent factors associated with having a recommendation for colonoscopy were significantly younger in age (odds ratios [OR] = 1.6), higher incomes (annual income ≥$40 000 vs <$40 000; OR = 1.8), physician or nurse discussion about colon cancer tests (OR = 1.6), physical visit in the preceding 26 months (OR = 1.7), distant relative with colon cancer (OR = 2.4), and a medical diagnosis of hyperlipidemia (OR = 2.1). Independent factors associated with following through on colonoscopy after a recommendation were age ≥65 years (OR = 0.3), male patient (OR = 0.4), and feeling that colon cancer screening is very important (OR = 3.2). CONCLUSIONS Socioeconomic factors are associated with receipt of a colonoscopy recommendation. Fewer than one third of patients had documentation of a physician colonoscopy recommendation and of those, less than half followed through.
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Affiliation(s)
- Jeanette M Daly
- Department of Family Medicine, University of Iowa, Iowa City, IA 52242, USA.
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Buchs AE, Silverman BG. Incidence of malignancies in patients with diabetes mellitus and correlation with treatment modalities in a large Israeli health maintenance organization: a historical cohort study. Metabolism 2011; 60:1379-85. [PMID: 21696791 DOI: 10.1016/j.metabol.2011.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 05/02/2011] [Accepted: 05/03/2011] [Indexed: 12/28/2022]
Abstract
It has been hypothesized that incidence of and mortality from several malignancies are increased among diabetic patients. Whether certain treatment modalities, including use of metformin, sulfonylureas, or insulins, affect cancer incidence or mortality and whether use of long-acting insulin analogues glargine and detemir may increase cancer incidence more than traditional human insulins are debated. The objective was to investigate the association between specific glucose-lowering agents and cancer incidence in diabetic members of an Israeli health maintenance organization. We studied a cohort of 36,342 diabetic patients aged at least 18 years with no history of cancer or treatment with insulin as of January 1, 2003. For the period from January 2003 to December 2007, we searched pharmacy records for purchases of glucose-lowering agents, including metformin, sulfonylureas, human insulin, and analogue insulins. Incident cancer diagnoses were identified from the health maintenance organization cancer registry. We studied the association of cancer incidence with the use of specific glucose-lowering agents, controlling for age, sex, and baseline glycohemoglobin measurement. Cancer was diagnosed in 6% of the study cohort during 164,652 person-years of follow-up time. Cancer incidence increased with age and varied with medication purchasing patterns. On multivariate analysis, age (hazard ratio [HR], 1.049; confidence interval [CI], 1.045-1.052), male sex (HR, 1.16; CI, 1.065-1.264), and number of insulin purchases (HR, 1.007; CI, 1.001-1.012) were significantly associated with increased cancer risk, whereas number of metformin purchases was associated with reduced cancer risk (HR, 0.996; CI, 0.994-0.998). Male sex, age, and human insulin purchases were associated with increased cancer incidence, whereas metformin purchases were associated with decreased cancer risk. There was a trend for increased cancer incidence associated with use of long-acting insulin analogues, but the number of long-acting insulin analogue users was too small for risk estimates to be conclusive.
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Affiliation(s)
- Andreas E Buchs
- Department of Medicine D, Assaf Harofe Medical Center, Zerifin, Israel.
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James AS, Daley CM, Engelman K, Greiner KA, Ellerbeck E. Process evaluation of recruitment for a cancer screening trial in primary care. Health Promot Pract 2011; 12:696-703. [PMID: 21471439 PMCID: PMC3319739 DOI: 10.1177/1524839910366402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many cancer screening studies are conducted in primary care settings, yet few systematically analyze recruitment challenges found at these sites. During a randomized trial promoting colorectal cancer screening, we implemented a process evaluation of recruitment. Recruiters maintained logs that registered the numbers of patients entering the clinic, approached by recruiters, declining to participate, and reasons for nonapproach and nonparticipation. One half of age-eligible patients were approached (n = 1,489), and half of those who met basic eligibility requirements agreed to engage further (n = 527). A small proportion of patients (n = 98) completed the 15-min assessment before their appointment. Major reasons for nonapproach included previous approach, patients called to the exam room, and appearing ill. The major reason for nonparticipation was "not interested"; a few patients did not want to share contact information. Some participants exited the assessment midway because of further ineligibility or time limitations. Best-practice recommendations for recruitment in primary care are discussed.
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Affiliation(s)
- Aimee S James
- Department of Surgery, Washington University in Saint Louis, School of Medicine, Saint Louis, MO 63110, U.S.A
| | - Christine M Daley
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, U.S.A
| | - Kimberly Engelman
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, U.S.A
| | - K. Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, U.S.A
| | - Edward Ellerbeck
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, U.S.A
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Curry WJ, Lengerich EJ, Kluhsman BC, Graybill MA, Liao JZ, Schaefer EW, Spleen AM, Dignan MB. Academic detailing to increase colorectal cancer screening by primary care practices in Appalachian Pennsylvania. BMC Health Serv Res 2011; 11:112. [PMID: 21600059 PMCID: PMC3128846 DOI: 10.1186/1472-6963-11-112] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 05/23/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the United States, colorectal cancer (CRC) is the third most frequently diagnosed cancer and second leading cause of cancer death. Screening is a primary method to prevent CRC, yet screening remains low in the U.S. and particularly in Appalachian Pennsylvania, a largely rural area with high rates of poverty, limited health care access, and increased CRC incidence and mortality rates. Receiving a physician recommendation for CRC screening is a primary predictor for patient adherence with screening guidelines. One strategy to disseminate practice-oriented interventions is academic detailing (AD), a method that transfers knowledge or methods to physicians, nurses or office staff through the visit(s) of a trained educator. The objective of this study was to determine acceptability and feasibility of AD among primary care practices in rural Appalachian Pennsylvania to increase CRC screening. METHODS A multi-site, practice-based, intervention study with pre- and 6-month post-intervention review of randomly selected medical records, pre- and post-intervention surveys, as well as a post-intervention key informant interview was conducted. The primary outcome was the proportion of patients current with CRC screening recommendations and having received a CRC screening within the past year. Four practices received three separate AD visits to review four different learning modules. RESULTS We reviewed 323 records pre-intervention and 301 post-intervention. The prevalence of being current with screening recommendation was 56% in the pre-intervention, and 60% in the post-intervention (p=0.29), while the prevalence of having been screened in the past year increased from 17% to 35% (p<0.001). Colonoscopies were the most frequently performed screening test. Provider knowledge was improved and AD was reported to be an acceptable intervention for CRC performance improvement by the practices. CONCLUSIONS AD appears to be acceptable and feasible for primary care providers in rural Appalachia. A ceiling effect for CRC screening may have been a factor in no change in overall screening rates. While the study was not designed to test the efficacy of AD on CRC screening rates, our evidence suggests that AD is acceptable and may be efficacious in increasing recent CRC screening rates in Appalachian practices which could be tested through a randomized controlled study.
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Affiliation(s)
- William J Curry
- Department of Family and Community Medicine, College of Medicine, The Pennsylvania State University, Hershey, PA 17033-0850, USA
- Penn State Ambulatory Research Network, The Pennsylvania State University, Hershey, PA 17033-0850, USA
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033-0855, USA
| | - Eugene J Lengerich
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033-0855, USA
- Penn State Hershey Cancer Institute, The Pennsylvania State University, Hershey, PA 17033-0850, USA
| | - Brenda C Kluhsman
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033-0855, USA
- Penn State Hershey Cancer Institute, The Pennsylvania State University, Hershey, PA 17033-0850, USA
| | - Marie A Graybill
- Department of Family and Community Medicine, College of Medicine, The Pennsylvania State University, Hershey, PA 17033-0850, USA
- Penn State Ambulatory Research Network, The Pennsylvania State University, Hershey, PA 17033-0850, USA
| | - Jason Z Liao
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033-0855, USA
- Penn State Hershey Cancer Institute, The Pennsylvania State University, Hershey, PA 17033-0850, USA
| | - Eric W Schaefer
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033-0855, USA
| | - Angela M Spleen
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033-0855, USA
| | - Mark B Dignan
- Department of Internal Medicine, University of Kentucky, Lexington, KY 40506-0093, USA
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Kozłowska E, Szewczyk MT, Banaszkiewicz Z, Jawień A, Cierzniakowska K, Jarmocik P. Knowledge of symptoms and diagnostic possibilities of cancer diseases. Arch Med Sci 2011; 7:304-9. [PMID: 22291771 PMCID: PMC3258706 DOI: 10.5114/aoms.2011.22082] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 03/05/2010] [Accepted: 04/21/2010] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of the present study was to analyse patients' knowledge in the field of neoplastic prophylaxis. MATERIAL AND METHODS The research was carried out between 2007 and 2008 in the Provincial Hospital in Bydgoszcz (i.e. general surgery, gynaecology and obstetrics, urology, breast surgery and thoracic surgery). Altogether 300 patients (of whom 250 were hospitalized) as well as 50 healthy subjects forming the control group were invited to participate in the study. A proprietary questionnaire containing eight multiple choice and another twelve open-ended questions was used for the purpose of the study. RESULTS Prostate and lung cancer patients were more aware of their diseases compared to the control group, but the differences were not significant (p = 0.85 and p = 0.53 respectively). In the field of screening the patients' knowledge, it was significantly higher in breast cancer subjects (p = 0.0008) while there was no difference compared to the control group in the remaining groups of cancer patients (i.e. colorectal, prostate or uterus cancer). Those most aware of their condition were patients from small towns (below 50,000), while subjects living in villages were the least aware. CONCLUSIONS Patients showed the greatest amount of knowledge regarding breast cancer and the least amount regarding prostate cancer. Oncological awareness in cancer patients was found to be related to variables such as education, age and residence. No difference was found between patients and controls, comparing their knowledge of disease symptoms as well as screening possibilities.
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Affiliation(s)
- Elżbieta Kozłowska
- Department of Surgery Nursing, Ludwik Rydygier Collegium Medicum, UMK, Bydgoszcz, Poland
| | - Maria T. Szewczyk
- Department of Surgery Nursing, Ludwik Rydygier Collegium Medicum, UMK, Bydgoszcz, Poland
- Department of Surgery Ludwik, Rydygier Collegium Medicum, UMK, Bydgoszcz, Poland
| | | | - Arkadiusz Jawień
- Department of Surgery Ludwik, Rydygier Collegium Medicum, UMK, Bydgoszcz, Poland
| | - Katarzyna Cierzniakowska
- Department of Surgery Nursing, Ludwik Rydygier Collegium Medicum, UMK, Bydgoszcz, Poland
- Department of Surgery Ludwik, Rydygier Collegium Medicum, UMK, Bydgoszcz, Poland
| | - Paweł Jarmocik
- Department of Surgery Ludwik, Rydygier Collegium Medicum, UMK, Bydgoszcz, Poland
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Morrow JB, Dallo FJ, Julka M. Community-based colorectal cancer screening trials with multi-ethnic groups: a systematic review. J Community Health 2011; 35:592-601. [PMID: 20224864 DOI: 10.1007/s10900-010-9247-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this review was to summarize the current literature of community-based colorectal cancer screening randomized controlled trials with multi-ethnic groups. The CDC reports 40% of adults do not receive time-appropriate colorectal cancer screening. Although overall screening rates have improved since 2000, disparities remain. Studies examining community characteristics may offer insight into improving screening rates and eliminating disparities. We identified community-based colorectal cancer screening studies using PubMed and Ovid Medline database searches. Inclusion criteria were: community-based, randomized controlled trials; English language; published from 1/2001 to 8/2009; all colorectal cancer screening test interventions recommended in the 2008 "Joint Consensus" report; and study participants from at least two racial/ethnic groups, with not more than 90% representation from one group. There were 29 relevant articles published during 2001-2009; with 15 meeting inclusion criteria. We categorized the final studies (n = 15) into the four categories of Patient mailings (n = 3), Telephone outreach (n = 3), Electronic/multimedia (n = 4), and Counseling/community education (n = 5). Of 15 studies, 11 (73%) demonstrated increased screening rates for the intervention group compared to controls, including all studies (100%) from the Patient mailings and Telephone outreach groups, 4 of 5 (80%) Counseling/community education studies, and 1 of 4 (25%) Electronic/multimedia interventions. Patient choice and tailoring of information were common features of trials that increased screening rates across study categories. Including community-level factors and social context may be useful in future design and evaluation of colorectal cancer interventions to reduce or prevent new cases of colorectal cancer.
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Affiliation(s)
- Jay B Morrow
- Department of Family and Community Medicine, UT Southwestern Medical Center at Dallas, 6263 Harry Hines Blvd, Dallas, TX 75390-9067, USA.
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Stock C, Haug U, Brenner H. Population-based prevalence estimates of history of colonoscopy or sigmoidoscopy: review and analysis of recent trends. Gastrointest Endosc 2010; 71:366-381.e2. [PMID: 19846082 DOI: 10.1016/j.gie.2009.06.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 06/15/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lower GI endoscopy, such as colonoscopy or sigmoidoscopy, is thought to have a substantial impact on colorectal cancer incidence and mortality through detection and removal of precancerous lesions and early cancers. We aimed to review prevalence estimates of history of colonoscopy or sigmoidoscopy in the general population and to analyze recent trends. METHODS A systematic review of the medical literature, including MEDLINE (1966 to August 2008) and EMBASE (1980 to August 2008), was undertaken, supplemented by searches of the European Health Interview & Health Examination Surveys database and bibliographies. Detailed age-specific and sex-specific prevalence estimates from the United States were obtained from the Behavioral Risk Factor Surveillance System surveys 2002, 2004, and 2006. RESULTS The search yielded 55 studies that met our inclusion criteria. The majority of the reports (43) originated from the United States. Other countries of origin included Australia (2), Austria (2), Canada (5), France (1), Germany (1), and Greece (1). Estimates from the United States were generally increasing over time up to 56% (2006) for lifetime use of colonoscopy or sigmoidoscopy in people aged 50 years and older. Analysis of national survey data showed higher prevalences among men aged 55 years and older than for women of the same age. Prevalences were highest for people aged 70 to 79 years. CONCLUSION Data from outside the United States were extremely limited. Prevalence estimates from the United States indicate that a considerable and increasing proportion of the population at risk has had at least 1 colonoscopy or sigmoidoscopy in their lives, although differences between age and sex groups persist. Prevalences of previous colonoscopy or sigmoidoscopy need to be taken into account in the interpretation of time trends in, and variation across, populations of colorectal cancer incidence and mortality.
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Affiliation(s)
- Christian Stock
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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Lamerato LE, Marcus PM, Jacobsen G, Johnson CC. Recruitment in the prostate, lung, colorectal, and ovarian (PLCO) cancer screening trial: the first phase of recruitment at Henry Ford Health System. Cancer Epidemiol Biomarkers Prev 2008; 17:827-33. [PMID: 18398023 DOI: 10.1158/1055-9965.epi-06-0528] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Recruitment of healthy subjects to long-term randomized controlled trials (RCTs) of cancer prevention or early detection has proven to be a difficult task. To quantify recruitment yield as well as characteristics of successfully recruited participants, we examined recruitment outcomes at 1 of the 10 centers participating in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, a National Cancer Institute-funded RCT of cancer screening modalities. MATERIALS AND METHODS During the early recruitment phase of PLCO (1993-1997), data on recruitment outcome were collected at the Henry Ford Health System (HFHS) in Detroit, Michigan. In this phase, HFHS identified potential participants using patient databases. Records were used to assess recruitment success by age, sex, race, household income (using area-based U.S. Census data), and preexisting morbidity. Logistic regression was used to assess whether enrollment success differed significantly according to these factors. RESULTS Of 74,139 persons ages 55 to 74 invited by HFHS to participate, 8,250 (11%) ;enrolled. In multivariate analyses, the odds of enrolling were modestly but significantly higher for women, Caucasians, persons in their 60's, and persons living in census blocks with higher median household income. Persons with two or more preexisting morbidities had significantly lower odds of enrolling compared to those with one or no preexisting morbidities. CONCLUSIONS These data suggest that only a small fraction of persons invited to enroll in long-term RCTs of cancer screening modalities actually do so. In this urban, Midwestern setting, certain characteristics including age, race, and income influenced recruitment success, albeit modestly.
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Affiliation(s)
- Lois E Lamerato
- Department of Biostatistics and Research Epidemiology, Henry Ford Health System, One Ford Place-5C, Detroit, MI 48125, USA.
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Acceptance of colonoscopy requires more than test tolerance. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2008; 22:41-7. [PMID: 18209780 DOI: 10.1155/2008/107467] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Colon cancer screening, including colonoscopy, lags behind other forms of cancer screening for participation rates. The intrinsic nature of the endoscopic procedure may be an important barrier that limits patients from finding this test acceptable and affects willingness to undergo screening. With colon cancer screening programs emerging in Canada, test characteristics and their impact on acceptance warrant consideration. OBJECTIVES To measure the acceptability of colonoscopy and define factors that contribute to procedural acceptability, in relation to another invasive gastrointestinal scope procedure, gastroscopy. PATIENTS AND METHODS Consecutive patients undergoing a colonoscopy (n=55) or a gastroscopy (n=33) were recruited. Their procedural experience was evaluated and compared pre-endoscopy, immediately before testing and postendoscopy. Questionnaires were used to capture multiple domains of the endoscopy experience and patient characteristics. RESULTS Patient scope groups did not differ preprocedurally for general or procedure-specific anxiety. However, the colonoscopy group did anticipate more pain. Those who had a gastroscopy demonstrated higher preprocedural acceptance than those who had a colonoscopy. The colonoscopy group had a significant decrease in scope concerns and anxiety postprocedurally. As well, they reported less pain than they anticipated. Regardless, postprocedurally, the colonoscopy group's acceptance did not increase significantly, whereas the gastroscopy group was almost unanimous in their test acceptance. The best predictor of pretest acceptability of colonoscopy was anticipated pain. CONCLUSIONS The findings indicate that concerns that relate specifically to colonoscopy, including anticipated pain, influence acceptability of the procedure. However, the experience of a colonoscopy does not lead to improved test acceptance, despite decreases in procedural anxiety and pain. Patients' preprocedural views of the test are most important and should be addressed directly to potentially improve participation in colonoscopy.
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Vernon SW, Tiro JA, Vojvodic RW, Coan S, Diamond PM, Greisinger A, Fernandez ME. Reliability and validity of a questionnaire to measure colorectal cancer screening behaviors: does mode of survey administration matter? Cancer Epidemiol Biomarkers Prev 2008; 17:758-67. [PMID: 18381467 DOI: 10.1158/1055-9965.epi-07-2855] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Valid and reliable self-report measures of cancer screening behaviors are important for evaluating efforts to improve adherence to guidelines. We evaluated test-retest reliability and validity of self-report of the fecal occult blood test (FOBT), sigmoidoscopy (SIG), colonoscopy (COL), and barium enema (BE) using the National Cancer Institute colorectal cancer screening (CRCS) questionnaire. A secondary objective was to evaluate reliability and validity by mail, telephone, and face-to-face survey administration modes. Consenting men and women, 51 to 74 years old, receiving care at a multispecialty clinic for at least 5 years who had not been diagnosed with colorectal cancer were stratified by prior CRCS status and randomized to survey mode (n = 857). Within survey mode, respondents were randomized to complete a second survey at 2 weeks, 3 months, or 6 months. Comparing self-report with administrative and medical records, concordance estimates were 0.91 for COL, 0.85 for FOBT, 0.85 for SIG, and 0.92 for BE. Overall sensitivity estimates were 0.91 for COL, 0.82 for FOBT, 0.76 for SIG, and 0.56 for BE. Specificity estimates were 0.91 for COL, 0.86 for FOBT, 0.89 for SIG, and 0.97 for BE. Sensitivity and specificity varied little by survey mode for any test. Report-to-records ratio showed overreporting for SIG (1.1), COL (1.15), and FOBT (1.57), and underreporting for BE (0.82). Reliability at all time intervals was highest for COL; there was no consistent pattern according to survey mode. This study provides evidence to support the use of the National Cancer Institute CRCS questionnaire to assess self-report with any of the three survey modes.
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Affiliation(s)
- Sally W Vernon
- University of Texas-Houston School of Public Health, Division of Health Promotion and Behavioral Sciences, Houston, TX 77030, USA.
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Schenck AP, Klabunde CN, Warren JL, Peacock S, Davis WW, Hawley ST, Pignone M, Ransohoff DF. Data sources for measuring colorectal endoscopy use among Medicare enrollees. Cancer Epidemiol Biomarkers Prev 2008; 16:2118-27. [PMID: 17932360 DOI: 10.1158/1055-9965.epi-07-0123] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Estimates of colorectal cancer test use vary widely by data source. Medicare claims offer one source for monitoring test use, but their utility has not been validated. We compared ascertainment of sigmoidoscopy and colonoscopy between three data sources: self reports, Medicare claims, and medical records. MATERIALS AND METHODS The study population included Medicare enrollees residing in North Carolina (n = 561) who had participated in a telephone survey on colorectal cancer tests. Medicare claims were obtained for the 5 years preceding the survey (January 1, 1998 to December 31, 2002). Information about sigmoidoscopy and colonoscopy procedures conducted in physician offices were abstracted from medical records. Sensitivity, specificity, positive predictive value, negative predictive value, agreement, and kappa statistics were calculated using the medical record as the gold standard. Agreement on specific procedure type and purpose was also assessed. RESULTS Agreement between claim and medical record regarding whether an endoscopic procedure had been done was high (over 90%). Agreement between self report and medical record and between self report and claim was good (79% and 74%, respectively). All three data sources adequately distinguished the type of procedure done. None of the data sources showed reliable levels of agreement regarding procedure purpose (screening or diagnostic). CONCLUSION Medicare claims can provide accurate information on whether a patient has undergone colorectal endoscopy and may be more complete than physician medical records. Medicare claims cannot be used to distinguish screening from diagnostic tests. Recognizing this limitation, researchers who use Medicare claims to assess rates of colorectal testing should include both screening and diagnostic endoscopy procedures in their analyses.
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Affiliation(s)
- Anna P Schenck
- The Carolinas Center for Medical Excellence, 100 Regency Forest, Suite 200, Cary, NC 27511-8598, USA.
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Wackerbarth SB, Tarasenko YN, Joyce JM, Haist SA. Physician colorectal cancer screening recommendations: an examination based on informed decision making. PATIENT EDUCATION AND COUNSELING 2007; 66:43-50. [PMID: 17098393 PMCID: PMC3635666 DOI: 10.1016/j.pec.2006.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Revised: 08/12/2006] [Accepted: 10/04/2006] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The purpose of this research was to examine the content of physicians' colorectal cancer screening recommendations. More specifically, using the framework of informed decision making synthesized by Braddock and colleagues, we conducted a qualitative study of the content of recommendations to describe how physicians are currently presenting this information to patients. METHODS We conducted semi-structured interviews with 65 primary care physicians. We analyzed responses to a question designed to elicit how the physicians typically communicate their recommendation. RESULTS Almost all of the physicians (98.5%) addressed the "nature of decision" element. A majority of physicians discussed "uncertainties associated with the decision" (67.7%). Fewer physicians covered "the patient's role in decision making" (33.8%), "risks and benefits" (16.9%), "alternatives" (10.8%), "assessment of patient understanding" (6.2%), or "exploration of patient's preferences" (1.5%). CONCLUSION We propose that the content of the colorectal screening recommendation is a critical determinant to whether a patient undergoes screening. Our examination of physician recommendations yielded mixed results, and the deficiencies identified opportunities for improvement. PRACTICE IMPLICATIONS We suggest primary care physicians clarify that screening is meant for those who are asymptotic, present tangible and intangible benefits and risks, as well as make a primary recommendation, and, if needed, a "compromise" recommendation, in order to increase screening utilization.
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Affiliation(s)
- Sarah B Wackerbarth
- Martin School of Public Policy and Administration, University of Kentucky, KY, USA.
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Fenton JJ, Cai Y, Weiss NS, Elmore JG, Pardee RE, Reid RJ, Baldwin LM. Delivery of cancer screening: how important is the preventive health examination? ARCHIVES OF INTERNAL MEDICINE 2007; 167:580-5. [PMID: 17389289 PMCID: PMC3443471 DOI: 10.1001/archinte.167.6.580] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Patients and physicians strongly endorse the importance of preventive or periodic health examinations (PHEs). However, the extent to which PHEs contribute to the delivery of cancer screening is uncertain. METHODS In a retrospective cohort study, we determined the association between receipt of a PHE and cancer testing in a population-based sample of enrollees in a Washington State health plan who were aged 52 to 78 years and eligible for colorectal, breast, or prostate cancer screening in 2002-2003 (N = 64 288). Outcomes included completion of any colorectal cancer testing (fecal occult blood testing, sigmoidoscopy, colonoscopy, or barium enema), screening mammography, and prostate-specific antigen testing. RESULTS More than half (52.4%) of the enrollees received a PHE during the study period. After adjusting for demographics, comorbidity, number of outpatient visits, and historical preventive service use before January 1, 2002, receipt of a PHE was significantly associated with completion of colorectal cancer testing (incidence difference, 40.4% [95% confidence interval (CI), 39.4%-41.3%]; relative incidence, 3.47 [95% CI, 3.34-3.59]), screening mammography [incidence difference, 14.2% [95% CI, 12.7%-15.7%]; relative incidence, 1.23 [95% CI, 1.20-1.25]), and prostate-specific antigen testing (incidence difference, 39.4% [95% CI, 38.3%-40.5%]; relative incidence, 3.06 [95% CI, 2.95-3.18]). CONCLUSIONS Among managed care enrollees eligible for cancer screening, PHE receipt is associated with completion of colorectal, breast, and prostate cancer testing. In similar populations, the PHE may serve as a clinically important forum for the promotion of evidence-based colorectal cancer and breast cancer screening and of screening with relatively less empirical support, such as prostate cancer screening.
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Affiliation(s)
- Joshua J Fenton
- Department of Family and Community Medicine, University of California, Davis, Sacramento, CA 95817, USA.
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Levy BT, Dawson J, Hartz AJ, James PA. Colorectal cancer testing among patients cared for by Iowa family physicians. Am J Prev Med 2006; 31:193-201. [PMID: 16905029 DOI: 10.1016/j.amepre.2006.04.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 01/30/2006] [Accepted: 04/03/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) can be largely prevented or effectively treated, yet about half of eligible Americans have not been screened. The purpose of this study was to examine patient and physician factors associated with documented CRC testing according to national guidelines. METHODS Cross-sectional study where 511 randomly selected rural patients aged 55 to 80 years of 16 board-certified Iowa family physicians were enrolled in 2004. Patient survey and medical record information were linked with physician surveys. Predictors of CRC testing were examined using a regression procedure that accommodated random physician effects (2005-2006). RESULTS Forty-six percent of patients were up-to-date with CRC testing in accordance with national guidelines. This percentage varied from 5% to 75% by physician (p < 0.0001). Of the patients who were up-to-date, 89% had colonoscopy, and 62% had symptoms prior to testing that could indicate CRC. The strongest univariate predictors other than symptoms were patient recollection of physician recommendation (odds ratio [OR] = 6.4, 95% confidence interval [CI] = 4.2-9.6) and physician documentation of recommendation (OR = 14.1, CI = 8.5-23.3). A multivariable regression model showed testing in accordance with guidelines significantly increased with government insurance (OR = 1.6, CI = 1.2-2.3), having a health maintenance visit in the preceding 26 months (OR = 2.4, CI = 1.4-4.1), family history of CRC (OR = 3.1, CI = 1.6-5.8), number of medical conditions (OR = 1.2 for each additional condition, CI = 1.1-1.3), high importance of screening to patient (OR = 2.6, CI = 1.5-4.5), patient satisfaction with doctor's discussions (OR = 3.3, CI = 2.2-4.8), physician trained in flexible sigmoidoscopy (OR = 2.3, CI = 1.6-3.4), and physician report of trying to follow American Cancer Society (ACS) guidelines (OR = 1.7, CI = 1.2-2.5). After excluding patients who had symptoms prior to screening, most of the ORs in the logistic regression analysis increased except that the number of medical conditions and physician trying to follow ACS guidelines became nonsignificant. CONCLUSIONS Fewer than half of rural patients received CRC testing, and most of those tested had symptoms. Physician recommendations and the manner of presenting the recommendations greatly influenced whether patients were tested.
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Affiliation(s)
- Barcey T Levy
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA.
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Lafata JE, Divine G, Moon C, Williams LK. Patient-physician colorectal cancer screening discussions and screening use. Am J Prev Med 2006; 31:202-9. [PMID: 16905030 PMCID: PMC4682196 DOI: 10.1016/j.amepre.2006.04.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 02/05/2006] [Accepted: 04/26/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Little is known about patient-physician colorectal cancer (CRC) screening discussions or how discussion content affects screening use. Analyses conducted in 2004-2005 of patient-physician CRC screening discussion content and its association with screening use are described. METHODS A mailed survey and retrospective claims data were used to compile information on insured, primary care patients aged 50 to 70 years (n = 4966). The survey collected information on patient-physician CRC screening discussion content (including the 5A's: assess, advise, agree, assist, and arrange). Survey responses were linked with 5-year retrospective claims data (ending December 31, 2003) on CRC screening use. Among patients reporting screening discussions, generalized estimating equation approaches were used to estimate the association of discussion content with screening use. RESULTS Among those reporting discussion information (n = 2463), 80% reported discussing CRC screening with their physician. The content of these discussions varied, and only 54% used CRC screening. Multivariable model results indicated that the likelihood of screening was greater among patients reporting help scheduling an appointment (assist) (odds ratio [OR] = 2.69, 95% confidence interval [CI] = 1.95-3.72) and those reporting a discussion of results or follow-up (arrange) (OR = 1.63, 95% CI = 1.18-2.24), and lower among patients offered a choice among screening modalities (agree) (OR = 0.57, 95% CI = 0.37-0.86) as well as among those who wanted more screening information (OR = 0.65, 95% CI = 0.43-0.97). CONCLUSIONS Not all patient-physician CRC screening discussions result in CRC screening use. It is important to understand which aspects of shared decision making and discussion content are likely to increase informed and value-concordant decisions to participate in recommended evidence-based CRC screening.
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Affiliation(s)
- Jennifer Elston Lafata
- Center for Health Services Research, Henry Ford Health System, Detroit, Michigan 48202, USA.
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Mauri D, Pentheroudakis G, Milousis A, Xilomenos A, Panagoulopoulou E, Bristianou M, Zacharias G, Christidis D, Mustou EA, Gkinosati A, Pavlidis N. Colorectal cancer screening awareness in European primary care. ACTA ACUST UNITED AC 2006; 30:75-82. [PMID: 16458453 DOI: 10.1016/j.cdp.2005.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2005] [Indexed: 11/15/2022]
Abstract
BACKGROUND Adjustment for stage at diagnosis markedly reduces USA versus European colorectal cancer survival differences and a screening bias was therefore suspected. Moreover, little is known about colorectal cancer screening habits in European primary care and the history of guidelines implementation. The purpose of the study was to index the overall colorectal cancer screening attitudes of European physicians involved in primary care activities. METHODS A systematic literature-search was performed in three major medical libraries: PubMed/MEDLINE, ISI web of science, and COCHRANE. RESULTS We found only five eligible studies, but valuable data were presented only in four. Colorectal cancer screening was recommended by 65-95% of physicians, but the major part of them implemented it only among high-risk individuals; stool occult blood testing was advised by 42-83% and prescription of screening endoscopic modalities was inconsistent. Most European reports found were not eligible and were mainly focused on diagnostic delay in symptomatic subjects rather than on screening procedures among asymptomatic individuals. CONCLUSION In comparison with European practice, colorectal cancer screening habits of American physicians are to a greater extent rational, evidence-based and well monitored and have a longer tradition in medical care thus allowing better prevention services for asymptomatic individuals.
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Affiliation(s)
- Davide Mauri
- PACMeR, Section of Public Health, Thoma Pashidi 31, TK 45445 Ioannina, Greece.
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Shokar NK, Carlson CA, Shokar GS. Physician and patient influences on the rate of colorectal cancer screening in a primary care clinic. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2006; 21:84-8. [PMID: 17020519 DOI: 10.1207/s15430154jce2102_9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) screening rates remain low, despite widespread recommendations. The study purpose was to ascertain whether lack of CRC screening is attributable to physicians' failure to address CRC screening or to patients' failure to comply with physician recommendation. This relationship was also examined over time. METHODS Retrospective chart review of 400 preventive health visits. RESULTS Physicians appropriately addressed screening 16.5% of the time during 1998-1999 and 51% of the time during 2002-2003 (P <or= .001). The rate of test completion by patients was 53% in 1998-1999 and 31% in 2002-2003, resulting in completed CRC screening rates of 5% and 16.5%, respectively (P <or= .001). CONCLUSIONS Further education is needed, especially to target patient barriers to CRC screening test completion.
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