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Olchowska-Kotala A, Bajcar B. Predictors of Undergoing Colonoscopy, Does Time Horizon Matter? J Prim Prev 2020; 41:127-137. [PMID: 31981005 PMCID: PMC7060149 DOI: 10.1007/s10935-020-00581-5] [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] [Indexed: 11/29/2022]
Abstract
When talking to patients about undergoing diagnostic colonoscopy, their doctors can present the risk of developing colorectal cancer (CRC) in different time horizons. Studies on time horizons suggest that people have different psychological associations for the near and distant future, which potentially influence their judgments and actions. The aim of this study was to examine what factors predict patients’ intentions to undergo diagnostic colonoscopy. We particularly focused on examining the role of the time horizon in which the probability of developing malignant CRC was presented, when taking into account the following factors: the perception of risk (perceived susceptibility to and perceived severity of CRC), expected discomfort related to the procedure, a previous colonoscopy, and subjective numeracy. Using the Health Belief Model, we sought to determine whether the intention to undergo a preventive colonoscopy is affected by the time horizon. We hypothesized that the risk of developing CRC in a proximal time horizon would be more threatening to an individual than a distal one and would consequently increase an individual’s behavioral intention to undergo a colonoscopy. We examined the effects of two different time horizons: the risk of developing a disease in the next few years and total lifetime risk. A total of 144 respondents (77 women and 67 men) aged 50–59 years participated in the study. We found that risk perception and expected discomfort significantly affected participants’ intention to undergo a colonoscopy. No empirical evidence was found to confirm that presenting a person with the risk of developing malignant CRC in the coming years, as compared to their lifetime risk, increases the behavioral intention to undergo a diagnostic colonoscopy.
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Affiliation(s)
- Agnieszka Olchowska-Kotala
- Department of Medical Humanities and Social Science, Wroclaw Medical University, ul. Mikulicza-Radeckiego 7, 50-367, Wrocław, Poland.
| | - Beata Bajcar
- Psychology and Ergonomics Group, Faculty of Computer Science and Management, Wrocław University of Science and Technology, Wrocław, Poland
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Byrd TL, Calderón-Mora J, Salaiz R, Shokar NK. Barriers and Facilitators to Colorectal Cancer Screening Within a Hispanic Population. HISPANIC HEALTH CARE INTERNATIONAL 2018; 17:23-29. [PMID: 30574791 DOI: 10.1177/1540415318818982] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) is the third leading cancer cause of death among US Hispanics. CRC screening among the Hispanic population is lower compared with non-Hispanic Whites. METHOD The purpose of this qualitative, exploratory study was to better understand the barriers and facilitators of CRC screening and preference for stool-based testing collection methods among the predominantly Hispanic population of El Paso, Texas. Nine focus groups were conducted by a trained bilingual facilitator with a moderator guide informed by the literature. Transcripts of the focus groups were entered into qualitative analysis software and a thematic network was developed. RESULTS Fifty-six participants were recruited: average age was 68.5 years, 58.9% were female, 98.2% were Hispanic, 87.5% had an annual income of less than $20,000, 58.9% had 9th grade education or less, 12.5% had a discount program, and 5.4% had no insurance. Barriers to CRC screening included cost, fear, and embarrassment. Facilitators to screening included in-person health education and physician recommendation. Participants preferred the hygienic nature of a stool test collected with a brush and bottle. CONCLUSION Overall, there was a lack of knowledge regarding CRC and significant barriers to CRC screening. A community-based CRC screening program was subsequently developed from our findings.
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Affiliation(s)
- Theresa L Byrd
- 1 Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Rebekah Salaiz
- 2 Texas Tech University Health Sciences Center, El Paso, TX, USA
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3
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Teixeira C, Martins C, Trabulo D, Ribeiro S, Cardoso C, Mangualde J, Freire R, Gamito É, Alves AL, Cremers I, Oliveira AP. Colorectal Cancer Screening: What Is the Population's Opinion. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2017; 25:62-67. [PMID: 29662929 DOI: 10.1159/000480705] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/19/2017] [Indexed: 11/19/2022]
Abstract
Background Colorectal cancer (CRC) is the first cause of death by cancer in Portugal and mortality has been increasing in the last 30 years. Materials and Methods During a raising awareness campaign performed by our Gastroenterology Department, in Setúbal, Portugal, an anonymous written questionnaire was developed and presented in order to evaluate the population's knowledge and attitude regarding CRC screening. Results The following results were reported: 140 persons; mean age 54.6 years; 61.4% women; 22.1% had a family history of colorectal cancer. The main risk factors mentioned by the respondents were family history of CRC, previous history of intestinal polyps, and intestinal infection. Screening was considered useful by all respondents. About 60% of the respondents had been counselled, at least, on one screening technique, mainly by their general practitioner: colonoscopy in 31, fecal occult blood test in 44, and flexible sigmoidoscopy in 9. Most of the respondents had had the appropriate screening test, according to their age and family history. Fourteen of the respondents had not undergone the recommended screening. Their answers showed that this was due to fear of pain/discovering a disease as well as embarrassment. Conclusion Although the majority of the respondents were aware of the importance of CRC screening, results show that there are still several misconceptions about risk factors, fear, and reluctance concerning the screening techniques. Awareness actions are useful to clarify possible questions and inform the population in order to increase compliance with screening.
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Affiliation(s)
- Cristina Teixeira
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Cláudio Martins
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Daniel Trabulo
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Suzane Ribeiro
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Cláudia Cardoso
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - João Mangualde
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Ricardo Freire
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Élia Gamito
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Ana Luisa Alves
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Isabelle Cremers
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Ana Paula Oliveira
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
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Schwartz PH, Perkins SM, Schmidt KK, Muriello PF, Althouse S, Rawl SM. Providing Quantitative Information and a Nudge to Undergo Stool Testing in a Colorectal Cancer Screening Decision Aid: A Randomized Clinical Trial. Med Decis Making 2017; 37:688-702. [DOI: 10.1177/0272989x17698678] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Peter H. Schwartz
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA (PHS, KKS, PFM)
- Indiana University Center for Bioethics, Indianapolis, IN, USA (PHS, PFM)
- Philosophy Department, Indiana University School of Liberal Arts, Indianapolis, IN, USA (PHS)
- Indiana University Simon Cancer Center, Indianapolis, IN, USA (PHS, SMP, SMR)
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA (SMP, SA)
| | - Susan M. Perkins
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA (PHS, KKS, PFM)
- Indiana University Center for Bioethics, Indianapolis, IN, USA (PHS, PFM)
- Philosophy Department, Indiana University School of Liberal Arts, Indianapolis, IN, USA (PHS)
- Indiana University Simon Cancer Center, Indianapolis, IN, USA (PHS, SMP, SMR)
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA (SMP, SA)
| | - Karen K. Schmidt
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA (PHS, KKS, PFM)
- Indiana University Center for Bioethics, Indianapolis, IN, USA (PHS, PFM)
- Philosophy Department, Indiana University School of Liberal Arts, Indianapolis, IN, USA (PHS)
- Indiana University Simon Cancer Center, Indianapolis, IN, USA (PHS, SMP, SMR)
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA (SMP, SA)
| | - Paul F. Muriello
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA (PHS, KKS, PFM)
- Indiana University Center for Bioethics, Indianapolis, IN, USA (PHS, PFM)
- Philosophy Department, Indiana University School of Liberal Arts, Indianapolis, IN, USA (PHS)
- Indiana University Simon Cancer Center, Indianapolis, IN, USA (PHS, SMP, SMR)
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA (SMP, SA)
| | - Sandra Althouse
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA (PHS, KKS, PFM)
- Indiana University Center for Bioethics, Indianapolis, IN, USA (PHS, PFM)
- Philosophy Department, Indiana University School of Liberal Arts, Indianapolis, IN, USA (PHS)
- Indiana University Simon Cancer Center, Indianapolis, IN, USA (PHS, SMP, SMR)
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA (SMP, SA)
| | - Susan M. Rawl
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA (PHS, KKS, PFM)
- Indiana University Center for Bioethics, Indianapolis, IN, USA (PHS, PFM)
- Philosophy Department, Indiana University School of Liberal Arts, Indianapolis, IN, USA (PHS)
- Indiana University Simon Cancer Center, Indianapolis, IN, USA (PHS, SMP, SMR)
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA (SMP, SA)
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Volk RJ, Linder SK, Lopez-Olivo MA, Kamath GR, Reuland DS, Saraykar SS, Leal VB, Pignone MP. Patient Decision Aids for Colorectal Cancer Screening: A Systematic Review and Meta-analysis. Am J Prev Med 2016; 51:779-791. [PMID: 27593418 PMCID: PMC5067222 DOI: 10.1016/j.amepre.2016.06.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 06/02/2016] [Accepted: 06/02/2016] [Indexed: 01/22/2023]
Abstract
CONTEXT Decision aids prepare patients to make decisions about healthcare options consistent with their preferences. Helping patients choose among available options for colorectal cancer screening is important because rates are lower than screening for other cancers. This systematic review describes studies evaluating patient decision aids for colorectal cancer screening in average-risk adults and their impact on knowledge, screening intentions, and uptake. EVIDENCE ACQUISITION Sources included Ovid MEDLINE, Elsevier EMBASE, EBSCO CINAHL Plus, Ovid PsycINFO through July 21, 2015, pertinent reference lists, and Cochrane review of patient decisions aids. Reviewers independently selected studies that quantitatively evaluated a decision aid compared to one or more conditions or within a pre-post evaluation. Using a standardized form, reviewers independently extracted study characteristics, interventions, comparators, and outcomes. Analysis was conducted in August 2015. EVIDENCE SYNTHESIS Twenty-three articles representing 21 trials including 11,900 subjects were eligible. Patients exposed to a decision aid showed greater knowledge than those exposed to a control condition (mean difference=18.3 of 100; 95% CI=15.5, 21.1), were more likely to be interested in screening (pooled relative risk=1.5; 95% CI=1.2, 2.0), and more likely to be screened (pooled relative risk=1.3; 95% CI=1.1, 1.4). Decision aid patients had greater knowledge than patients receiving general colorectal cancer screening information (pooled mean difference=19.3 of 100; 95% CI=14.7, 23.8); however, there were no significant differences in screening interest or behavior. CONCLUSIONS Decision aids improve knowledge and interest in screening, and lead to increased screening over no information, but their impact on screening is similar to general colorectal cancer screening information.
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Affiliation(s)
- Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Suzanne K Linder
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, Texas
| | - Maria A Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Geetanjali R Kamath
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel S Reuland
- Division of General Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Smita S Saraykar
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Viola B Leal
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael P Pignone
- Division of General Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Turgeon DK, Ruffin MT. Screening strategies for colorectal cancer in asymptomatic adults. Prim Care 2014; 41:331-53. [PMID: 24830611 DOI: 10.1016/j.pop.2014.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article provides an update for the primary care community on the evidence and recommendations for colorectal cancer screening in the adult population without symptoms at average and increased risk, excluding patients with high-risk genetic syndromes. The current and possible new screening strategies are reviewed, along with clinical wisdom related to the implementation of each method.
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Affiliation(s)
- D Kim Turgeon
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Mack T Ruffin
- Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48104-1213, USA.
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Daskalakis C, Vernon SW, Sifri R, DiCarlo M, Cocroft J, Sendecki JA, Myers RE. The effects of test preference, test access, and navigation on colorectal cancer screening. Cancer Epidemiol Biomarkers Prev 2014; 23:1521-8. [PMID: 24813819 DOI: 10.1158/1055-9965.epi-13-1176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Little is known about how colorectal cancer screening test preferences operate together with test access and navigation to influence screening adherence in primary care. METHODS We analyzed data from a randomized trial of 945 primary care patients to assess the independent effects of screening test preference for fecal immunochemical test (FIT) or colonoscopy, mailed access to FIT and colonoscopy, and telephone navigation for FIT and colonoscopy, on screening. RESULTS Preference was not associated with overall screening, but individuals who preferred FIT were more likely to complete FIT screening (P = 0.005), whereas those who preferred colonoscopy were more likely to perform colonoscopy screening (P = 0.032). Mailed access to FIT and colonoscopy was associated with increased overall screening (OR = 2.6, P = 0.001), due to a 29-fold increase in FIT use. Telephone navigation was also associated with increased overall screening (OR = 2.1, P = 0.005), mainly due to a 3-fold increase in colonoscopy performance. We estimated that providing access and navigation for both screening tests may substantially increase screening compared with a preference-tailored approach, mainly due to increased performance of nonpreferred tests. CONCLUSIONS Preference influences the type of screening tests completed. Test access increases FIT and navigation mainly increases colonoscopy. Screening strategies providing access and navigation to both tests may be more effective than preference-tailored approaches. IMPACT Preference tailoring in colorectal cancer screening strategies should be avoided if the objective is to maximize screening rates, although other factors (e.g., costs, necessary follow-up) should also be considered.
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Affiliation(s)
| | - Sally W Vernon
- Division of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Melissa DiCarlo
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - James Cocroft
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | | | - Ronald E Myers
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania; and
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8
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Jimbo M, Kelly-Blake K, Sen A, Hawley ST, Ruffin MT. Decision Aid to Technologically Enhance Shared decision making (DATES): study protocol for a randomized controlled trial. Trials 2013; 14:381. [PMID: 24216139 PMCID: PMC3842677 DOI: 10.1186/1745-6215-14-381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 10/29/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Clinicians face challenges in promoting colorectal cancer screening due to multiple competing demands. A decision aid that clarifies patient preferences and improves decision quality can aid shared decision making and be effective at increasing colorectal cancer screening rates. However, exactly how such an intervention improves shared decision making is unclear. This study, funded by the National Cancer Institute, seeks to provide detailed understanding of how an interactive decision aid that elicits patient's risks and preferences impacts patient-clinician communication and shared decision making, and ultimately colorectal cancer screening adherence. METHODS/DESIGN This is a two-armed single-blinded randomized controlled trial with the target of 300 patients per arm. The setting is eleven community and three academic primary care practices in Metro Detroit. Patients are men and women aged between 50 and 75 years who are not up to date on colorectal cancer screening. ColoDATES Web (intervention arm), a decision aid that incorporates interactive personal risk assessment and preference clarification tools, is compared to a non-interactive website that matches ColoDATES Web in content but does not contain interactive tools (control arm). Primary outcomes are patient uptake of colorectal cancer screening; patient decision quality (knowledge, preference clarification, intent); clinician's degree of shared decision making; and patient-clinician concordance in the screening test chosen. Secondary outcome incorporates a Structural Equation Modeling approach to understand the mechanism of the causal pathway and test the validity of the proposed conceptual model based on Theory of Planned Behavior. Clinicians and those performing the analysis are blinded to arms. DISCUSSION The central hypothesis is that ColoDATES Web will improve colorectal cancer screening adherence through improvement in patient behavioral factors, shared decision making between the patient and the clinician, and concordance between the patient's and clinician's preferred colorectal cancer screening test. The results of this study will be among the first to examine the effect of a real-time preference assessment exercise on colorectal cancer screening and mediators, and, in doing so, will shed light on the patient-clinician communication and shared decision making 'black box' that currently exists between the delivery of decision aids to patients and subsequent patient behavior. TRIAL REGISTRATION ClinicalTrials.gov ID NCT01514786.
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Affiliation(s)
- Masahito Jimbo
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Karen Kelly-Blake
- Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI, USA
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sarah T Hawley
- Departments of Internal Medicine and Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Mack T Ruffin
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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9
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Fleisher L, Myers R, Wai C. Challenges and opportunities: putting into practice research-tested approaches to increase colorectal cancer screening. COLORECTAL CANCER 2012. [DOI: 10.2217/crc.12.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Linda Fleisher
- Fox Chase Cancer Center, 510 Township Line Road, Cheltenham, PA 19012, USA
| | - Ronald Myers
- Division of Population Science, Department of Medical Oncology, 1025 Walnut Street, Suite 1014 College Bldg, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Christina Wai
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
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10
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Cheng J, Pullenayegum E, Marshall DA, Marshall JK, Thabane L. An empirical comparison of methods for analyzing correlated data from a discrete choice survey to elicit patient preference for colorectal cancer screening. BMC Med Res Methodol 2012; 12:15. [PMID: 22348526 PMCID: PMC3306749 DOI: 10.1186/1471-2288-12-15] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 02/20/2012] [Indexed: 03/10/2023] Open
Abstract
Background A discrete choice experiment (DCE) is a preference survey which asks participants to make a choice among product portfolios comparing the key product characteristics by performing several choice tasks. Analyzing DCE data needs to account for within-participant correlation because choices from the same participant are likely to be similar. In this study, we empirically compared some commonly-used statistical methods for analyzing DCE data while accounting for within-participant correlation based on a survey of patient preference for colorectal cancer (CRC) screening tests conducted in Hamilton, Ontario, Canada in 2002. Methods A two-stage DCE design was used to investigate the impact of six attributes on participants' preferences for CRC screening test and willingness to undertake the test. We compared six models for clustered binary outcomes (logistic and probit regressions using cluster-robust standard error (SE), random-effects and generalized estimating equation approaches) and three models for clustered nominal outcomes (multinomial logistic and probit regressions with cluster-robust SE and random-effects multinomial logistic model). We also fitted a bivariate probit model with cluster-robust SE treating the choices from two stages as two correlated binary outcomes. The rank of relative importance between attributes and the estimates of β coefficient within attributes were used to assess the model robustness. Results In total 468 participants with each completing 10 choices were analyzed. Similar results were reported for the rank of relative importance and β coefficients across models for stage-one data on evaluating participants' preferences for the test. The six attributes ranked from high to low as follows: cost, specificity, process, sensitivity, preparation and pain. However, the results differed across models for stage-two data on evaluating participants' willingness to undertake the tests. Little within-patient correlation (ICC ≈ 0) was found in stage-one data, but substantial within-patient correlation existed (ICC = 0.659) in stage-two data. Conclusions When small clustering effect presented in DCE data, results remained robust across statistical models. However, results varied when larger clustering effect presented. Therefore, it is important to assess the robustness of the estimates via sensitivity analysis using different models for analyzing clustered data from DCE studies.
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Affiliation(s)
- Ji Cheng
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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11
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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.
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12
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The effect of study design biases on the diagnostic accuracy of magnetic resonance imaging for detecting silicone breast implant ruptures: a meta-analysis. Plast Reconstr Surg 2011; 127:1029-1044. [PMID: 21364405 DOI: 10.1097/prs.0b013e3182043630] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The U.S. Food and Drug Administration has recommended that all silicone breast implant recipients undergo serial screening to detect implant rupture with magnetic resonance imaging. The authors performed a systematic review and meta-analysis to examine the effect of study design biases on the estimation of magnetic resonance imaging diagnostic accuracy measures. METHODS Studies were identified using the MEDLINE, EMBASE, ISI Web of Science, and Cochrane library databases. Two reviewers independently screened potential studies for inclusion and extracted data. Study design biases were assessed using the Quality of Diagnostic Accuracy Studies tool and the Standards for Reporting of Diagnostic Accuracy Studies checklist. Meta-analyses estimated the influence of biases on diagnostic odds ratios. RESULTS Among 1175 identified articles, 21 met the inclusion criteria. Most studies using magnetic resonance imaging (10 of 16) and ultrasound (10 of 13) examined symptomatic subjects. Magnetic resonance imaging studies evaluating symptomatic subjects had 14-fold higher diagnostic accuracy estimates compared with studies using an asymptomatic sample (relative diagnostic odds ratio, 13.8; 95 percent confidence interval, 1.83 to 104.6) and 2-fold higher diagnostic accuracy estimates compared with studies using a screening sample (relative diagnostic odds ratio, 1.89; 95 percent confidence interval, 0.05 to 75.7). CONCLUSIONS Many of the published studies using magnetic resonance imaging or ultrasound to detect silicone breast implant rupture are flawed with methodologic biases. These methodologic shortcomings may result in overestimated magnetic resonance imaging diagnostic accuracy measures and should be interpreted with caution when applying the data to a screening population.
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13
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Schroy PC, Emmons K, Peters E, Glick JT, Robinson PA, Lydotes MA, Mylvanaman S, Evans S, Chaisson C, Pignone M, Prout M, Davidson P, Heeren TC. The impact of a novel computer-based decision aid on shared decision making for colorectal cancer screening: a randomized trial. Med Decis Making 2011; 31:93-107. [PMID: 20484090 PMCID: PMC4165390 DOI: 10.1177/0272989x10369007] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Eliciting patients' preferences within a framework of shared decision making (SDM) has been advocated as a strategy for increasing colorectal cancer (CRC) screening adherence. Our objective was to assess the effectiveness of a novel decision aid on SDM in the primary care setting. METHODS An interactive, computer-based decision aid for CRC screening was developed and evaluated within the context of a randomized controlled trial. A total of 665 average-risk patients (mean age, 57 years; 60% female; 63% black, 6% Hispanic) were allocated to 1 of 2 intervention arms (decision aid alone, decision aid plus personalized risk assessment) or a control arm. The interventions were delivered just prior to a scheduled primary care visit. Outcome measures (patient preferences, knowledge, satisfaction with the decision-making process [SDMP], concordance between patient preference and test ordered, and intentions) were evaluated using prestudy/poststudy visit questionnaires and electronic scheduling. RESULTS Overall, 95% of patients in the intervention arms identified a preferred screening option based on values placed on individual test features. Mean cumulative knowledge, SDMP, and intention scores were significantly higher for both intervention groups compared with the control group. Concordance between patient preference and test ordered was 59%. Patients who preferred colonoscopy were more likely to have a test ordered than those who preferred an alternative option (83% v. 70%; P < 0.01). Intention scores were significantly higher when the test ordered reflected patient preferences. CONCLUSIONS Our interactive computer-based decision aid facilitates SDM, but overall effectiveness is determined by the extent to which providers comply with patient preferences.
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Affiliation(s)
- Paul C Schroy
- Department of Medicine, Boston University School of Medicine, Boston, MA (PCS, JTG, PAR, MAL, SM, PD)
| | - Karen Emmons
- Medical Oncology, Dana Farber Cancer Institute, Boston, MA (KE)
| | | | - Julie T Glick
- Department of Medicine, Boston University School of Medicine, Boston, MA (PCS, JTG, PAR, MAL, SM, PD)
| | - Patricia A Robinson
- Department of Medicine, Boston University School of Medicine, Boston, MA (PCS, JTG, PAR, MAL, SM, PD)
| | - Maria A Lydotes
- Department of Medicine, Boston University School of Medicine, Boston, MA (PCS, JTG, PAR, MAL, SM, PD)
| | - Shamini Mylvanaman
- Department of Medicine, Boston University School of Medicine, Boston, MA (PCS, JTG, PAR, MAL, SM, PD)
| | - Stephen Evans
- Data Coordinating Center, Boston University School of Public Health, Boston, MA (SE, CC)
| | - Christine Chaisson
- Data Coordinating Center, Boston University School of Public Health, Boston, MA (SE, CC)
| | - Michael Pignone
- Department of Medicine, University of North Carolina, Chapel Hill, NC (MP)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA (MP)
| | - Marianne Prout
- Department of Epidemiology, Boston University School of Public Health, Boston, MA (MP)
| | - Peter Davidson
- Department of Medicine, Boston University School of Medicine, Boston, MA (PCS, JTG, PAR, MAL, SM, PD)
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA (TCH)
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What is most important to patients when deciding about colorectal screening? J Gen Intern Med 2010; 25:688-93. [PMID: 20309740 PMCID: PMC2881957 DOI: 10.1007/s11606-010-1318-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 10/20/2009] [Accepted: 02/16/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) screening can be administered through tests with varied characteristics and is a preference-sensitive decision. OBJECTIVE To assess patient experiences with a Maximum Differences Scaling (MDS) tool for eliciting values about CRC screening test characteristics and determine whether patients vary in how they prioritize test characteristics and whether this variation relates to test preferences. DESIGN MDS survey to elicit patients' values for characteristics related to fecal occult blood testing, sigmoidoscopy, colonoscopy, CT colonography and colon capsule endoscopy. PARTICIPANTS 92 patients enrolled in primary care clinics at a VA hospital and associated university. RESULTS Patients reported that the tool was easy to use (95%). On completion 62% would choose colonoscopy, 23% colon capsule endoscopy and 10% CT colonography. Of the attributes evaluated, patients valued sensitivity, risk of tear and need for a second test most. Sensitivity was more important to those choosing colonoscopy than those choosing other tests (median importance = 21.5 versus 19.6, p < 0.01). Concern with complications and sedation was positively associated with age (p < 0.001 and p < 0.001), whereas concern with colon preparation and missing work was negatively associated with age (p < 0.009 and p < 0.03). Patients with fair or poor health status were less concerned with sensitivity than patients in good to excellent health (median importance = 19.3 versus 21.4, p < 0.008). CONCLUSIONS This pilot study suggests that patients vary in how they prioritize colorectal cancer screening test attributes; this variation is associated with test preferences, and this MDS tool is feasible to use and may help patients construct their preferences.
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Powell AA, Burgess DJ, Vernon SW, Griffin JM, Grill JP, Noorbaloochi S, Partin MR. Colorectal cancer screening mode preferences among US veterans. Prev Med 2009; 49:442-8. [PMID: 19747502 DOI: 10.1016/j.ypmed.2009.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 09/02/2009] [Accepted: 09/02/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess colorectal cancer (CRC) screening mode preferences and correlates of these preferences among US veterans at average risk for CRC. METHOD A cross-sectional survey of a nationally representative sample of VA patients was conducted between January 2005 and December 2006. We report preference distributions for screening modes among 2068 average-risk veterans and across patient subgroups based on personal, behavioral, and environmental factors. Independent predictors of preferences are identified through hierarchical logistic regression models. RESULTS Colonoscopy (37%) was the most preferred mode followed by fecal occult blood test (FOBT) (29%). The strongest predictors of preferences were previous screening experience, provider recommendation, and use of non-VA healthcare services. Participants in higher socioeconomic groups were more likely to choose colonoscopy and less likely to indicate no preference. CONCLUSION Screening programs that offer only one mode fail to accommodate the preferences of a substantial proportion of patients. Within the VA, adding screening colonoscopy to programs currently offering only FOBT is likely to increase preferences for colonoscopy, as patients incorporate provider recommendations for and personal experience with colonoscopy into their preferences. This is likely to disproportionately benefit lower socioeconomic groups who do not currently have access to non-VA colonoscopy services.
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Affiliation(s)
- Adam A Powell
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417, USA.
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16
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The public prefers fecal occult blood test over colonoscopy for colorectal cancer screening. Eur J Cancer Prev 2008; 17:430-7. [PMID: 18714185 DOI: 10.1097/cej.0b013e328305a0fa] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The acceptability of colorectal cancer (CRC) screening tests to the population influences adherence. Population preferences between fecal occult blood test (FOBT) and colonoscopy for CRC screening were examined by previous test experience. The study population was a random sample of 413 members of Israel's largest Health Maintenance Organization (HMO) aged 48-68 years. In a telephone interview, an explanation was provided regarding FOBT and colonoscopy. Participants were asked which they preferred and their degree (1-6) of agreement with each of eight test characteristics. Overall Attitude Scores toward FOBT and colonoscopy were compared. Predictors of colonoscopy preference and of refusal to undergo screening were examined using a logistic regression model. FOBT was preferred as a screening test by 70.2% of the participants, colonoscopy by 9.3%, 7.4% were indecisive, and 13.1% were not interested in screening. FOBT and colonoscopy similarly scored highly as life saving (5.2 vs. 5.1, respectively), with colonoscopy scoring significantly higher as time consuming (3.8 vs. 1.3, P<0.0001), disturbing (4.6 vs. 1.8, P<0.0001), painful (4.1 vs. 1.0, P<0.0001), annoying (4.8 vs. 1.9, P<0.0001), and involving risk (3.2 vs. 1.0, P<0.0001). In a logistic multivariate analysis, preference of colonoscopy was associated with the perception of being at CRC risk [odds ratio (OR): 3.1 (95% confidence interval (CI): 1.3-7.6)], with more positive attitude scores towards this test [OR: 2.2 (95% CI: 1.6-3.0)], and with a more negative one toward FOBT [OR: 0.4 (95% CI: 0.3-0.7)]. Target population preferences for CRC screening supports a policy of FOBT screening for an average risk population and colonoscopy for high-risk individuals.
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Katsumura Y, Yasunaga H, Imamura T, Ohe K, Oyama H. Relationship between risk information on total colonoscopy and patient preferences for colorectal cancer screening options: analysis using the analytic hierarchy process. BMC Health Serv Res 2008; 8:106. [PMID: 18492286 PMCID: PMC2412845 DOI: 10.1186/1472-6963-8-106] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Accepted: 05/21/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the fecal occult blood test (FOBT) is the preferred program for colorectal cancer screening in Japan, many medical institutions have recently begun to provide total colonoscopy (TCS) as an initial screening program. However, there are a number of severe risks associated with TCS, such as colorectal bleeding and perforation. The justification for performing such a procedure on healthy patients remains unclear. We used the analytic hierarchy process (AHP) to investigate whether risk information on TCS affects patient preferences for colorectal cancer screening. METHODS We performed a questionnaire survey using an AHP decision-making model, targeting 285 people aged 40-59 years. We randomly assigned the subjects into Groups A (n = 146) and B (n = 139). Both groups were provided with information on the effectiveness, cost and disadvantages of the two screening programs. Group A was provided with additional information regarding the risks of TCS. Individual priorities were calculated with pair-wise comparisons between the two alternatives in each selection criteria. The influence of the risk information was analyzed using a logistic regression analysis. RESULTS The aggregated priorities in Group A for 'effectiveness', 'costs', and 'risks' were 0.603, 0.147, and 0.250, respectively, while those in Group B were 0.652, 0.149, and 0.199, respectively. A logistic regression analysis showed that the provision of risk information significantly reduced the subjects' priorities for TCS (p = 0.036). CONCLUSION The lack of risk information was related to the differences in priorities assigned to effectiveness and risks of the two procedures. Patients must be well informed before making decisions concerning their preferred colorectal cancer screening procedure.
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Affiliation(s)
- Yuichi Katsumura
- Department of Health Management and Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Parekh M, Fendrick AM, Ladabaum U. As tests evolve and costs of cancer care rise: reappraising stool-based screening for colorectal neoplasia. Aliment Pharmacol Ther 2008; 27:697-712. [PMID: 18248653 PMCID: PMC3170173 DOI: 10.1111/j.1365-2036.2008.03632.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Colorectal cancer screening and treatment are rapidly evolving. Aims To reappraise stool-based colorectal cancer screening in light of changing test performance characteristics, lower test cost and increasing colorectal cancer care costs. METHODS Using a Markov model, we compared faecal DNA testing every 3 years, annual faecal occult blood testing or immunochemical testing, and colonoscopy every 10 years. RESULTS In the base case, faecal occult blood testing and faecal immunochemical testing gained life-years/person and cost less than no screening. Faecal DNA testing version 1.1 at $300 (the current PreGen Plus test) gained 5323 life-years/100 000 persons at $16 900/life-year gained and faecal DNA testing version 2 (enhanced test) gained 5795 life-years/100 000 persons at $15 700/life-year gained vs. no screening. In the base case and most sensitivity analyses, faecal occult blood testing and faecal immunochemical testing were preferred to faecal DNA testing. Faecal DNA testing version 2 cost $100 000/life-year gained vs. faecal immunochemical testing when per-cycle adherence with faecal immunochemical testing was 22%. Faecal immunochemical testing with excellent adherence was superior to colonoscopy every 10 years. CONCLUSIONS As novel biological therapies increase colorectal cancer treatment costs, faecal occult blood testing and faecal immunochemical testing could become cost-saving. The cost-effectiveness of faecal DNA testing compared with no screening has improved, but faecal occult blood testing and faecal immunochemical testing are preferred to faecal DNA testing when patient adherence is high. Faecal immunochemical testing may be comparable to colonoscopy every 10 years in persons adhering to yearly testing.
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Affiliation(s)
- Murtaza Parekh
- Division of Gastroenterology, University of California, San Francisco,Department of Medicine, University of California, San Francisco
| | - A. Mark Fendrick
- Department of Internal Medicine, University of Michigan, Ann Arbor,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor,Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies (CHOICES), University of Michigan, Ann Arbor
| | - Uri Ladabaum
- Division of Gastroenterology, University of California, San Francisco,Department of Medicine, University of California, San Francisco
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Schroy Iii PC, Glick JT, Robinson PA, Heeren T. Screening preferences of patients at familial risk of colorectal cancer. Dig Dis Sci 2007; 52:2788-95. [PMID: 17404844 DOI: 10.1007/s10620-006-9670-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 11/07/2006] [Indexed: 12/09/2022]
Abstract
Our primary objective was to assess the screening preferences of patients at familial risk of colorectal cancer. Asymptomatic subjects aged 18-75 with a single first-degree relative diagnosed with colorectal cancer (n = 48) or polyps (n = 52) were asked to identify a preferred screening strategy, test features influencing their choice, and level of interest in decision-making after reviewing a decision aid describing the pros and cons of currently recommended screening tests. Although both groups preferred colonoscopy, 40% of subjects with a family history of colorectal cancer and 48% of those with a family history of polyps preferred alternative strategies. Accuracy was the most commonly identified test feature influencing test preference. Most subjects (66%) felt that selection of screening test should be a patient dominant or shared process. We conclude that patients at familial risk of colorectal cancer have distinct screening preferences that often vary from current recommendations.
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Affiliation(s)
- Paul C Schroy Iii
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
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Ruffin MT, Fetters MD, Jimbo M. Preference-based electronic decision aid to promote colorectal cancer screening: results of a randomized controlled trial. Prev Med 2007; 45:267-73. [PMID: 17689600 DOI: 10.1016/j.ypmed.2007.07.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 07/02/2007] [Accepted: 07/06/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Despite the burden of colorectal cancer and improved health care outcomes with early detection and treatment, screening rates among eligible adults are low. We previously developed through a series of studies an interactive electronic tool, Colorectal Web, to promote colorectal cancer screening. METHOD From May 2002 to December 2003, we conducted a randomized controlled trial of Colorectal Web compared to a standard Web site on colorectal cancer screening in urban, suburban, and rural communities in Michigan with high colorectal cancer burden. Study participants were age 50 years and older, with no previous colorectal cancer screening. Major outcome was screened for colorectal cancer by 24 weeks post-intervention. RESULTS 174 eligible adults were randomized and participated. Immediately post-intervention, Colorectal Web participants were significantly more likely to have a preferred colorectal cancer screening method, but this difference did not persist at subsequent follow-up. Eighty-nine participants had been screened for colorectal cancer by 24 weeks post-intervention. The probability of being screened for the Colorectal Web intervention study arm compared to the control is OR=3.23 (2.73-3.50 95% Confidence Interval). CONCLUSION Colorectal Web is more effective than a standard colorectal cancer Web site at prompting previously unscreened individuals to choose a preferred colorectal cancer screening test and to be screened for colorectal cancer.
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Affiliation(s)
- Mack T Ruffin
- University of Michigan Health System, Department of Family Medicine, 1018 Fuller Street SPC 5708, Ann Arbor, MI 48109-5708, USA.
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Abstract
PURPOSE To explore patient responsiveness when exposed to an online educational tool and to determine level of engagement in their medical care/treatment as a consequence of this exposure. METHOD More than 2,400 patients were exposed to the Emmi Solutions online, interactive and illustrated education tool for the procedures of gastric bypass, total hip replacement and colonoscopy. These procedures were chosen to reflect an elective surgery, a significant surgery (non-elective) and an elective diagnostic procedure. Patient responses were then analyzed to determine the level of engagement through feedback questions and comments, as well as determination of the value of the experience as rated by the patient. RESULTS More than 80 percent of patients felt that the online educational tool enhanced their understanding of the procedure/treatment. Specific comments and ratings reflect that the patients were more informed after the experience, and more than 90 percent felt sufficiently impressed with the tool to share it with their friends/family. CONCLUSIONS Utilizing an interactive educational tool enhances the patient's appreciation for the specifics of the treatment/procedure, increases their awareness of risks, provides information and comfort in knowledge and increases their confidence in the provider of the treatment/procedure. A significant percentage of the patients even engaged their family and friends in reviewing the tool, illustrating significant engagement in their pre-treatment/procedure experience.
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