Research articleHealthcare system factors and colorectal cancer screening
Introduction
While mammography and Papanicolaou tests are currently used at appropriate intervals by a majority of the eligible U.S. population, colorectal cancer (CRC) screening rates have not kept pace.1, 2 Approximately 20% of people aged ≥50 report having a fecal occult blood test (FOBT) within the previous year; 30% a flexible sigmoidoscopy (FSIG) within 5 years; 41% either; and 10% both.2, 3 Estimates for colonoscopy and barium enema (BE) are considerably lower.4 Low rates of CRC screening are disturbing, given the relatively high incidence of CRC5 and effectiveness of early detection.6
Numerous studies document barriers to and facilitators of breast and cervical cancer screening,7, 8 including health-system factors, such as insurance type and the level of coverage.9, 10, 11, 12 Other factors include clinician and patient characteristics,13, 14, 15 patient mix within care systems,16, 17 and access to a personal physician.18, 19, 20 These factors, however, have largely gone unstudied in CRC screening.21 This study explores the relationship of CRC screening with insurance coverage and type, access to a regular physician, and demographic factors. It differs from previous studies as it reflects recently released guidelines indicating that FOBT, FSIG, colonoscopy, and BE all have a legitimate role in CRC screening,22 and was conducted during a period of health-system turmoil.23
Section snippets
Study sample and data collection
Participants were Massachusetts residents, aged ≥50, who had a working residential telephone number and had never been diagnosed with CRC. A random-digit-dial telephone survey was conducted in English or Spanish from June to August 1998. Three samples—a basic random sample, a male oversample, and a racial/ethnic minority oversample targeting African Americans and Hispanics—were drawn using the Kish sampling method.24 Of people contacted and eligible, 64% (n = 1119) were surveyed. Of these, 117
Population characteristics and testing status
Of participants, 521 (Table 1) were aged 50 to 64 (52%) and 481 were aged ≥65 (48%). Both groups were predominantly white. About 10% indicated a family history of CRC. The younger group reported higher levels of education and income, more hours at work, and better health status. A larger proportion of elders were widowed. Significantly more elders reported having a regular physician, having checkups more often than yearly, and having received a physician recommendation for an FSIG.
Overall,
Discussion
While previous studies examined either FOBT or FSIG alone, we examined an overall CRC screening measure based on recent guidelines. Using this definition, 52% of people aged 50 to 64 and 62% of people aged ≥65 were currently screened for CRC. Relying on only a single testing modality as a measure of CRC screening compliance underestimates prevalence, as there are numerous pathways to current status.
In this study, the elderly enrolled in Medicare HMOs had somewhat higher screening rates, as has
Acknowledgements
This study was supported by the National Institutes of Health (grant number RO1 CA69653). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute. We thank Stephen Erban, MD, Graham Barnard, MD, and Barbara Estabrook, MS, for their contributions to the project and helpful reviews of this manuscript.
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Cited by (164)
Reducing Disparities and Achieving Health Equity in Colorectal Cancer Screening
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2022, Contemporary Clinical TrialsCitation Excerpt :Intervention efforts must address individual-level factors, such as knowledge, attitudes, and beliefs, as well as social and healthcare systems factors that influence screening. Provider recommendation is a key predictor of CRC screening completion [14–16] especially when recommendations align with patient preferences for a specific screening modality [17,18]. Despite healthcare providers recognizing that collaborative decision making that attends to patient preferences improves screening uptake [4,19–24], shared decision-making for CRC screening is underutilized [18,25].
Patient preferences on general health and colorectal cancer screening decision-making: Results from a national survey
2022, Patient Education and CounselingCitation Excerpt :Despite the availability of multiple screening methods, average-risk CRC screening remain underutilized in the US [7–10]. Provider recommendation has been consistently reported to play a strong role in CRC screening completion [11,12] and provider recommendations that are consonant with patient preferences may lead to better CRC screening acceptance and adherence [13,14]. It has been advocated that the best CRC screening method is the one that patients are most likely to complete [15] and that healthcare providers should engage patients in shared decision-making [16] regarding CRC screening, a process through which patients and their providers make clinical decisions collaboratively and take into account the best scientific evidence available as well as the patient’s values, needs, and preferences [6,17,18].
Health Care Provider Characteristics Associated With Colorectal Cancer Screening Preferences and Use
2022, Mayo Clinic ProceedingsColorectal cancer screening completion: An examination of differences by screening modality
2020, Preventive Medicine Reports