A Poster of Disparity: A Visual Colorectal Cancer Screening Awareness Campaign Did Not Increase Screening Colonoscopy in African Americans

Abstract

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States. African Americans have an increased incidence and mortality from CRC compared to other ethnicities. Despite this, African Americans continue to have lower screening rates than Caucasians. Special efforts are needed to increase CRC screening participation among African Americans. This study evaluated the effect of a simple, picture-predominant campaign promoting awareness of CRC and screening. Methods: A visual CRC awareness campaign was conducted at an urban academic medical center. Posters promoting CRC screening, comprised mainly of pictures and few words, were placed at the registration desks and waiting and examination rooms in the internal medicine department and gastroenterology division for one month. Using electronic health records, we performed a retrospective review of colonoscopies performed in the month of and one month after the campaign and in the same two months of the prior year. Patient demographics and procedure indication were obtained. Statistical analysis was conducted using Fisher's Exact Test with significance set at p< 0.05. Results: Our CRC awareness campaign of simple placards and signs increased the overall number of screening colonoscopies, but the increase among African Americans was not as significant as others. African American patients may have been less receptive to the campaign, or more reluctant to undergo the procedure or were unable to arrange a colonoscopy immediately following the campaign and within our study period. Additional efforts are needed in order to identify effective patient education techniques to increase screening rates in all patients and especially in African-Americans. Conclusion: Our CRC awareness campaign of simple placards and signs increased the overall number of screening colonoscopies, but the increase among African Americans was meager. African American patients may have been less receptive to the campaign or more reluctant to undergo the procedure. Alternatively, they may have been less able or motivated to arrange a colonoscopy immediately following the campaign and within our study period. African Americans are at increased risk for CRC morbidity and mortality and have a low rate of screening compared to Caucasians. Additional efforts are needed in order to identify effective patient education techniques to increase screening rates in this population.