RACIAL DISPARITY IN COLORECTAL CANCER SCREENING CAN PERSIST DESPITE AN EDUCATIONAL INTERVENTION

Abstract

Purpose: There is evidence that suggests that physicians may less often perform colorectal cancer screening in African-Americans (AA) compared to whites (W). There are no published studies that have assessed the impact of an educational intervention upon reducing racial disparities in colorectal cancer screening. This study evaluated the impact of an educational intervention upon internal medicine resident physicians' colorectal cancer screening practices in AA and W. Methods: A medical record review of physicians' colorectal cancer screening practices in AA and W was conducted prior to and following an educational intervention. Consecutive AA and W patients ≥50 years of age and of average risk for colorectal cancer who presented for a health maintenance evaluation were included. Physicians' performance of rectal exams, fecal occult blood testing (FOBT), and endoscopic assessment in AA and W patients was assessed 6 months prior to and following an educational intervention. Statistical significance was assessed using Fischer's exact test. Results: Medical records of 177 consecutive patients (116 AA, 61 W) were included in the pre-intervention assessment. Rectal exams were performed in 86 (48.6%; 48 AA, 38 W), FOBT in 86 (48.6%; 46 AA, 40 W) and endoscopic assessment in 92 (52%; 31 AA, 61 W). There was a statistically significant difference in the rate at which rectal exams (p = 0.0039), FOBT (p = 0.0006) and endoscopic assessment (p <0.0001) were performed. Following the educational intervention, the medical records of 200 consecutive patients (132 AA, 68 W) were included in the study. Rectal exams were performed in 77 (38.5%; 51 AA, 26 whites), FOBT in 75 (37.5%; 50 AA, 25 W) and endoscopic assessment in 126 (63%; 78 AA, 48 W). There was no statistically significant difference in the rate at which rectal exams (p = 0.1217) or FOBT (p = 0.1212) were performed. There was a statistically significant difference (p = 0.0349) in the rate at which endoscopic assessment was performed in AA compared to W. Conclusions: There was a racial disparity in the adherence to colorectal cancer screening recommendations by physicians when comparing AA to W patients. Educational intervention decreased the disparity in the rate of rectal exams and FOBT performed in AA and W patients. There was an improvement in the rate of endoscopic assessment in AA patients. However, there continued to be a racial disparity in the rate at which endoscopic screening was performed in AA compared to W patients despite a focused educational strategy.