Colorectal Cancer Screening Discussions Research Articles

Awareness, attitude and barriers of colorectal cancer screening among high-risk populations in China: a cross-sectional study

ObjectiveTo assess the awareness, attitude and barriers of colorectal cancer screening among high-risk populations in China.DesignA cross-sectional study was employed.SettingThis study was conducted in nine hospitals in Hunan province, China.ParticipantsIndividuals...

Factors associated with colorectal cancer screening in a peer-counseling intervention study in partnership with African American churches.

Colorectal cancer (CRC) mortality is 47% higher in African American men and 34% higher in African American women compared to non-Hispanic white men and women. This analysis assessed factors associated with CRC screening among 163 African American participants of a peer-counseling intervention study (2016-2018). In a one-group pre/post-test pilot study, trained Community Health Advisors (CHAs) at 9 African American churches in Los Angeles (LA) promoted CRC screening via one-on-one counseling, print materials and telephone reminder calls. Participants completed telephone surveys 3-6months after the intervention. We fit bivariate and multivariate mixed effects logistic regression models to assess correlates, including participants' demographic characteristics, access to care, cancer-related knowledge and attitudes and receipt of CHA counseling of (1) discussion of CRC screening with provider and (2) receipt of CRC screening during follow-up. After controlling for gender and education, receipt of CHA counseling (OR 3.77) was significantly associated with discussing CRC screening with a provider during follow-up but not with CRC screening. Instead, a routine check-up in the past 12months (OR 4.47) and discussion of CRC screening with a provider (OR 3.07) were significantly associated with CRC screening during follow-up. Residence in South LA (OR 0.38) was significantly associated with lack of CRC screening. Findings confirm the important role of health care providers and suggest that residence in South LA constitutes an additional barrier to CRC screening. Further research and additional resources are needed to address disparities in the uptake of CRC screening among African Americans, especially in South LA.

Abstract PO-035: Factors associated with colorectal cancer screening in a peer-counseling intervention study in partnership with African American churches

Abstract Background: Colorectal cancer (CRC) mortality is 47% higher in African American men and 34% higher in African American women compared to non-Hispanic white men and women. Methods: Nine African American churches in Los Angeles (LA) participated in a one-group pre/post-test pilot study to promote cancer screening (2015-2018). Each church identified 5 Community Health Advisors (CHAs) who received training to recruit study participants ages 50 to 75; assess participants’ adherence to cancer screening guidelines of the U.S. Preventive Services Task Force; and provide one-on-one counseling for participants who were not adherent. Participants completed telephone surveys 3 months after the intervention. The goal of this analysis was to understand CRC screening outcomes among 163 African American participants who were baseline non-adherent to CRC screening guidelines. We fit bivariate and multivariate mixed effects logistic regression models to assess correlates of (1) discussion of CRC screening with provider and (2) receipt of CRC screening during follow-up. Results: 49% of respondents reported that they discussed CRC screening with a provider during the follow-up period and 28% of respondents reported receipt of CRC screening. Respondents who reported that they were counseled by a CHA were more than twice as likely to discuss CRC screening with their provider as those who reported that they did not receive the intervention (54% versus 24%, p<0.005). Those who had a regular doctor, who had more than 3 health care visits in the past 3 months and who had a routine check-up in the past 12 months were also significantly more likely to discuss CRC screening with a provider (all p<.001). Females were almost twice as likely as males to receive CRC screening during the follow-up period than males (35% versus 18%, p<.02) and South LA residents were significantly less likely to receive CRC screening than participants outside of South LA (22% versus 38%, p<.02). Those who had a routine check-up in the past 12 months were also significantly more likely to report receipt of CRC testing during the follow-up period (all p<0.01). Those who had discussed CRC screening with a provider were significantly more likely to obtain CRC screening (p<.001). Knowledge of CRC screening guidelines was low overall but significantly higher among those who received CRC screening than among their counterparts who did not receive screening (p<.02). In multivariable analyses, receipt of CHA counseling (OR 3.77) was significantly associated with discussing CRC screening with a provider during follow-up but not with CRC screening. Residence in South LA (OR 0.38) was significantly associated with lack of CRC screening. Conclusions: Findings confirm the important role of health care providers and suggest that residence in South LA constitutes an additional barrier to CRC screening. Further research and additional resources are needed to address disparities in the uptake of CRC screening among African Americans, especially in South LA. Citation Format: Annette E. Maxwell, Aziza Lucas-Wright, Cindy Chang, Rhonda Santifer, Catherine M. Crespi. Factors associated with colorectal cancer screening in a peer-counseling intervention study in partnership with African American churches [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-035.

S0327 Patient Perspectives and Experience With Colorectal Cancer Screening

INTRODUCTION: Compliance with colorectal cancer (CRC) screening is dependent on patient’s perceptions and care provider’s recommendations. Characterizing the patient’s decision-parameters regarding CRC screening and predictors of getting a colonoscopy has not been well studied. This study addressed both of these aspects of CRC screening from the patient perspective. METHODS: WebMD conducted a consumer survey from May 14 to May 26, 2020. Data were collected anonymously via pop-up from the WebMD page. The study was exempt from institutional review board approval. Respondents were from the United States and were 50 years of age or older. They must have had a CRC screening recommended to them previously. 238 consumers responded; data were used for 233 who had complete responses. Descriptive statistics were calculated, and logistic regression examined significant predictors of getting any CRC screening or a colonoscopy. RESULTS: 69% selected colonoscopy as their CRC screening (Table 1). 15% of participants reported that they discussed multiple options with providers, and only 36% of those got a colonoscopy (Table 2). Participants who discussed multiple tests with their providers had significantly lower odds of getting a colonoscopy (Table 3). Patients who did not discuss multiple options were over 7 times more likely to get a colonoscopy. Patients whose providers recommended a colonoscopy had significant higher odds (3 times as likely to get) of having a CRC screening performed. CONCLUSION: Patient perception of CRC screening is weighted towards detection of cancers and polyps, yet only 69% chose colonoscopy. Notably, patient expressed desire for polyp detection paradoxically was not associated with getting colonoscopy. Although 95% selected detection of precancerous polyps or detection of both cancer and polyps as an important feature of their screening, 30% ultimately didn’t get a colonoscopy. Presenting multiple options when discussing CRC screening may inhibit patient selection of colonoscopy screening. Better understanding of patient’s perspectives for CRC screening identifies areas for patient directed education as well as care providers to direct these conversations. Limitations include the use of a convenience sample, and thereby, data represent those who use the internet to find health information at WebMD.com and are not representative of all races and ethnicities or ages over 50.Table 1.: Descriptive Characteristics for Patient SampleTable 2.: CRC Screening Test Selection for Those Who Discussed Multiple OptionsTable 3.: Logistic Regression Results for Colonoscopy as Last CRC Screening Method

Hereditary colorectal cancer screening: A 10-year longitudinal cohort study following an educational intervention.

Family history (FH) of a first-degree relative with colorectal cancer (CRC) is associated with two to fourfold increased risk, yet screening uptake is suboptimal despite proven mortality reduction. We developed a FH-based CRC Risk Triage/Management tool for family physicians (FPs), and educational booklet for patients with CRC FH. This report describes physician referral and patient screening behavior 5 and 10 years post-educational intervention, and factors associated with screening.Longitudinal cohort study. FPs/patients in Ontario and Newfoundland, Canada were sent questionnaires at baseline (2005), 5 and 10 years (2015) following tool/booklet receipt. FPs were asked about CRC screening, patients about FH, screening type and timing. “Correct” screening was concordance with tool recommendations.Results reported for 29/121 (24%) FPs and 98/297 (33%) patients who completed all 3 questionnaires. Over 10 years 2/3 patients received the correct CRC screening test at appropriate timing (baseline 75%, 5-year 62%, 10-year 65%). About half reported their FP recommended CRC screening (5-year 51%, 10-year 63%). Fewer than half the patients correctly assessed their CRC risk (44%, 40%, 41%). Patients were less likely to have correct screening timing if female (RR 0.78; 95% CI 0.61, 0.99; p = 0.045). Patients were less likely to have both correct test and timing if moderate/high CRC risk (RR 0.66; 95% CI 0.47, 0.93; p = 0.017) and more likely if their physician recommended screening (RR1.69; 95% CI 1.15, 2.49; p = 0.007).Physician discussion of CRC risk and screening can positively impact patient screening behavior. Efforts are particularly needed for women and patients at moderate/high CRC risk.

Abstract B105: Providing colorectal cancer screening interventions at Federally Qualified Health Centers (FQHCs): Addressing the issues of language, culture, and health literacy through culturally tailored education and navigation

Abstract Background: Colorectal cancer (CRC) screening is effective in preventing and detecting cancer at an early stage, yet CRC continues to be the second leading cause of cancer death, and populations served by Federally Qualified Health Centers (FQHCs) are screened at lower rates (39%) than the national average (67%), with the lowest screening rates recent immigrants (34%). Time constraints impede providers from discussing CRC screening; insufficient access to screening facilities and patients' fear regarding colonoscopy preparation and procedure are just some of the challenges CHCs face. These issues are only compounded by significant language and cultural barriers. Methods: This quality improvement (QI) initiative measured CRC screening rates from August 2016 to April 2018 at an urban FQHC providing primary care services to diverse, low-income, and predominantly non-English speaking population with two clinic locations (intervention and control site). The patient navigator assigned to the intervention site provided both provider and patient education, developed culturally tailored patient education materials (visual), assisted in scheduling and coordinating services (transportation, interpreters, obtaining prep solution for colonoscopy) and distributed fecal immunochemical testing (FIT) for those refusing or ineligible for a colonoscopy. Our rationale for the project, supported by preliminary data, was that FQHC providers want to increase screening rates, particularly in non-English speaking patients, but need tools and support to implement change. Results: Between August 2016 and April 2018, the intervention site increased from 32% to 59% of eligible patients screened for CRC, with the most notable change in the non-English speaking patients, primarily Burmese, Nepali and Spanish speaking. The change in CRC screening rates at the intervention from baseline is highly significant (p < 0.001), although the change from baseline in control site is also significant (p=0.020), but only in the second year. One year post intervention, there was a 24% increase in odds of participating in screening for a person at the intervention center compared to the control center. By April 2018, this effect increased significantly and the odds of participating in CRC screening are 86% higher for a person at the intervention center compared to the control center. In August 2018, intervention efforts will expand to the control site, piloting a culturally tailored educational video targeting the predominantly African American population served at the site. Conclusions: Specialized and tailored education plus navigation are effective in increasing CRC screening rates at FQHCs, particularly in non-English speaking populations. Understanding how different populations think about CRC screening informs navigation strategies on how to better promote screening in diverse populations and develop more targeted interventions. Citation Format: Kathryn M. Glaser, Tessa Flores, Miranda Lynch, Jessie Mossop, Alyssa Abrams, Carolyn Johnson, Deborah O. Erwin, Mary Reid. Providing colorectal cancer screening interventions at Federally Qualified Health Centers (FQHCs): Addressing the issues of language, culture, and health literacy through culturally tailored education and navigation [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B105.

Abstract B025: “Kulu the Colon”: An assessment of a colorectal cancer education intervention in Guam

Abstract Background. The island of Guam is a U.S. territory where a large proportion of Pacific Islanders and Filipinos reside. CHamoru, the indigenous people of Guam, have the overall highest incidence and mortality rates in colorectal cancer (CRC). CRC is the third leading cause of cancer death for both men and women on island. CRC screening data indicate 44.2% of persons age 50 and above have met USPSTF screening standards for CRC compared to 67.3% of the same cohort in the U.S. (CDC, 2019). In addition, CRC diagnoses often occur in the late stages with recent data revealing that 75.0% of these occur at Stage 3, while 18.0% occur at Stage 1 (Pacific Regional Central Cancer Registry, 2018). These late stage diagnoses have implications for early detection and CRC screening education interventions. The aim of this study was to provide CRC education via a giant inflatable colon and to assess changes in CRC knowledge, intent to screen for CRC, and willingness to discuss CRC with others. Methods. A pre- and post-test study design was used to assess changes in knowledge, beliefs, likelihood of discussing CRC screening with family members, and intent to screen after a guided tour through a giant inflatable colon. Participant response to whether the inflatable colon was a culturally appropriate education tool was also evaluated. We recruited participants at a health fair in a mall and an island-wide university event, through flyers, and convenience sampling. At the launch of the inflatable colon, we held a name-the-colon contest to engage community. The winning entry was “Kulu,” which is the CHamoru word for a conch shell and symbolizes a “call to action” to get screened for CRC. Results. A total of 201 participants completed a pre/post assessment. Majority of participants were CHamoru (40.8%) and Filipino (33.8%), female (65.0%), had a college degree (31.8%), and had health insurance (89.6%). Mean age was 36.6. Preliminary results at baseline indicate half of participants reported knowing what CRC (53.0%) and a polyp (50.5%) are. Overall, 72.4% reported knowing what a colonoscopy is and 42.4% indicated they knew what a stool test was. Prior to participating in the guided tour, 73.5% rated their general knowledge about CRC as neutral or unknowledgeable. At baseline, participants reported intent to discuss CRC screening with others (parents = 84.0%; spouses/partners = 90.3%). Conclusion. We hypothesize that using an inflatable colon to deliver CRC information: 1) increases CRC and related screening knowledge; 2) is a culturally appropriate way to provide CRC education; and 3) facilitates increased willingness to talk to others about CRC, especially among families. Pre-/post-test comparisons regarding CRC knowledge, willingness to talk to others about CRC, and intention to screen among persons 50 and above will be presented. Findings may provide insight toward more interactive CRC education for Pacific Islanders, and potentially improve CRC screening participation in Guam. Citation Format: Tressa P. Diaz, Maurissa Sayama, Lilnabeth Somera, Angelina Mummert. “Kulu the Colon”: An assessment of a colorectal cancer education intervention in Guam [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B025.

A risk prediction tool for colorectal cancer screening: a qualitative study of patient and provider facilitators and barriers

BackgroundDespite proven effectiveness of colorectal cancer (CRC) screening, at least 35% of screen-eligible adults are not current with screening. Decision aids and risk prediction tools may help increase uptake, adherence, and efficiency of CRC screening by presenting lower-risk patients with options less invasive than colonoscopy. The purpose of this qualitative study was to determine patient and provider perceptions of facilitators and barriers to use of a risk prediction tool for advanced colorectal neoplasia (CRC and advanced, precancerous polyps), to maximize its chances of successful clinical implementation.MethodsWe conducted qualitative, semi-structured interviews with patients aged 50–75 years who were not current with CRC screening, and primary care providers (PCPs) at an academic and a U.S. Department of Veterans Affairs Medical Center in the Midwest from October 2016 through March 2017. Participants were asked about their current experiences discussing CRC screening, then were shown the risk tool and asked about its acceptability, barriers, facilitators, and whether they would use it to guide their choice of a screening test. The constant comparative method guided analysis.ResultsThirty patients and PCPs participated. Among facilitators were the tool’s potential to increase screening uptake, reduce patient risk, improve resource allocation, and facilitate discussion about CRC screening. PCP-identified barriers included concerns about the tool’s accuracy, consistency with guidelines, and time constraints.ConclusionsPatients and PCPs found the risk prediction tool useful, with potential to increase uptake, safety, and efficiency of CRC screening, indicating potential acceptability and feasibility of implementation into clinical practice.

Lower Adherence: A Description of Colorectal Cancer Screening Barrier Talk

Understanding how patients and physicians discuss screening barriers may illuminate reasons for non-adherence to recommended colorectal cancer (CRC) screening. The goal of the present study was to describe patients’ reporting of and physicians’ responses to CRC screening barriers and examine their associations with patients’ CRC screening behaviors. Audio-recorded primary care consultations (N = 413) with patients due for CRC screening were used to identify CRC screening-related barrier talk and physician responses. Presence of barrier talk was associated with less patient adherence to CRC screening (OR = 0.568, p = 0.007). Neither CRC screening talk (n = 413) nor physician responses (n = 151) were associated with patients’ CRC screening. Among the consultations in which barrier talk occurred (n = 151), patients most often reported test-related (28.9%) and psychological (26.1%) barriers. Barriers were most often reported in the context of CRC screening discussions (45.7%) or in direct response to a physician’s question about CRC screening (48.6%). Results indicated that patients rarely raised CRC screening barriers unprompted and that presence of barrier talk was predictive of CRC screening behavior. These findings may help improve future clinical practice by highlighting that patients may benefit from physicians initiating and facilitating discussions of CRC screening barriers and directly helping patients overcome known barriers to CRC screening.

PreView: a Randomized Trial of a Multi-site Intervention in Diverse Primary Care to Increase Rates of Age-Appropriate Cancer Screening.

Women aged 50-70 should receive breast, cervical (until age 65), and colorectal cancer (CRC) screening; men aged 50-70 should receive CRC screening and should discuss prostate cancer screening (PSA). PreView, an interactive, individually tailored Video Doctor Plus Provider Alert Intervention, adresses all cancers for which average risk 50-70-year-old individuals are due for screening or screening discussion. We conducted a randomized controlled trial in 6 clinical sites. Participants were randomized to PreView or a video about healthy lifestyle. Intervention group participants completed PreView before their appointment and their clinicians received a "Provider Alert." Primary outcomes were receipt of mammography, Pap tests (with or without HPV testing), CRC screening (FIT in last year or colonoscopy in last 10 years), and PSA screening discussion. Additional outcomes included breast, cervical, and CRC screening discussion. A total of 508 individuals participated, 257 in the control group and 251 in the intervention group. Screening rates were relatively high at baseline. Compared with baseline screening rates, there was no significant increase in mammography or Pap smear screening, and a nonsignificant increase (18% vs 12%) in CRC screening. Intervention participants reported a higher rate of PSA discussion than did control participants (58% vs 36%: P < 0.01). Similar increases were seen in discussions about mammography, cervical cancer, and CRC screening. In clinics with relatively high overall screening rates at baseline, PreView did not result in significant increases in breast, cervical, or CRC screening. PreView led to an increase in PSA screening discussion. Clinician-patient discussion of all cancer screenings significantly increased, suggesting that interventions like PreView may be most useful when discussion of the pros and cons of screening is recommended and/or with patients reluctant to undergo screening. Future research should investigate PreView's impact on those who are hesitant or reluctant to undergo screening. ClinicalTrials.gov: NCT02264782.

Offering patients a choice for colorectal cancer screening: a quality improvement pilot study in a quality circle of primary care physicians

BackgroundGuidelines recommend primary care physicians (PCPs) offer patients a choice between colonoscopy and faecal immunochemical test (FIT) for colorectal cancer (CRC) screening. Patients choose almost evenly between both tests but...

A Cross-sectional Study of Knowledge, Attitude and Barriers to Colorectal Cancer Screening among Cancer Survivors.

Introduction:Understanding behaviour of cancer survivors is imperative as they are at risk of recurrence or second cancers. Colorectal cancer (CRC) is one of the most common cancers globally. We aim to determine the uptake rate, barriers and predictors of CRC screening among cancer survivors. Methods:Within a public hospital in Singapore, 150 non-CRC survivors were enrolled. Questionnaire on knowledge, screening behaviour, motivators and barriers towards CRC screening was administered. Results:Majority were survivors of breast (69.3%), prostate (7.3%), endometrial (4%) and ovarian (4%) cancers. More than half had high knowledge scores for CRC symptoms, screening tests and risk factors. About a third had received physician’s recommendation on CRC screening. Approximately half had undergone screening. The most common barriers to CRC screening were lack of symptoms and physician’s recommendation. Cancer survivors with higher education, higher household income, family history and those who perceived “great need” or “some need” were more likely to have undergone screening (56.4% vs 30.6%, p=0.003; 62.2% vs 41.9%, p=0.022; 70.6% vs 45.1%, p=0.048; 70.8% vs 27.4%, p<0.001). Physician’s recommendation (76.4% vs 31.6%, p<0.001) and high CRC symptom knowledge (55.8% vs 34.5%, p=0.012) were associated with increased likelihood of screening.On multivariate analysis, physician’s recommendation, higher household income and survivors’ perceived need to undergo screening remained strong predictors for CRC screening (p<0.001; p=0.010; p<0.001). Conclusion:The uptake rate of CRC screening among non-CRC survivors was modest. Physicians need to be more active in discussing CRC screening with cancer survivors as part of the survivorship care plan.

Study aims to improve colorectal cancer screening rates.

Study aims to improve colorectal cancer screening rates.

Abstract C80: Implementing a mailed colorectal cancer screening program: A safety-net clinic case study

Abstract Introduction: Screening for colorectal cancer (CRC) may reduce incidence and mortality, but screening rates are low, particularly in the community health center setting that often serves patients experiencing the greatest health disparities. Lack of time during office visits for providers to engage in CRC screening discussions, insufficient access to colonoscopy resources, and patients' fears regarding the colonoscopy preparation and procedure are some of the challenges community health centers face when promoting CRC screening. Methods: We conducted a qualitative case study to document the acceptability and reactions to a pilot direct-mail CRC screening program using fecal immunochemical testing (FIT). The pilot was implemented in a Latino-serving safety-net clinic that provides primary care to diverse and low-income populations. After the implementation of the direct-mail CRC screening program, we conducted 29 semistructured telephone interviews: nine with clinic staff and leaders involved in implementing the screening program, and twenty with patients who had received the CRC outreach via a mailed FIT test. Patient interviews were conducted with both English (10) and Spanish (10) language participants. To analyze our case study, we used a qualitative content analysis approach, guided by grounded theory coding techniques, to identify themes from the interviews. Two coding dictionaries (one patient and one staff/leader) were developed by having each member of the analysis team (JLS, JSR, GC) read several patient and staff transcripts and mark passages of text with codes indicating their content. The team compared coding notes, discussed areas of disagreement, and from this process developed a coding scheme for use with subsequent transcripts. Transcripts were coded by trained coders (JLS, JSR, GC); Spanish-language transcripts were coded and reviewed by bilingual coders (JSR, GC). All coded transcripts were entered into Atlas.ti 5.0, a qualitative analysis software program used to electronically code and manage data and to generate reports of coded text for ongoing thematic analysis. The analysis team reviewed coded text using an iterative process to develop and refine themes. Results: Our content analysis revealed that staff valued the program and found it could be integrated into their workflow and electronic medical record. Organizational facilitators to program implementation included having skilled staff, a culture that supported change, engaged leaders, and an overall desire to improve CRC screening rates. Access to colonoscopy was sufficient, because only the few percent of individuals with positive fecal tests needed colonoscopy. Health center barriers included managing the complexity of program components (e.g., ordering, packaging, and mailing kits; documentation in the medical record; reminders; coordination following a positive result, etc.) and limited staffing resources to deliver the intervention. The majority of patients, both Spanish and English, found the direct-mail fecal testing program acceptable and personally helpful, with eighty percent supporting the program and related materials. Four patients either disliked the idea of mailing fecal matter (2), or could not recall receiving the outreach (2). All staff and patients (regardless of personal utility of the outreach) felt the program should be continued as an ongoing health center outreach activity. Conclusion: Our interview findings may by useful to other community health centers looking to improve their CRC screening rates through implementation of a similar type of mailed, population-based CRC screening approach. Many of the barriers anticipated by community health centers were not realized; however, some challenges remained. Citation Format: Jennifer L. Schneider, Morgan J. Fuoco, Jennifer S. Rivelli, Jennifer Coury, Beverly B. Green, Amanda F. Petrik, Ann Turner, Tanya Kapka. Implementing a mailed colorectal cancer screening program: A safety-net clinic case study [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C80.

Abstract 5282: Implementing a colorectal cancer screening program: A navigation led effort in an urban community health center

Abstract Background: Colorectal cancer (CRC) screening is effective in preventing and detecting cancer at an early stage. Yet populations served by community health centers (CHCs) are screened at lower rates than the general population, and screening rates are even lower in non-English speaking populations. Time constraints during office visits often impede providers from discussing CRC screening, insufficient access to colonoscopy resources and facilities, and patients' fear regarding colonoscopy preparation and procedure are just some of the challenges CHCs face when promoting CRC screening. These issues are only compounded by significant language and cultural barriers. Methods: We conducted a quality improvement initiative that serves as a case study to measure the increase in CRC screening rates over a one year period at a CHC with two clinic locations (intervention and non-intervention site) providing primary care to diverse and low-income populations. A pilot site was selected by the CHC to test an intervention using patient education and navigation, while the second site received no direct navigation intervention. The patient navigator assigned to the intervention site provided patient education and developed new patient education materials (visual), in addition to assistance in scheduling and coordinating services (transportation, interpreters, obtaining prep solution etc.) for the actual colonoscopy, as well as distributing fecal immunochemical testing (FIT) for those refusing or ineligible for a colonoscopy. Our rationale for the project, supported by preliminary data was that CHC providers want to increase screening rates, particularly in non-English speaking patients, but need tools and support to implement change. Results: Between August 2016 and August 2017, the intervention site increased from 32% to 42% of eligible patients screened for CRC, with the most notable change in the non-English speaking patients (12% increase), primarily Burmese, Nepali and Spanish speaking, while there was only a 1% increase at the non-intervention site. Patient navigation efforts at the intervention site focused primarily on educating and navigating non-English speaking patients due to the increased barriers to understanding CRC and accessing preventative screening services. In total, 224 additional patients were screened for CRC during the intervention period with 86% of patients received screening colonoscopies over a FIT test. Conclusions: Specialized and tailored education and navigation can be effective to increase CRC screening rates at CHCs, particularly in non-English speaking populations. Understanding how different populations think about CRC screening would inform navigation strategies on how to better promote screening in diverse populations and develop more targeted interventions. Citation Format: Kathryn M. Glaser, Carly Nichols, Alyssa Abrams, Deborah O. Erwin, Mary Reid. Implementing a colorectal cancer screening program: A navigation led effort in an urban community health center [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5282.

Abstract B17: Effects of promotores-led small-group education on colorectal cancer knowledge among underserved Hispanics

Abstract Background: Great strides in cancer prevention and early detection have led to a decrease in colorectal cancer (CRC) incidence and mortality (Zauber, 2015). Nevertheless, CRC continues to be a leading cause of cancer-related deaths among men and women aged 50 and older in the US and Washington State (WA) (ACS, 2013; WA DOH, 2013). CRC disparities also continue to persist with regard to access to timely and effective cancer education and screening among minority and underserved populations (CDC, 2013; Tammana, 2014). The lower Yakima Valley of WA is a very rural, poor, and medically underserved area where a high proportion of Hispanics reside. Data from the Behavioral Risk Factor Surveillance System demonstrate that CRC screening rates in Yakima (79.87%), Franklin (75.03%), and Benton counties (79.46%) are lower than the WA screening rate (81.25%) (WA DOH, 2014). Thus, CRC screening promotion efforts in the lower Yakima Valley are of high importance. In this study, we used promotores to deliver the Colorectal Cancer 101 curriculum at “home health parties.” The aim of this study was to assess changes in CRC knowledge and intent to screen for CRC among Hispanics in the Yakima Valley. Methods: A pre- and post-test study design was used to assess changes in knowledge, attitudes, and beliefs around CRC and screening at baseline and at 3-month follow-up after receipt of a promotores-led home-based educational intervention. We recruited participants at local community events, through flyers, and snowball sampling. CRC home health parties were conducted in English and Spanish by bilingual-trained promotores between March and September 2012. Results: A total of 129 participants completed a pre/post assessment. Majority of participants were Hispanic (98.4%), female (73.4%), and had less than a high school education (86.0%). Although 72.1% had a regular doctor and 95.3% had a regular health clinic, only 50% reported having health insurance. Preliminary results show that at baseline, less than 40% of the participants reported having a physician recommend and discuss CRC screening, while 54.4% indicated thinking about going to a physician or clinic to receive CRC screening. Overall, 62% of the respondents stated having heard of the stool test, 55% had received a stool test in the past, and 63% reported considering obtaining a stool test within the next three months. Approximately 62% had heard of a colonoscopy or sigmoidoscopy; 37.4% had received such a test in the past and 36% were considering obtaining a colonoscopy or sigmoidoscopy within the next three months. At baseline, participants reported intent to discuss CRC screening with others (family members = 34.4%; friends = 40.3%). Conclusion: We hypothesize that using promotores to deliver CRC information: 1) is a culturally relevant way to increase knowledge about CRC and awareness of CRC screening, and 2) will result in increased intention to talk to others about CRC. Pre/post-test comparisons regarding CRC knowledge, intention to screen, and intention to talk to others about CRC will be presented. Citation Format: Katherine J. Briant, Janet Sanchez, Monica Escareno, Virginia Gonzalez, Beti Thompson. Effects of promotores-led small-group education on colorectal cancer knowledge among underserved Hispanics [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B17.

Individualized Colorectal Cancer Screening Discussions Between Older Adults and Their Primary Care Providers: A Cross-Sectional Study.

Introduction. Discussions of colorectal cancer (CRC) screening with older adults should be individualized to maximize appropriate screening. Our aim was to describe CRC screening discussions and explore their associations with patient characteristics and screening intentions. Methods. Cross-sectional survey of 422 primary care patients aged ≥70 years and eligible for CRC screening, including open-ended questions about CRC screening discussions. Primary outcomes were the frequency with which CRC screening discussions occurred, who had those discussions, and the domains that emerged from thematic analysis of participants’ brief reports of their discussions. We also examined the associations between 1) patient characteristics and whether a screening discussion occurred and 2) the domains discussed and what screening decisions were made. Results. Of 422 participants, 209 reported having discussions and 201 responded to open-ended questions about CRC discussions. In a regression analysis, several factors were associated with increased odds of having a discussion: participants’ preference to pursue screening (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.3, 3.9), good health (OR 2.9, 95% CI 1.7, 4.8), and receipt of the decision aid (OR 2.1, 95% CI 1.4, 3.2). Our thematic analysis identified five domains related to discussion content and three related to discussion process. The CRC screening–related information domain was the most commonly discussed content domain, and the timing/frequency domain was associated with increased odds of intent to pursue screening. Decision-making role, the most commonly discussed process domain, was associated with increased odds of the intent to forgo CRC screening. Conclusions and Relevance. CRC screening discussions varied by type of participant and content. Future work is needed to determine if interventions focused on specific domains alters the appropriateness of participants’ colorectal cancer screening intentions.

A systematic review of the psychological impact of false-positive colorectal cancer screening: What is the role of the general practitioner?

Screening for colorectal cancer (CRC) has both advantages (e.g. reduction in morbidity and mortality) and disadvantages (e.g. false positives and distress). A systematic review was therefore performed to improve our understanding of how false-positive CRC screening results affect patients psychologically (and to make recommendations for primary care). The PubMed, Embase, PsychINFO, CINAHL and Cochrane databases were searched in October 2014 and supplemented in December 2016 to identify studies on the psychological impact of false-positive CRC screening. Original studies were eligible when they assessed psychological impact in a screening setting, provided they also included false-positive CRC screening results. Two authors independently assessed 2,367 available manuscripts and included seven. Heterogeneity in their outcome measures meant that data could not be pooled. Two studies showed that a false-positive CRC screening result caused some moderate psychological distress shortly before and after colonoscopy. The remaining five studies illustrated that the psychological distress of patients with true-positive and false-positive CRC screening results was comparable. We conclude that a false-positive CRC screening result may cause some moderate psychological distress, especially just before or after colonoscopy. We recommend that general practitioners mention this when discussing CRC screening with patients and monitor those with a false-positive outcome for psychological distress.

Barriers to Colorectal Cancer Screening in a Racially Diverse Population Served by a Safety-Net Clinic.

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the US, yet screening rates remain low among minority populations. The purpose of the current study was to identify differences in the endorsement of barriers to CRC screening and to evaluate the association between provider recommendation and CRC screening adherence among Hispanic, Pacific Islander and White patients. This study utilized a cross sectional survey design to identify patient-reported barriers to CRC screening. Logistic regression was utilized to evaluate the association between patient demographic characteristics (race/ethnicity, gender, age), having received provider recommendation, and patient awareness of CRC screening. The study sample was comprised of a diverse population (N = 197); 48% Hispanic, 25% White, 10% Pacific Islander, 4% Black and 13% other races/ethnicity. The median age of participants was 58, yet fewer than 30% were up-to-date for CRC screening. The most commonly cited barriers included fear of test results (27.6%), inability to leave work for a CRC screening appointment (26.9%), being unaware of the need for colonoscopy (25.4%), and lack of provider recommendation for CRC screening (24.9%). Only 16.2% of participants reported that a provider had discussed CRC screening options with them. After adjusting for age and gender, Hispanic patients were less likely to report having had a provider discuss CRC screening options compared to White patients (OR = 0.24, 95% CI: 0.09-0.68, p < 0.05). The findings from this study indicate that patient's perceived screening barriers, lack of awareness and a lack of provider communication about CRC screening options may contribute to low screening rates among minority populations.

Capsule Commentary on Dolan et al., The Effectiveness of a Physician-Only and Physician-Patient Intervention on Colorectal Cancer Screening Discussions Between Providers and African American and Latino Patients.

C olorectal cancer (CRC) is one of the most prevalent cancers in the United States, and has several screening options. Unfortunately, screening rates have been suboptimal for years. For most screening modalities, colon preparation is not endearing, and screening is not yet fully reimbursed by insurance without provider referrals, as is the case for Pap smears, or without a provider visit at all, as with some nicotine replacement therapies. This study sought to evaluate the usefulness of patient education via video compared to physician education as a means of enhancing screening among patients at federally qualified health centers or academic medical centers. The ‘waiting room video’ is an attractive way to use patient downtime before an appointment, and is available in both English and Spanish. Providing information directly to patients matches the intent of the Ecological Model for Ambulatory Patient Safety in Chronic Disease to produce collaboration between an activated patient and a proactive practice team. An important limitation is the failure of clinic randomization, making generalization more difficult. It is also not clear whether medical residents always saw patients with the same attending; sub-total concordance may have reduced the efficiency of physician randomization, which was done by attending. Since non-white Americans have lower rates of CRC screening, it is a study strength that all patients were either Non-Hispanic Black or Hispanic/Latino. Why were colonoscopy discussions more popular than other screening modalities? This test may be preferred by patients, as it does not require user contact with fecal samples. Providers may prefer it because it has the longest ‘shelf-life’up to 10 years—and is required to address abnormalities on the other tests. Unfortunately, many of the study patients may lack access to colonoscopy. Alternatively, high rates of fecal occult blood testing can be obtained in low-income populations. This study focused on discussions rather than actual rates of CRC screening. What can be done next? Pre-visit videos may be more effective if provided via electronic medical record portals or the internet earlier than at the hour of the visit. Studies of the effect of increasing screening discussions on actual screening rates are needed.