Receipt Of Colorectal Cancer Screening Research Articles

Individual and geospatial factors associated with receipt of colorectal cancer screening: a state-wide mixed-level analysis

BackgroundColorectal cancer (CRC) is the second leading cause of cancer death in US adults but can be reduced by screening. The roles of individual and contextual factors, and especially physician...

Limited English proficiency and reported receipt of colorectal cancer screening among adults 45–75 in 2019 and 2021

IntroductionSubstantial barriers to screening exist for medically underserved populations, especially adults with limited English proficiency (LEP). We examined the proportion of US adults aged 45–75 up-to-date with colorectal cancer (CRC) screening by LEP after 2018. The American Cancer Society began recommending CRC screening for adults 45–49 in 2018. MethodsWe analyzed cross-sectional data of adults 45–75 years old participating in the 2019 or 2021 National Health Interview Survey (N = 25,611). Adults were considered up-to-date with screening if they reported any stool test within 1 year, stool-DNA testing within 3 years, or colonoscopy within 10 years. Adults who interviewed in a language other than English were considered to have LEP. Adults not up-to-date with screening were asked if a healthcare professional (HCP) recommended screening, and if so which test(s). Regression models conducted in 2022–2023 evaluated receipt of screening, adjusting for sociodemographics, year, and healthcare access. ResultsOverall, 54.0 % (95 % CI 53.1–54.9 %) of participants were up-to-date with screening (9.4 % aged 45–49 vs 75.5 % aged 65–75); prevalence increased from 2019 (52.9 %) to 2021(55.2 %). Adults with LEP (vs English proficiency) were less likely to be up-to-date with screening (31.6 % vs. 56.8 %, [aPR 0.86 (0.77–0.96)]). Among adults not up-to-date, 15.0 % reported their HCP recommended screening (8.4 % among adults with LEP). ConclusionsNearly half of US adults were not up-to-date with CRC screening in 2019 and 2021 and few reported being recommended screening. Adults with LEP and those 45–49 were least likely to be screened suggesting targeted interventions are needed for these populations.

Colorectal Cancer Screening Receipt Does Not Differ by 10-Year Mortality Risk Among Older Adults.

Health status and life expectancy are important considerations for assessing potential benefits and harms of colorectal cancer (CRC) screening programs, particularly among older adults. We examined receipt of past-year CRC screening according to predicted 10-year mortality risk among 25,888 community-dwelling adults aged 65-84 years who were not up-to-date with screening in the nationwide National Health Interview Survey. Ten-year mortality risk was estimated using a validated index; from the lowest to highest quintiles of the index, risk was 12%, 24%, 39%, 58%, and 79%, respectively. We also examined the proportion of screening performed among adults with life expectancy <10 years. The prevalence of past-year CRC screening was 39.5%, 40.6%, 38.7%, 36.4%, and 35.4%, from the lowest to highest quintile of 10-year mortality risk. Odds of CRC screening did not differ between adults in the lowest vs highest quintile (adjusted odds ratio 1.05, 95% confidence interval: 0.93-1.20). One-quarter (27.9%) of past-year CRC screening occurred in adults with life expectancy <10 years, and more than half (50.7%) of adults aged 75-84 years had 10-year mortality risk ≥50% at the time of screening. In an exploratory analysis, invasive but not noninvasive screening increased as 10-year mortality risk increased ( P < 0.05) among adults aged 70-79 years. Past-year CRC screening does not differ by predicted 10-year mortality risk. An age-based approach to CRC screening results in underscreening of older, healthier adults and overscreening of younger adults with chronic conditions. Personalized screening with incorporation of individual life expectancy may increase the value of CRC screening programs.

Association of Preventive Care Attitudes and Beliefs with Colorectal Cancer Screening History among African American Patients of Community Health Centers.

Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer-related death among African Americans in the United States. However, when detected early, CRC is treatable and survival rates are high. CRC health disparities for African Americans compared with other groups may be due in part to lower screening adherence and later stage diagnosis. The objective of this research phase was to test predictors of ever having received CRC screening (i.e., self-report of lifetime receipt of CRC screening) using survey measures in the domains of healthcare communication, trust in doctors, CRC perceived susceptibility, CRC worry, negative cancer beliefs, CRC screening self-efficacy, and cultural constructs for CRC screening in a sample of African American community health center patients. The study recruited 115 African American patients between the ages of 45 to 64years old from community health centers in north Florida to complete the baseline survey. Our results show significant differences in CRC screening history by age, marital status, level of mistrust of healthcare providers, and level of empowerment toward cancer screening. To increase CRC screening in this population, the study findings suggest development of intervention programs that focus on priority populations of younger, unmarried African Americans, especially given the current trend of early onset CRC. Moreover, survival rates are lower for unmarried and younger African Americans relative to older and married individuals. Such interventions should also aim to increase trust in healthcare providers and increase empowerment for CRC screening decision making to increase screening participation.

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&amp;lt;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&amp;lt;.001). Females were almost twice as likely as males to receive CRC screening during the follow-up period than males (35% versus 18%, p&amp;lt;.02) and South LA residents were significantly less likely to receive CRC screening than participants outside of South LA (22% versus 38%, p&amp;lt;.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&amp;lt;0.01). Those who had discussed CRC screening with a provider were significantly more likely to obtain CRC screening (p&amp;lt;.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&amp;lt;.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.

Abstract PO-058: Barriers and facilitators to colorectal cancer screening: A Utah community- based study

Abstract There are disparities in colorectal cancer screening related to variations in patient- level factors including race, ethnicity, geography, and language. We conducted a survey among a diverse sample of adults eligible for colorectal cancer screening at three community health events in Salt Lake City, Utah to identify barriers and facilitators to screening. We report descriptive statistics and results of chi-squared testing to identify factors associated with the receipt of colorectal cancer screening. Of the 117 respondents, 37% were Caucasian, 17% African-American, 11% Asian, 3% American-Indian, and 1% Native Hawaiian/ Pacific Islander; 33% identified as Hispanic or Latino/a. Twenty-four percent of the study participants completed surveys in Spanish, the remainder in English. Half (50%) of the responders were ≤55 years, 37% were 56-69 years and 13% were ≥ 70 years. A majority (76%) attended college and 20% completed high school or less. Over half (51%) were employed at the time of the survey and 75% reported having health insurance. Sixty percent previously underwent colorectal cancer screening, most commonly with colonoscopy (57%) or a stool-based test (13%). Most patients (70%) reported that the number one reason they were screened was due to a physician recommendation. Screened patients reported that their preferred colorectal cancer screening test was colonoscopy (40%) or a stool-based test (24%). Forty percent of respondents did not undergo any kind of colorectal cancer screening. This was significantly associated with Spanish speaking (p=0.02) and lack of health insurance (p&amp;lt;0.01). We explored barriers to screening among those without colorectal cancer screening. With regards to stool-based testing, the most common barrier (23%) was not understanding how to do a test at home. Others were worried about handling their stool (15%), receiving a positive result (15%), or the cost of the test (15%). With regards to colonoscopy, the most common barriers were the bowel preparation (36%) and worry about discomfort or pain during the procedure (34%). The “not screened” group preferred screening by stool-based tests (49%). In conclusion, we found that among a racial, ethnic, educational, and economically diverse population of health event attendees, a substantial proportion did not receive colorectal cancer screening. These results indicate that there is a significant potential for improved screening in our community, particularly among the Spanish-speaking and uninsured populations. Future studies should evaluate cultural and language concordant interventions that can address identified barriers while promoting the observed facilitators. Citation Format: Svenja Pauleck, Sheetal Hardikar, Jordan Esplin, Maranda Pahlkotter, Andrea Williamson, Federica S. Brecha, Garrett Harding, Nathaniel Ferre, Nancy Ortiz, Robin Marcus, Mark Lewis, Jessica Cohen. Barriers and facilitators to colorectal cancer screening: A Utah community- based study [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-058.

Effect of a Digital Health Intervention on Decreasing Barriers and Increasing Facilitators for Colorectal Cancer Screening in Vulnerable Patients.

Colorectal cancer is the second leading cause of cancer-related death in the United States, in part, because one third of Americans fail to get screened. In a prior randomized controlled trial, we found that an iPad patient decision aid called Mobile Patient Technology for Health-CRC (mPATH-CRC) doubled the proportion of patients who completed colorectal cancer screening. All data for the current analysis were collected as part of a randomized controlled trial to determine the impact of mPATH-CRC on receipt of colorectal cancer screening within 24 weeks. Participants were enrolled from six community-based primary care practices between June 2014 and May 2016 and randomized to either usual care or mPATH-CRC. Six potential mediators of the intervention effect on screening were considered. The Iacobucci method was used to assess the significance of the mediation. A total of 408 patients had complete data for all potential mediators. Overall, the potential mediators accounted for approximately three fourths (76.3%) of the effect of the program on screening completion. Perceived benefits, self-efficacy, ability to state a screening decision, and patient-provider discussion were statistically significant mediators. Patient-provider discussion accounted for the largest proportion of the effect of mPATH-CRC (70.7%). mPATH-CRC increased completion of colorectal cancer screening by affecting patient-level and system-level mediators. However, the most powerful mediator was the occurrence of a patient-provider discussion about screening. Digital interventions like mPATH-CRC are an important adjunct to the patient-provider encounter. Understanding the factors that mediated mPATH-CRC's success is paramount to developing other effective interventions.

Abstract C122: Efficacy of in-language mailers on receipt of colorectal cancer screening among Chinese Americans: A randomized controlled trial

Abstract Background: Colorectal cancer (CRC) is the second most common cancer among Chinese Americans, the largest group of Asian Americans. Asian Americans and Chinese Americans are less likely than non-Hispanic whites to be screened for CRC. There are few randomized controlled trials (RCT) of interventions to increase CRC screening among Chinese Americans. Methods: A community-academic research team consisting of academic researchers and community organization leaders collaborated with 3 health care systems to develop an intervention called Small Media Interventions for Limited English Speakers (SMILES) project. The SMILES intervention consisted of a mailed letter and brochure about CRC screening in English and Chinese sent twice over the course of 1 month. The mailer also included a link to a website which provided additional in-language written and video information about CRC screening. Chinese American patients aged 50 to 75 who were due for CRC screening in 3 healthcare systems (an academic medical center, a community hospital network, and a federally-qualified health center) in San Francisco were eligible for the RCT. Eligible patients were randomized to the intervention arm versus a usual care comparison arm. Intervention participants were also given the opportunity to return a postcard indicating that they had read the mailer. CRC screening status were assessed using electronic health record 9 months after the first mailing. Results: There were 1,707 enrolled patients with 929 in the intervention arm and 778 in the comparison arm. The average age was 59.6 years (SD 6.0), with 45.6% female, 12.4% English speakers, 63.2% Cantonese speakers, and 10.8% Mandarin speakers. At 9-month post-intervention initiation, the CRC screening rate was 51.9% in the intervention group and 49.5% in the comparison group (p=0.331). For the age group 50 to 60, the screening rate was 47.4% vs. 42.2% (p&amp;lt;0.0001). Multivariable analyses showed that the adjusted odds ratio for the intervention was 1.10 (95% CI: 1.001, 1.21). Other significant factors associated with CRC screening at post-intervention were female sex (OR: 1.37, 95% CI: 1.10, 1.71), age 61-75 (OR: 1.64, 95% CI: 1.57, 1.71, ref. age 50-60), and speaking a Chinese language (OR: 2.42, 95% CI: 1.22, 4.76). In multivariable analyses of the intervention group only, those who had documented engagement with the intervention (returning a postcard or going to the website) had an OR of 2.96 (95% CI: 2.08, 4.21) for CRC screening receipt compared to those who did not. Conclusions: A linguistically appropriate intervention to promote CRC screening among Chinese Americans using a mailed reminder, brochure, and access to a website led to a modest but significant increase in CRC screening compared to usual care among overdue patients in 3 healthcare systems. Mailed in-language materials should be considered as a low-resource intervention to increase CRC screening among Chinese Americans. Citation Format: Tung T Nguyen, Janice Tsoh, Angela Sun, Kent Woo, Joyce Cheng, Ching Wong, Jian Zhang, Janet Bernet, Stella Pan, Ginny Gildengorin. Efficacy of in-language mailers on receipt of colorectal cancer screening among Chinese Americans: A randomized controlled trial [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 C122.

Associations with theReceipt of Colon Cancer Screening Among a Diverse Sample of Arab Americans in NYC.

Arab Americans (AA) face increased risk for colorectal cancer (CRC), the third leading cause of cancer-related death in the US, due to low utilization of preventative care and socioeconomic disparities. This study explores associations with the receipt of CRC screening among AA in New York City. A cross-sectional survey was conducted among 100 individuals attending religious and community organizations with interviewer-administered surveys in Arabic and English. Results from 100 participants showed they were more likely to complete CRC screening with a doctor recommendation (74%) and were more likely to get a recommendation with a high school education or higher (86%). Uninsured participants and those with public insurance were the least likely to complete screening. Those with a higher mean score in Spiritual Life/Faith (13.34 vs. 11.67) were less likely to complete screening. Findings suggest the need for culturally sensitive interventions to increase CRC screening rates among AA.

Results of a lay health education intervention to increase colorectal cancer screening among Filipino Americans: A cluster randomized controlled trial.

Filipino colorectal cancer (CRC) screening rates fall below Healthy People 2020 goals. In this study, the authors explore whether a lay health educator (LHE) approach can increase CRC screening among Filipino Americans ages 50 to 75 years in Hawai'i. A cluster randomized controlled trial from 2012 through 2015 compared an intervention, which consisted of LHEs delivering 2 education sessions and 2 telephone follow-up calls on CRC screening plus a CRC brochure versus an attention control, in which 2 lectures and 2 follow-up calls on nutrition and physical activity plus a CRC brochure were provided. The primary outcome was change in self-reported ever receipt of CRC screening at 6 months. Among 304 participants (77% women, 86% had > 10 years of residence in the United States), the proportion of participants who reported ever having received CRC screening increased significantly in the intervention group (from 80% to 89%; P = .0003), but not in the control group (from 73% to 74%; P = .60). After covariate adjustment, there was a significant intervention effect (odds ratio, 1.9; 95% confidence interval, 1.0-3.5). There was no intervention effect on up-to-date screening. This first randomized controlled trial for CRC screening among Hawai'i's Filipinos used an LHE intervention with mixed, but promising, results. Cancer 2018;124:1535-42. © 2018 American Cancer Society.

Effect of a Digital Health Intervention on Receipt of Colorectal Cancer Screening in Vulnerable Patients: A Randomized Controlled Trial.

Screening for colorectal cancer (CRC) reduces mortality, yet more than one third of age-eligible Americans are unscreened. To examine the effect of a digital health intervention, Mobile Patient Technology for Health-CRC (mPATH-CRC), on rates of CRC screening. Randomized clinical trial. (ClinicalTrials.gov: NCT02088333). 6 community-based primary care practices. 450 patients (223 in the mPATH-CRC group and 227 in usual care) scheduled for a primary care visit and due for routine CRC screening. An iPad application that displays a CRC screening decision aid, lets patients order their own screening tests, and sends automated follow-up electronic messages to support patients. The primary outcome was chart-verified completion of CRC screening within 24 weeks. Secondary outcomes were ability to state a screening preference, intention to receive screening, screening discussions, and orders for screening tests. All outcome assessors were blinded to randomization. Baseline characteristics were similar between groups; 37% of participants had limited health literacy, and 53% had annual incomes less than $20000. Screening was completed by 30% of mPATH-CRC participants and 15% of those receiving usual care (logistic regression odds ratio, 2.5 [95% CI, 1.6 to 4.0]). Compared with usual care, more mPATH-CRC participants could state a screening preference, planned to be screened within 6 months, discussed screening with their provider, and had a screening test ordered. Half of mPATH-CRC participants (53%; 118 of 223) "self-ordered" a test via the program. Participants were English speakers in a single health care system. A digital health intervention that allows patients to self-order tests can increase CRC screening. Future research should identify methods for implementing similar interventions in clinical care. National Cancer Institute.

The Role of Physician Recommendation in Colorectal Cancer Screening Receipt Among Immigrant Chinese Americans.

Chinese Americans have low colorectal cancer (CRC) screening rates. It is unclear whether physicians should offer all CRC screening modalities (fecal occult blood test [FOBT], sigmoidoscopy, colonoscopy) to Chinese Americans to increase screening. Seven hundred and twenty-five Chinese Americans were asked in a survey if their physician had ever recommended CRC screening and to self-report receipt and type of CRC screening. Participants whose physician had recommended all CRC screening modalities were significantly more likely to report ever having screening (adjusted odds ratio 4.29, 95% CI 1.26-14.68) and being up-to-date (4.06, 95% CI 2.13-7.74) than those who reported that their physician only recommended FOBT. Participants who received a recommendation of only one type of screening did not report a significant difference in ever having or being up-to-date for screening. A potential strategy to increase CRC screening among Chinese Americans is for clinicians to recommend all available CRC screening modalities to each patient.

Colorectal cancer screening at US community health centers: Examination of sociodemographic disparities and association with patient‐provider communication

Colorectal cancer (CRC) screening rates are low among underserved populations. High-quality patient-physician communication potentially influences patients' willingness to undergo CRC screening. Community health centers (HCs) provide comprehensive primary health care to underserved populations. This study's objectives were to ascertain national CRC screening rates and to explore the relations between sociodemographic characteristics and patient-provider communication on the receipt of CRC screening among HC patients. Using 2014 Health Center Patient Survey data, bivariate and multivariate analyses examined the association of sociodemographic variables (sex, race/ethnicity, age, geography, preferred language, household income, insurance, and employment status) and patient-provider communication with the receipt of CRC screening. Patients between the ages of 65 and 75 years (adjusted odds ratio [aOR], 2.49; 95% confidence interval [CI], 1.33-4.64) and patients not in the labor force (aOR, 2.32; 95% CI, 1.37-3.94) had higher odds of receiving CRC screening, whereas patients who were uninsured (aOR, 0.33; 95% CI, 0.18-0.61) and patients who were non-English-speaking (aOR, 0.42; 95% CI, 0.18-0.99) had lower odds. Patient-provider communication was not associated with the receipt of CRC screening. The CRC screening rate for HC patients was 57.9%, whereas the rate was 65.1% according to the 2012 Behavioral Risk Factor Surveillance System and 58.2% according to the 2013 National Health Interview Survey. The high ratings of patient-provider communication, regardless of the screening status, suggest strides toward a patient-centered medical home practice transformation that will assist in a positive patient experience. Addressing the lack of insurance, making culturally and linguistically appropriate patient education materials available, and training clinicians and care teams in cultural competency are critical for increasing future CRC screening rates. Cancer 2017;123:4185-4192. © 2017 American Cancer Society.

Colorectal Cancer Screening Initiation After Age 50 Years in an Organized Program

Recent studies report racial disparities among individuals in organized colorectal cancer (CRC) programs; however, there is a paucity of information on CRC screening utilization by race/ethnicity among newly age-eligible adults in such programs. This was a retrospective cohort study among Kaiser Permanente Northern California enrollees who turned age 50 years between 2007 and 2012 (N=138,799) and were served by a systemwide outreach and facilitated in-reach screening program based primarily on mailed fecal immunochemical tests to screening-eligible people. Kaplan-Meier and Cox model analyses were used to estimate differences in receipt of CRC screening in 2015-2016. Cumulative probabilities of CRC screening within 1 and 2 years of subjects' 50th birthday were 51% and 73%, respectively. Relative to non-Hispanic whites, the likelihood of completing any CRC screening was similar in blacks (hazard ratio, 0.98; 95% CI=0.96, 1.00); 5% lower in Hispanics (hazard ratio, 0.95; 95% CI=0.93, 0.96); and 13% higher in Asians (hazard ratio, 1.13; 95% CI=1.11, 1.15) in adjusted analyses. Fecal immunochemical testing was the most common screening modality, representing 86% of all screening initiations. Blacks and Hispanics had lower receipt of fecal immunochemical testing in adjusted analyses. CRC screening uptake was high among newly screening-eligible adults in an organized CRC screening program, but Hispanics were less likely to initiate screening near age 50 years than non-Hispanic whites, suggesting that cultural and other individual-level barriers not addressed within the program likely contribute. Future studies examining the influences of culturally appropriate and targeted efforts for screening initiation are needed.

Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System.

Screening outreach programs using population health management principles offer services uniformly to all eligible persons, but racial/ethnic colorectal cancer (CRC) screening patterns in such programs are not well known. To examine the association between race/ethnicity and the receipt of CRC screening and timely follow-up of positive results before and after implementation of a screening program. Retrospective cohort study of screen-eligible individuals at the Kaiser Permanente Northern California community-based integrated healthcare delivery system (2004-2013). A total of 868,934 screen-eligible individuals 51-74 years of age at cohort entry, which included 662,872 persons in the period before program implementation (2004-2006), 654,633 during the first 3years after implementation (2007-2009), and 665,268 in the period from 4 to 7 years (2010-2013) after program implementation. A comprehensive system-wide long-term effort to increase CRC that included leadership alignment, goal-setting, and quality assurance through a PHM approach, using mailed fecal immunochemical testing (FIT) along with offering screening at office visits. Differences over time and by race/ethnicity in up-to-date CRC screening (overall and by test type) and timely follow-up of a positive screen. Race/ethnicity categories included non-Hispanic white, non-Hispanic black, Hispanic/Latino, Asian/Pacific Islander, Native American, and multiple races. From 2004 to 2013, age/sex-adjusted CRC screening rates increased in all groups, including 35.2 to 81.1% among whites and 35.6 to 78.0% among blacks. Screening rates among Hispanics (33.1 to 78.3%) and Native Americans (29.4 to 74.5%) remained lower than those for whites both before and after program implementation. Blacks, who had slightly higher rates before program implementation (adjusted rate ratio [RR] = 1.04, 99 % CI: 1.02-1.05), had lower rates after program implementation (RR for period from 4 to 7 years = 0.97, 99 % CI: 0.96-0.97). There were also substantial improvements in timely follow-up of positive screening results. In this screening program using core PHM principles, CRC screening increased markedly in all racial/ethnic groups, but disparities persisted for some groups and developed in others, which correlated with levels of adoption of mailed FIT.

Association Between Primary Care Visits and Colorectal Cancer Screening Outcomes in the Era of Population Health Outreach

Population outreach strategies are increasingly used to improve colorectal cancer (CRC) screening. The influence of primary care on cancer screening in this context is unknown. To assess associations between primary care provider (PCP) visits and receipt of CRC screening and colonoscopy after a positive fecal immunochemical (FIT) or fecal occult blood test (FOBT). Population-based cohort study. A total of 968,072 patients ages 50-74 years who were not up to date with CRC screening in 2011 in four integrated healthcare systems (three with screening outreach programs using FIT kits) in the Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. Demographic, clinical, PCP visit, and CRC screening data were obtained from electronic health records and administrative databases. We examined associations between PCP visits in 2011 and receipt of FIT/FOBT, screening colonoscopy, or flexible sigmoidoscopy (CRC screening) in 2012 and follow-up colonoscopy within 3months of a positive FIT/FOBT in 2012. We used multivariable logistic regression and propensity score models to adjust for confounding. Fifty-eight percent of eligible patients completed a CRC screening test in 2012, most by FIT. Those with a greater number of PCP visits had higher rates of CRC screening at all sites. Patients with ≥1 PCP visit had nearly twice the adjusted-odds of CRC screening (OR = 1.88, 95% CI: 1.86-1.89). Overall, 79.6% of patients with a positive FIT/FOBT completed colonoscopy within 3months. Patients with ≥1 PCP visit had 30% higher adjusted odds of completing colonoscopy after positive FIT/FOBT (OR = 1.30; 95% CI: 1.22-1.40). Patients with a greater number of PCP visits had higher rates of both incident CRC screening and colonoscopy after positive FIT/FOBT, even in health systems with active population health outreach programs. In this era of virtual care and population outreach, primary care visits remain an important mechanism for engaging patients in cancer screening.

Correlates of Receipt of Colorectal Cancer Screening among American Indians in the Northern Plains.

Research has consistently documented lower colorectal cancer (CRC) screening rates for racial and ethnic minority populations, with the lowest screening rates among American Indians (AIs). Given the low CRC screening rates among AIs residing in the Northern Plains region, the objective of this research was to identify CRC screening correlates for Northern Plains AIs. With a sample of 181 AIs age 50 years or older, the authors used Andersen's behavioral model to examine the following factors related to receipt of CRC screening: (a) predisposing factors-age, education, marital status, and gender; (b) need factors-personal and family history of cancer; and (c) enabling factors-having a particular place to receive medical care, annual health checkup, awareness of the availability of CRC screening, knowledge of CRC, and self-efficacy of CRC. Nested logistic regression identified the following correlates of receipt of CRC screening: (a) predisposing factors-older age; (b) need factors-having a personal history of cancer; and (c) enabling factors-having an annual health checkup, greater awareness of CRC screening, and greater self-efficacy of CRC. Given the findings, prevention and intervention strategies, including public awareness and education about CRC screening, are promising avenues to reduce cancer screening disparities among AIs.

Abstract B73: Examining colorectal cancer screening barriers and facilitators though a cultural lens: A mixed methods study of Chinese and Korean Americans

Abstract Background: Among Asian Americans, colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer death. Although screening has been found to significantly reduce CRC mortality, Chinese and Korean Americans continue to report lower CRC screening rates than White and African Americans. Therefore, this study aims to examine the barriers and facilitators of CRC screening, taking into account a cultural perspective, in these underserved populations. Methods: We employed a mixed methods study to gain further understanding regarding CRC screening behaviors among Asian Americans. Specifically, we collected quantitative data through surveys from 120 participants, who were self-identified Chinese and Korean Americans, aged 50 years and over. Multivariable-adjusted logistic regression was conducted to analyze survey data, independently assessing for receipt of colonoscopy and fecal occult blood test (FOBT). In addition, qualitative data from 17 key informant interviews (with physicians, health department employees, patient navigators, and community leaders) and 12 focus groups (n=120) were transcribed, translated to English, back-translated to ensure accuracy, coded, and analyzed for salient themes. Results: Based on focus group findings, major cultural themes influencing CRC screening included language- and health-related attitudes and beliefs. In particular, participants identified having limited English proficiency, low health literacy, and reliance on children for translation as being key barriers. Thus, participants emphasized the importance of having linguistically appropriate services, such as patient navigators. Additional barriers included fearing a CRC diagnosis, having fatalistic views of CRC, and facing stigma towards cancer. In addition, quantitative analysis found that individuals who believed screening is not needed when asymptomatic were less likely to receive a colonoscopy (Odds Ratio (OR): 0.02; 95% Confidence Interval (CI): 0.002-0.23) and FOBT (OR: 0.16; 95% CI: 0.03-0.72). These findings were supported by key informants and focus group participants, who expressed that Chinese and Koreans often times do not prioritize preventive healthcare and believe that seeking healthcare is not necessary when symptoms are not noticeable. Moreover, this study corroborated previous findings of non-cultural factors influencing CRC screening such as cost, insurance, knowledge, and time -some of which were influenced by underlying cultural attitudes and beliefs. Patient-physician communication was another key influential factor. For instance, those having a doctor talk about [(OR: 6.1; 95% CI: 2.4-15.4) for colonoscopy; (OR: 3.1; 95% CI: 1.1-8.5) for FOBT)] or recommend CRC screening [(OR: 6.6; 95% CI: 2.6-16.7) for colonoscopy; (OR: 4.0; 95% CI: 1.4-11.2) for FOBT)] were more likely to have received screening. Conclusions: Receipt of CRC screening is influenced by cultural and non-cultural factors, both of which need to be addressed in order to increase screening uptake among Chinese and Korean Americans. These findings can inform the development of more effective CRC screening programs and interventions that are culturally and linguistically tailored to these populations. Citation Format: Sunmin Lee, Mary Jung, Xiaoxiao Lu, Jamie Sim, Diane Ng. Examining colorectal cancer screening barriers and facilitators though a cultural lens: A mixed methods study of Chinese and Korean Americans. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B73.

Abstract B74: Effects of a culturally targeted physician communication intervention on colorectal cancer screening among older Chinese American patients

Abstract Asian Americans have much lower colorectal cancer (CRC) screening rates than other ethnic groups, even after controlling for access and language factors. According to a national report, Chinese Americans (the largest Asian subgroup) had the lowest screening rates. Their low screening rates were largely attributed to the lack of physicians' recommendations, in addition to lacking screening knowledge and stressing self-care over medical checkups. Thus, we conducted a cluster randomized controlled trial to examine whether an intervention group of Chinese-speaking primary care physicians would motivate their Chinese-speaking patients to obtain higher rates of CRC screening versus usual care practice (control group). The physician-based intervention was culturally targeted and guided by social cognitive theory. It consisted of two components: a communication guide describing and responding to Chinese patients' screening barriers and two in-office training sessions mimicking real life medical encounters to practice the guide. Twenty-five Chinese primary care physician practices from Washington DC, Philadelphia, and New York City were enrolled and randomized (13 to intervention and 12 to control). Patients aged 50 -75 years, non-adherent to CRC screening guidelines, and were active patients of the 25 physicians were eligible. In total, 371 out of 458 consented patients who completed both of the baseline assessment and 12-month post-baseline follow-up via telephone were included in the outcome analysis. Physicians were blinded about their patients' participation until the follow-up assessment was completed. The end outcome was patients' self-reported receipt of CRC screening. Medical verification of the self-reported screening was conducted among 20% of the screened patients. Validated measures were used to assess physicians' knowledge of screening guidelines, self-efficacy in communication, and outcome expectancies, as well as patients' knowledge, self-care views, and perceived quality communication with physicians about CRC screening. We examined the screening outcome by two-sample t-tests, due to a balanced randomization of physician practices, and ran hierarchical logistic regression models to examine the impact of physician and patient factors in the screening outcome. The weighted (by sample size) CRC screening rates after one year of follow-up were .31 for the intervention group and .23 for the control group. The 8 percentage point difference was not statistically significant (P=.17), even after adjusting for group differences in patient characteristics. Self-reported screening was 100% consistent with medical records among those who were verifiable. Patients who had better knowledge, lower self-care views, and perceived better communication with physicians were more likely to obtain CRC screening after controlling for group assignment and patient demographics. Overall, the physician-based intervention led to a modest increase in Chinese patients' CRC screening rates, although patients in the intervention group had a greater increase in knowledge and perceived quality communication (both p&amp;lt;.01). Many of our physicians reported a time constraint in reading through the communication guide and attending the intervention. This might have limited their capacity to maximize the intervention effects. Educating Chinese patients about CRC screening and how to communicate with physicians may be an efficient alternative to promote their overall screening rates. Citation Format: Judy Huei-yu Wang, Grace X. Ma, Wenchi Liang, Edmund Gehan, Yin Tan, Kepher MaKambi, Yiru Wang, Sally W. Vernon, Shin-Ping Tu, Jeanne Mandelblatt. Effects of a culturally targeted physician communication intervention on colorectal cancer screening among older Chinese American patients. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B74.