Colorectal cancer screening: Physician recommendation is influential advice to Marylanders

Gilbert, Amy; Kanarek, Norma

doi:10.1016/j.ypmed.2005.01.008

Cited by 73 publications

(50 citation statements)

References 20 publications

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“…Previous research supports the importance of provider recommendations for CRC screening, and patients who have never completed CRC screening may need provider counseling before completing a FIT. 30 , 33 , [37][38][39] Our study has several limitations. First, it was conducted in a single organization with a somewhat homogenous population and few clinical sites.…”

Section: Discussionmentioning

confidence: 95%

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

et al. 2015

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INTRODUCTION:Colorectal cancer (CRC) screening rates are low among vulnerable populations. Fecal immunochemical tests (FITs) are one screening modality with few barriers. Studies have shown that outreach can improve CRC screening, but little is known about its effectiveness among individuals with no CRC screening history. We sought to determine whether outreach increases FIT uptake among patients with no CRC screening history compared to usual care. METHODS: This study was a patient-level randomized controlled trial, including 420 patients who had never completed CRC screening and were eligible for FIT; 66 % were female, 62.1 % were Latino, and 70.7 % were uninsured. The main outcome measure was FIT completion within 6 months of the randomization date. We assessed FIT completion at different time points corresponding to receipt of outreach components. All analyses were re-run with 12-month data. RESULTS: Patients who received outreach were more likely to complete FIT than those in usual care (36.7 % vs. 14.8 %; p<0.001). FIT completion was more common among patients with increased clinic visits. The difference in FIT completion between the outreach and usual care groups decreased over time. DISCUSSION: The intervention improved FIT uptake among patients with no CRC screening history. However, the intervention was less effective than in a previous trial targeting patients due for repeat screening. Additional research is needed to determine the best methods for improving CRC screening among this hard-to-reach group.KEY WORDS: health disparities; cancer prevention; care delivery system.

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Section: Discussionmentioning

confidence: 95%

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

et al. 2015

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“…[24][25][26][27][28][29][30][31][32][33] The purpose of our study was to assess system-level factors that are known to contribute to health care delivery outcomes, such as cancer screening. Previous studies have found patientlevel factors (ie, lack of knowledge), 24,25 clinician-level factors (ie, offering colorectal cancer screening), 22,[26][27][28] socioeconomic factors (ie, education, income), [29][30][31] and system-level factors (ie, health insurance status) 32,33 to be barriers and facilitators to colorectal cancer screening. Ross et al found lack of health insurance to be associated with a signifi cant decrease in use of preventive services.…”

Section: Discussionmentioning

confidence: 99%

Having a Personal Health Care Provider and Receipt of Colorectal Cancer Testing

Cardarelli¹,

Thomas²

2009

The Annals of Family Medicine

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PURPOSE We wanted to assess the relationship between having a personal health care provider and receiving colorectal cancer testing.METHODS Self-reported data were obtained from the United States 2004 Behavioral Risk Factor Surveillance System. Men and women aged 50 years and older were included, and associations of having a personal health care provider, age, sex, race/ethnicity, education, income, and health insurance status with colorectal cancer testing were examined. Multiple logistic regression was performed on a fi nal sample of 120,221 individuals. RESULTSHaving at least 1 personal health care provider signifi cantly predicted up-to-date colorectal cancer testing in both the univariate (odds ratio [OR] = 3.96; 95% confi dence interval [CI] 3.56-4.41) and multiple regression models (OR = 2.91; 95% CI 2.58-3.28). Age, sex, race/ethnicity, education, income, and health insurance were also signifi cantly associated with up-to-date colorectal cancer testing.CONCLUSIONS Having a personal health care provider was associated with up-todate colorectal cancer testing. Efforts to increase and support the primary care workforce are needed to improve up-to-date colorectal cancer screening rates. INTRODUCTIOND ebate in the United States over health care reform is rampant, with many advocates claiming reform is a necessary step to revitalize a current nonfunctional health care system. 1 This debate has been a central focus for many Americans since reports ranked the US health care system last, or close to last, in satisfaction, health equity, access to care, and various health indicators, even though the United States is among the highest of all industrialized nations in spending for health care.2 One component being promoted is universal health coverage in which a primary care workforce provides fi rst-line health care services.That primary care has a positive effect on population health has been shown in a landmark study by Starfi eld et al, 3 who found access to primary care prevents illness and death and results in more equitable health. In a preventive health care delivery system that some believe is fragmented and fundamentally fl awed, 4 the Starfi eld et al fi ndings lend support to improving rates of preventive health care screening. One such preventive screening test is for colorectal cancer. Colorectal cancer has garnered particular attention because it has low screening rates among men and women (approximately 50% in the United States) and accounts for 1 of the top 3 causes of cancer deaths. [5][6][7] Moreover, persistent colorectal cancer disparities exist, with African Americans suffering 15% and 40% higher incidence of and mortality from colorectal cancer, respectively, than whites. [8][9][10][11][12][13] Further studies with a sample representative of the US population are needed to assess whether access to primary care clinicians improves colorecRoberto Cardarelli, DO PER S ONA L CL INICIA N A ND COLOR EC TA L C A NC ER T ES T INGtal cancer screening rates beyond changes in socioeconomic fac...

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“…[1][2][3] Among eligible foreign-born U.S. Latinos, only 22% are screened for CRC with any of the recommended tests 1 . One of the most important factors influencing CRC screening rates is clinician recommendation 4,5 . Interventions that target more than one level (patients, providers) often are more effective in increasing cancer screening.…”

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial of a Multilevel Intervention to Increase Colorectal Cancer Screening among Latino Immigrants in a Primary Care Facility

et al. 2010

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BACKGROUND: Latino immigrants face a higher burden of colorectal cancer (CRC) and screening rates are low. OBJECTIVE: To assess the effectiveness of a multilevel intervention in increasing the rate of CRC screening among Latino immigrants. DESIGN: A randomized controlled trial, with randomization at the physician level. PARTICIPANTS: Pairs of 65 primary care physicians and 65 Latino immigrant patients participated, 31 in the intervention and 34 in the control group. INTERVENTION: CRC educational video in Spanish on a portable personal digital video display device accompanied by a brochure with key information for the patient, and a patient-delivered paper-based reminder for their physician. MEASUREMENTS: Completed CRC screening, physician recommendation for CRC screening, and patient adherence to physician recommended CRC screening. RESULTS: The overall rate of completed screening for CRC was 55% for the intervention and 18% for the control group (p=0.002). Physicians recommended CRC screening for 61% of patients in the intervention group versus 41% in the control group (p=0.08). Of those that received a recommendation, 90% in the intervention group adhered to it versus 26% in the control group (p=0.007). CONCLUSIONS: The intervention was successful in increasing rates of completed CRC screening primarily through increasing adherence after screening was recommended. Additional efforts should focus on developing new strategies to increase physician recommendation for CRC screening, while employing effective patient adherence interventions.

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Colorectal cancer screening: Physician recommendation is influential advice to Marylanders

Cited by 73 publications

References 20 publications

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

Having a Personal Health Care Provider and Receipt of Colorectal Cancer Testing

A Randomized Controlled Trial of a Multilevel Intervention to Increase Colorectal Cancer Screening among Latino Immigrants in a Primary Care Facility

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