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Correlates of Patient Intent and Preference on Colorectal Cancer Screening

Published:February 04, 2017DOI:https://doi.org/10.1016/j.amepre.2016.11.026

      Introduction

      Information is limited on patient characteristics that influence their preference among screening options and intent to be screened for colorectal cancer (CRC). A mechanistic pathway to intent and preference was examined through a formal mediation analysis.

      Methods

      From 2012 to 2014, a total of 570 adults aged 50–75 years were recruited from 15 primary care practices in Metro Detroit for a trial on decision aids for CRC screening. Confirmatory factor, regression, and mediation analyses were performed in 2015–2016 on baseline cross-sectional data. Main outcomes were patient intent and preference. Perceived risk and self-efficacy were secondary outcomes. Covariates included demographic information, health status, previous CRC screening experience, patient attitudes, and knowledge.

      Results

      Mean age was 57.7 years, 56.1% were women, and 55.1% white and 36.6% black. Women had 32% and 41% lower odds than men of perceiving CRC to be high/moderate risk (OR=0.68, 95% CI=0.47, 0.97, p=0.03) and having high self-efficacy (OR=0.59, 95% CI=0.42, 0.85, p=0.006), respectively. Whites had 63% and 47% lower odds than blacks of having high self-efficacy (OR=0.37, 95% CI=0.25, 0.57, p<0.001) and intent to undergo CRC screening (OR=0.53, 95% CI=0.34, 0.84, p=0.007), respectively. Younger age, higher knowledge, lower level of test worries, and medium/high versus low self-efficacy increased the odds of intent of being screened. Self-efficacy, but not perceived risk, significantly mediated the association between race, attitude, and test worries and patient screening intent.

      Conclusions

      Self-efficacy mediated the association between race, attitude, and test worries and patient intent.
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      References

        • Hardcastle J.D.
        • Chamberlain J.O.
        • Robinson M.H.
        • et al.
        Randomised controlled trial of faecal-occult-blood screening for colorectal cancer.
        Lancet. 1996; 348: 1472-1477https://doi.org/10.1016/S0140-6736(96)03386-7
        • Kronborg O.
        • Fenger C.
        • Olsen J.
        • Jorgensen O.D.
        • Sondergaard O.
        Randomised study of screening for colorectal cancer with faecal-occult-blood test.
        Lancet. 1996; 348: 1467-1471https://doi.org/10.1016/S0140-6736(96)03430-7
        • Levin B.
        • Lieberman D.A.
        • McFarland B.
        • et al.
        Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology.
        CA Cancer J Clin. 2008; 58: 130-160https://doi.org/10.3322/CA.2007.0018
        • Mandel J.S.
        • Bond J.H.
        • Church T.R.
        • et al.
        Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study.
        N Engl J Med. 1993; 328: 1365-1371https://doi.org/10.1056/NEJM199305133281901
      1. U.S. Preventive Services Task Force. Screening for colorectal cancer. www.uspreventiveservicestaskforce.org/uspstf/uspscolo.htm.

        • Joseph D.A.
        • King J.B.
        • Miller J.W.
        • et al.
        Prevalence of colorectal cancer screening among adults--Behavioral Risk Factor Surveillance System, United States, 2010.
        MMWR Suppl. 2012; 61: 51-56
        • American Cancer Society
        Colorectal cancer facts & figures 2011–2013.
        American Cancer Society, Atlanta, GA2011
        • National Institutes of Health
        State-of-the-Science conference statement on enhancing use and quality of colorectal cancer screening February 2-4. 2010;
        • Briss P.
        • Rimer B.
        • Reilley B.
        • et al.
        Promoting informed decisions about cancer screening in communities and healthcare systems.
        Am J Prev Med. 2004; 26: 67-80https://doi.org/10.1016/j.amepre.2003.09.012
        • Leard L.E.
        • Savides T.J.
        • Ganiats T.G.
        Patient preferences for colorectal cancer screening.
        J Fam Pract. 1997; 45: 211-218https://doi.org/10.1046/j.1525-1497.1999.00018.x
        • Hawley S.
        • Lillie S.
        • Cooper G.
        • Elston Lafata J.
        Managed care patients’ preferences, physician recommendations, and colon cancer screening.
        Am J Manag Care. 2014; 20: 555-561
        • Myers R.E.
        • Sifri R.
        • Daskalakis C.
        • et al.
        Increasing colon cancer screening in primary care among African Americans.
        J Natl Cancer Inst. 2014; 106: dju344https://doi.org/10.1093/jnci/dju344
        • Beydoun H.A.
        • Beydoun M.A.
        Predictors of colorectal cancer screening behaviors among average-risk older adults in the United States.
        Cancer Causes Control. 2008; 19: 339-359https://doi.org/10.1007/s10552-007-9100-y
        • Sutton S.
        • Wardle J.
        • Taylor T.
        • et al.
        Predictors of attendance in the United Kingdom flexible sigmoidoscopy screening trial.
        J Med Screen. 2000; 7: 99-104https://doi.org/10.1136/jms.7.2.99
        • Myers R.E.
        • Trock B.J.
        • Lerman C.
        • et al.
        Adherence to colorectal cancer screening in an HMO population.
        Prev Med. 1990; 19: 502-514https://doi.org/10.1016/0091-7435(90)90049-P
        • McQueen A.
        • Vernon S.W.
        • Myers R.E.
        • et al.
        Correlates and predictors of colorectal cancer screening among male automotive workers.
        Cancer Epidemiol Biomarkers Prev. 2007; 16: 500-509https://doi.org/10.1158/1055-9965.EPI-06-0757
        • Hummel J.M.
        • Steuten L.G.
        • Groothuis-Oudshoorn C.J.
        • Mulder N.
        • Ijzerman M.J.
        Preferences for colorectal cancer screening techniques and intention to attend: a multi-criteria decision analysis.
        Appl Health Econ Health Policy. 2013; 11: 499-507https://doi.org/10.1007/s40258-013-0051-z
        • Ajzen I.
        The theory of planned behaviour.
        Organ Behav Hum Decis Process. 1991; 50: 179-211https://doi.org/10.1016/0749-5978(91)90020-T
        • Ajzen I.
        Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior.
        J Appl Soc Psychol. 2002; 32: 665-683https://doi.org/10.1111/j.1559-1816.2002.tb00236.x
        • Jimbo M.
        • Kelly-Blake K.
        • Sen A.
        • Hawley S.T.
        • Ruffin IV, M.T.
        Decision Aid to Technologically Enhance Shared decision making (DATES): study protocol for a randomized controlled trial.
        Trials. 2013; 14: 381https://doi.org/10.1186/1745-6215-14-381
        • Wardle J.
        • Miles A.
        • Atkin W.
        Gender differences in utilization of colorectal cancer screening.
        J Med Screen. 2005; 12: 20-27https://doi.org/10.1258/0969141053279158
        • Vernon S.W.
        • Myers R.E.
        • Tilley B.C.
        Development and validation of an instrument to measure factors related to colorectal cancer screening adherence.
        Cancer Epidemiol Biomarkers Prev. 1997; 6: 825-832
        • Tiro J.A.
        • Vernon S.W.
        • Hyslop T.
        • Myers R.E.
        Factorial validity and invariance of a survey measuring psychosocial correlates of colorectal cancer screening among African Americans and Caucasians.
        Cancer Epidemiol Biomarkers Prev. 2005; 14: 2855-2861https://doi.org/10.1158/1055-9965.EPI-05-0217
        • Hu L.
        • Bentler P.M.
        Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives.
        Struct Equ Modeling. 1999; 6: 1-55https://doi.org/10.1080/10705519909540118
        • Nagelkerke N.J.
        A note on a general definition of the coefficient of determination.
        Biometrika. 1991; 78: 691-692https://doi.org/10.1093/biomet/78.3.691
        • Baron R.M.
        • Kenny D.A.
        The moderator-mediator distinction in social psychological research: conceptual, strategic, and statistical considerations.
        J Pers Soc Psychol. 1986; 51: 1173-1182https://doi.org/10.1037/0022-3514.51.6.1173
        • Hosmer Jr, D.W.
        • Lemeshow S.
        • Sturdivant R.X.
        Applied Logistic Regression.
        John Wiley & Sons, New York, NY2013https://doi.org/10.1002/9781118548387
        • Brant R.
        Assessing proportionality in the proportional odds model for ordinal logistic regression.
        Biometrics. 1990; 46: 1171-1178https://doi.org/10.2307/2532457
        • Meissner H.I.
        • Breen N.
        • Klabunde C.N.
        • Vernon S.W.
        Patterns of colorectal cancer screening uptake among men and women in the United States.
        Cancer Epidemiol Biomarkers Prev. 2006; 15: 389-394https://doi.org/10.1158/1055-9965.EPI-05-0678
        • Robb K.A.
        • Miles A.
        • Wardle J.
        Demographic and psychosocial factors associated with perceived risk for colorectal cancer.
        Cancer Epidemiol Biomarkers Prev. 2004; 13: 366-372
        • McQueen A.
        • Vernon S.W.
        • Meissner H.I.
        • Rakowski W.
        Risk perceptions and worry about cancer: does gender make a difference?.
        J Health Commun. 2008; 13: 56-79https://doi.org/10.1080/10810730701807076
        • Cram P.
        • Fendrick A.M.
        • Inadomi J.
        • Cowen M.E.
        • Carpenter D.
        • Vijan S.
        The impact of a celebrity promotional campaign on the use of colon cancer screening: the Katie Couric effect.
        Arch Intern Med. 2003; 163: 1601-1605https://doi.org/10.1001/archinte.163.13.1601
        • Grembowski D.
        • Patrick D.
        • Diehr P.
        • et al.
        Self-efficacy and health behavior among older adults.
        J Health Soc Behav. 1993; 34: 89-104https://doi.org/10.2307/2137237
        • Shi L.
        • Lebrun L.A.
        • Zhu J.
        • Tsai J.
        Cancer screening among racial/ethnic and insurance groups in the United States: a comparison of disparities in 2000 and 2008.
        J Health Care Poor U. 2011; 22: 945-961https://doi.org/10.1353/hpu.2011.0079
        • Lumpkins C.Y.
        • Cupertino P.
        • Young K.
        • et al.
        Racial/ethnic variations in colorectal cancer screening self-efficacy, fatalism and risk perception in a safety-net clinic population: implications for tailored interventions.
        J Community Med Health Educ. 2013; 3: 11284
        • Semrad T.J.
        • Tancredi D.J.
        • Baldwin L.-M.
        • Green P.
        • Fenton J.F.
        Geographic variation of racial/ethnic disparities in colorectal cancer testing among Medicare enrollees.
        Cancer. 2011; 117: 1755-1763https://doi.org/10.1002/cncr.25668
        • Ling B.S.
        • Klein W.M.
        • Dang Q.
        Relationship of communication and information measures to colorectal cancer screening utilization: results from HINTS.
        J Health Commun. 2006; 11: 181-190https://doi.org/10.1080/10810730600639190
        • Jimbo M.
        • Rana G.K.
        • Hawley S.
        • et al.
        What is lacking in current decision aids on cancer screening?.
        CA Cancer J Clin. 2013; 63: 193-214https://doi.org/10.3322/caac.21180
        • Griffith J.M.
        • Lewis C.L.
        • Brenner A.R.
        • Pignone M.P.
        The effect of offering different numbers of colorectal cancer screening test options in a decision aid: a pilot randomized trial.
        BMC Med Inform Decis. 2008; 8: 4https://doi.org/10.1186/1472-6947-8-4
        • Griffith J.M.
        • Fichter M.
        • Fowler F.J.
        • Lewis C.
        • Pignone M.P.
        Should a colon cancer screening decision aid include the option of no testing? A comparative trial of two decision aids.
        BMC Med Inform Decis. 2008; 8: 10https://doi.org/10.1186/1472-6947-8-10
        • Trevena L.J.
        • Irwig L.
        • Barratt A.
        Randomized trial of a self-administered decision aid for colorectal cancer screening.
        J Med Screen. 2008; 15: 76-82https://doi.org/10.1258/jms.2008.007110
        • Lewis C.
        • Golin C.E.
        • DeLeon C.
        • et al.
        A targeted decision aid for the elderly to decide whether to undergo colorectal cancer screening: Development and results of an uncontrolled trial.
        BMC Med Inform Decis. 2010; 10: 54https://doi.org/10.1186/1472-6947-10-54
        • Miller Jr., D.P.
        • Spangler J.G.
        • Case L.D.
        • et al.
        Effectiveness of a web-based colorectal cancer screening patient decision aid: a randomized controlled trial in a mixed-literacy population.
        Am J Prev Med. 2011; 40: 608-615https://doi.org/10.1016/j.amepre.2011.02.019
        • Schroy 3rd, P.C.
        • Emmons K.
        • Peters E.
        • et al.
        The impact of a novel computer-based decision aid on shared decision making for colorectal cancer screening: a randomized trial.
        Med Decis Making. 2011; 31: 93-107https://doi.org/10.1177/0272989X10369007