Colorectal Cancer Screening Adherence in African–American Men and Women 50 Years of Age and Older Living in Maryland

Abstract

African Americans experience disproportionate incidence and mortality rates from colorectal cancer (CRC). This health disparity is partially explained by low participation in screening. This study aimed to identify factors influencing adherence to colorectal cancer screening among African Americans. Telephone interviews were conducted with African Americans living in Maryland (57% response rate). A total of 504 respondents agreed to participate. The survey primarily assessed participation in CRC screening, health beliefs and attitudes about CRC screening, and demographics. Nearly 77% of respondents reported being adherent to CRC screening guidelines. Of those not adherent, nearly 50% reported not ever receiving a physician recommendation to be screened. Having health insurance was a strong correlate of adherence. Study participants with greater perceived CRC risk were more likely to be adherent. Further, those who reported that they were caregivers were less likely to be adherent to screening. Findings indicate that those who were the primary care takers of children or disabled persons were less likely to participate in CRC screening. Efforts are needed to ensure that caregivers do not neglect their own preventive health, including CRC screening. Further, access to care and health insurance coverage also appear to be an important factor for participation in CRC screening. Ensuring that those who do not have adequate healthcare coverage are not excluded from participation in CRC screening due to cost should be an important priority if reduction in CRC health disparity is to be achieved.

Comparison Study of Uptake of Colorectal Cancer Testing between Ethnic Minorities and the General Population in Hong Kong

“…In fact, the present result is consistent with previous studies in finding that a health professional's recommendation is an important factor contributing to the use of CRC screening (Etzioni et al, 2004;Fernandez et al, 2008;Griffith, 2009;Palmer et al, 2011). The low uptake rate of CRC screening in the study populations can be largely explained by the low rate of health professionals' recommendations for such testing, suggesting that a recommendation from a health professional is the strongest external cue to action.…”

“…The low uptake rate of CRC screening in the study populations can be largely explained by the low rate of health professionals' recommendations for such testing, suggesting that a recommendation from a health professional is the strongest external cue to action. Only 7% of the GP and 3% of the EM groups in the current study population received a recommendation from a health professional, much lower figures than the 67-68% of the ethnic minority group (African-Americans) reported in studies conducted in the US (Griffith, 2009;Palmer et al, 2011). Also, previous studies have found that barriers to professional recommendation include prior patient refusal of screening, lack of reminder or test tracking systems, and a lack of knowledge of the recommended screening modalities (Sewitch et al, 2006;Guerra et al, 2007).…”

Physicians' beliefs about effectiveness of cancer screening tests: A national survey of family physicians, general internists, and obstetrician–gynecologists

“…Also, some physicians' recommendations regarding specific CRC tests may be influenced by reimbursement policies and rates from insurance providers. This may in turn influence their beliefs (Guessous et al, 2010; Palmer et al, 2010 Nov 24). …”

Influence of provider discussion and specific recommendation on colorectal cancer screening uptake among U.S. adults

“…Although there are multiple acceptable modalities for colorectal cancer (CRC) screening in the United States such as fecal occult blood test (FOBT) and fecal DNA testing, double contrast barium enema, CT colonography, flexible sigmoidoscopy, and colonoscopy (Levin et al, 2008), the uptake of CRC screening is suboptimal in the general population (Carcaise-Edinboro and Bradley, 2008; Palmer et al, 2011; Seeff et al, 2004; Shapiro et al, 2001; Shapiro et al, 2008). Previous studies have shown that a lack of patient awareness is a commonly reported barrier to undergoing screening, while having seen a physician within the past year, spending adequate time discussing screening, and lower perceived barriers to CRC testing are strongly associated with increased uptake of CRC screening (Bazargan et al, 2009; Carcaise-Edinboro and Bradley, 2008; Seeff et al, 2004).…”