National Institutes of Health State-of-the-Science Conference Statement: Enhancing Use and Quality of Colorectal Cancer Screening

Steinwachs, Donald M.; Allen, Jennifer D.; Barlow, William E.; Duncan, R. Paul; Egede, Leonard E.; Friedman, Lawrence S.; Keating, Nancy L.; Kim, Paula; Lave, Judith R.; LaVeist, Thomas A.; Ness, Roberta B.; Optican, Robert J.; Virnig, Beth A

doi:10.7326/0003-4819-152-10-201005180-00237

Cited by 105 publications

(117 citation statements)

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“…Colonoscopy at present is estimated to decrease CRC-related mortality by 53 %, with further decrements expected if a greater proportion of individuals received age-appropriate screening [4]. Given limited healthcare resources, information that enables practitioners to focus interventions on populations most likely to be non-adherent to screening colonoscopy is valuable.Multiple patient factors influence adherence to CRC screening [5,6]. Demographic factors associated with lower rates of screening include female gender, younger age, low income or educational attainment, recent immigrant status, lack of health insurance, and persons of African-American or Hispanic descent [5].…”

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confidence: 99%

“…Multiple patient factors influence adherence to CRC screening [5,6]. Demographic factors associated with lower rates of screening include female gender, younger age, low income or educational attainment, recent immigrant status, lack of health insurance, and persons of African-American or Hispanic descent [5].…”

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confidence: 99%

“…Demographic factors associated with lower rates of screening include female gender, younger age, low income or educational attainment, recent immigrant status, lack of health insurance, and persons of African-American or Hispanic descent [5]. Health factors associated with non-adherence include multiple medical comorbidities and decreased primary care utilization [6].…”

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confidence: 99%

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Adherence to Screening Colonoscopy: Can We Get Our Recommendations to Stick?

Rogers

Keswani

2015

Dig Dis Sci

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Although colorectal cancer (CRC) remains the second leading cause of cancer-related mortality in the USA, its incidence and mortality have decreased in men and women since 1997, a reduction attributed, in part, to the increased use of CRC screening modalities [1]. Colonoscopy, regarded by most expert advisory groups as the mainstay of CRC screening, is the only modality that both detects and removes neoplastic polyps from the entire colon. Despite its efficacy, only 20-38 % of the population is adherent to CRC screening guidelines [2,3]. Colonoscopy at present is estimated to decrease CRC-related mortality by 53 %, with further decrements expected if a greater proportion of individuals received age-appropriate screening [4]. Given limited healthcare resources, information that enables practitioners to focus interventions on populations most likely to be non-adherent to screening colonoscopy is valuable.Multiple patient factors influence adherence to CRC screening [5,6]. Demographic factors associated with lower rates of screening include female gender, younger age, low income or educational attainment, recent immigrant status, lack of health insurance, and persons of African-American or Hispanic descent [5]. Health factors associated with non-adherence include multiple medical comorbidities and decreased primary care utilization [6]. Nevertheless, little is known about how adherence differs among patients who are undergoing surveillance colonoscopy indicated for a history of colorectal polyps or are undergoing screening colonoscopy.In this issue of Digestive Diseases and Sciences, Greenspan et al. [7] report the results of a prospective study comparing rates of adherence to screening and surveillance colonoscopy in a population of 617 patients seeking care at an urban, tertiary medical center. Of multiple demographic factors studied in patients scheduled to undergo colonoscopy, patients scheduled for screening colonoscopy were significantly less likely to undergo their procedures than those scheduled for surveillance of adenomatous polyps (RR 5.42,). This intuitive finding represents a new, easily identifiable factor toward which patient adherence efforts can be directed.While univariate analysis indicated that female gender and the presence of medical comorbidities (represented by clopidogrel use and a history of congestive heart failure) were associated with an increased risk of non-adherence, these were not significant according to multivariable logistic regression analysis, consistent with prior studies [8]. The single factor associated with non-adherence and repeated procedure cancellations according to multivariable analysis, was indication for colonoscopy [7]. Although patients with a prior history of adenomatous polyps are at high risk of the development of adenomas or carcinoma (20-50 %) at subsequent surveillance colonoscopy, the risk of adenoma or carcinoma in asymptomatic patients undergoing screening colonoscopy can also be as high as 50 % [9]. Thus, it is appropriate to direct efforts toward ensuri...

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confidence: 99%

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confidence: 99%

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Adherence to Screening Colonoscopy: Can We Get Our Recommendations to Stick?

Rogers

Keswani

2015

Dig Dis Sci

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“…Of the barriers and facilitators of CRC screening that have been studied, receipt of a physician recommendation has consistently been found to be associated with screening use [2]. Yet, at the same time, overall adherence to physician-recommended CRC screening remains low [3][4][5] and a 2010 National Institutes of Health (NIH) consensus statement on CRC screening specifically highlighted the need for research on the role of physician recommendation and CRC screening adherence [2].There have now been over a dozen reports describing patient-physician communication and decisionmaking in the context of CRC screening [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Approximately half of these studies relied on patient reports to understand these processes, while the remainder utilized direct observation methods.…”

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confidence: 99%

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confidence: 99%

Physician use of persuasion and colorectal cancer screening

Lafata

Wunderlich

Flocke

et al. 2014

Behav. Med. Pract. Policy Res.

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The impact of patient-physician communication on subsequent patient behavior has rarely been evaluated in the context of colorectal cancer (CRC) screening discussions. We describe physicians' use of persuasive techniques when recommending CRC screening and evaluate its association with patients' subsequent adherence to screening. Audio recordings of N =414 periodic health examinations were joined with screening use data from electronic medical records and pre-/post-visit patient surveys. The association between persuasion and screening was assessed using generalized estimating equations. According to observer ratings, primary care physicians frequently use persuasive techniques (63 %) when recommending CRC screening, most commonly argument or refutation. However, physician persuasion was not associated with subsequent screening adherence. Physician use of persuasion may be a common vehicle for information provision during CRC screening discussions; however, our results do not support the sole reliance on persuasive techniques if the goal is to improve adherence to recommended screening. KeywordsColorectal cancer, Screening, Patient-physician communication, Persuasion Colorectal cancer (CRC) screening remains relatively underutilized compared to other evidencebased recommended preventive screening services [1]. Of the barriers and facilitators of CRC screening that have been studied, receipt of a physician recommendation has consistently been found to be associated with screening use [2]. Yet, at the same time, overall adherence to physician-recommended CRC screening remains low [3][4][5] and a 2010 National Institutes of Health (NIH) consensus statement on CRC screening specifically highlighted the need for research on the role of physician recommendation and CRC screening adherence [2].There have now been over a dozen reports describing patient-physician communication and decisionmaking in the context of CRC screening [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Approximately half of these studies relied on patient reports to understand these processes, while the remainder utilized direct observation methods. Among the latter, only four studies have evaluated the association of patient-physician communication content with patients' subsequent use of CRC screening [11,18,24,25]. Collectively, those studies have highlighted opportunities to improve patient-physician CRC screening decision-making processes relative to that which is recommended by experts [26]. Yet, ambiguities remain regarding key patient-physician conversational content and techniques that may enhance the decision-making processes from the patients' perspective or improve adherence to physicianrecommended CRC screening. For example, Lafata and colleagues found that a physician recommendation that included not only advice to be screened but also a reason for screening, along with verbal assistance obtaining screening, resulted in a greater likelihood of screening use [25]. Ling, on the other hand, found that pa...

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A Randomized Comparison of Print and Web Communication on Colorectal Cancer Screening

Weinberg¹,

Keenan²,

Ruth³

et al. 2013

JAMA Intern Med

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Background: New methods to enhance colorectal cancer (CRC) screening rates are needed. The web offers novel possibilities to educate patients and to improve health behaviors, such as cancer screening. Evidence supports the efficacy of health communications that are targeted and tailored to improve the uptake of recommendations.Methods: We identified unscreened women at average risk for CRC from the scheduling databases of obstetrics and gynecology practices in 2 large health care systems. Participants consented to a randomized controlled trial that compared CRC screening uptake after receipt of CRC screening information delivered via the web or in print form. Participants could also be assigned to a control (usual care) group. Women in the interventional arms received tailored information in a high-or low-monitoring Cognitive Social Information Processing model-defined attentional style. The primary outcome was CRC screening participation at 4 months.Results: A total of 904 women were randomized to the interventional or control group. At 4 months, CRC screen-ing uptake was not significantly different in the web (12.2%), print (12.0%), or control (12.9%) group. Attentional style had no effect on screening uptake for any group. Some baseline participant factors were associated with greater screening, including higher income (P=.03), stage of change (P Ͻ.001), and physician recommendation to screen (PϽ .001).Conclusions: A web-based educational intervention was no more effective than a print-based one or control (no educational intervention) in increasing CRC screening rates in women at average risk of CRC. Risk messages tailored to attentional style had no effect on screening uptake. In average-risk populations, use of the Internet for health communication without additional enhancement is unlikely to improve screening participation.

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National Institutes of Health State-of-the-Science Conference Statement: Enhancing Use and Quality of Colorectal Cancer Screening

Cited by 105 publications

References 0 publications

Adherence to Screening Colonoscopy: Can We Get Our Recommendations to Stick?

Adherence to Screening Colonoscopy: Can We Get Our Recommendations to Stick?

Physician use of persuasion and colorectal cancer screening

A Randomized Comparison of Print and Web Communication on Colorectal Cancer Screening

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