Patients Whose Physicians Recommend Colonoscopy and Those Who Follow Through

Daly, Jeanette M.; Xu, Yinghui; Levy, Barcey T.

doi:10.1177/2150131912464887

Cited by 7 publications

(6 citation statements)

References 36 publications

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“…Fifty-six percent of the sample in this study went on to be screened for CRC following a physician recommendation for screening, with no significant differences between visits with and without observer-coded use of physician persuasion. This number compares favorably to a recent study examining post-physician recommendation rate of colonoscopy in a Midwestern practice-based research network, which found that only 39 % of participants followed through with a colonoscopy after a physician recommendation [46]. Similarly, another study conducted in two academic primary care clinics in California found that, following a discussion about CRC screening with their physicians, only 45 % of patients completed the recommended screening [11].…”

Section: Discussionsupporting

confidence: 51%

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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Section: Discussionsupporting

confidence: 51%

Physician use of persuasion and colorectal cancer screening

Lafata

Wunderlich

Flocke

et al. 2014

Behav. Med. Pract. Policy Res.

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“…The influence of income on congruent self-reporting, consistent across both multinomial and binomial analyses, may be due to several interrelated factors. Previous data indicate that higher income patients are more likely to be prescribed CRC screening, 44,45 and evidence indicates that having received a doctor’s recommendation for screening increased the probability of accurately recalling past screenings. 12 When considered together, these data suggest mediational paths in which higher income increases the probability of doctor’s recommendation for CRC screening, which decreases the odds of incongruently self-reporting positive screening.…”

Section: Discussionmentioning

confidence: 99%

Predicting Incongruence between Self-reported and Documented Colorectal Cancer Screening in a Sample of African American Medicare Recipients

Manning

Burnett

Chapman

2015

Behavioral Medicine

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Assessments of colorectal cancer (CRC) screening rates typically rely on self-reported screening data, which are often incongruent with medical records. We used multilevel models to examine health-related, socio-demographic and psychological predictors of incongruent self-reports for CRC screening among Medicare-insured African Americans (N = 3740). Results indicated that living alone decreased, and income increased, the odds of congruently self-reporting endoscopic CRC screening. Being male and having greater number of comorbidities decreased, and having less than a high school education increased, the odds of congruently self-reported fecal occult blood tests. Living alone, age and income had the most robust effects across classifications into one of four mutually exclusive categories defined by screening status (screened/unscreened) and congruence of self-reports. The results underscore the clinical importance of gathering socio-demographic data via patient interviews, and the relevance of these data for judging the veracity of self-reported CRC screenings behaviors.

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“…This finding merits further investigation. The second sociodemographic factor associated with colonoscopy completion, higher income, has been found to be predictive for colonoscopy completion [9, 45-48] with only rare exception [49]. …”

Section: Discussionmentioning

confidence: 99%

Predicting Colonoscopy Completion Among African American and Latino/a Participants in a Patient Navigation Program

Pelto

Sly

Winkel

et al. 2014

J. Racial and Ethnic Health Disparities

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Patient Navigation (PN) effectively increases screening colonoscopy (SC) rates, a key to reducing deaths from colorectal cancer (CRC). Ethnic minority populations have disproportionately low SC rates and high CRC mortality rates and, therefore, especially stand to benefit from PN. Adapting the Health Belief Model as an explanatory model, the current analysis examined predictors of SC rates in two randomized studies that used PN to increase SC among 411 African American and 461 Latino/a patients at a large urban medical center. Speaking Spanish but not English (OR 2.192; p<0.005), having a higher income (OR 1.218; p<0.005), and scoring higher on the Pros of Colonoscopy scale (OR 1.535; p=0.023) independently predicted colonoscopy completion. Health education and PN programs that increase awareness of the benefits of getting a colonoscopy may encourage colonoscopy completion. In the context of language-appropriate PN programs for African American and Latino/a individuals, those with lower incomes and English speakers may require additional education and counseling to support their decision-making around colonoscopy.

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Patients Whose Physicians Recommend Colonoscopy and Those Who Follow Through

Abstract: Socioeconomic factors are associated with receipt of a colonoscopy recommendation. Fewer than one third of patients had documentation of a physician colonoscopy recommendation and of those, less than half followed through.

Cited by 7 publications

References 36 publications

Physician use of persuasion and colorectal cancer screening

Physician use of persuasion and colorectal cancer screening

Predicting Incongruence between Self-reported and Documented Colorectal Cancer Screening in a Sample of African American Medicare Recipients

Predicting Colonoscopy Completion Among African American and Latino/a Participants in a Patient Navigation Program

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