Understanding Those Who Do and Do Not Plan to Get Colorectal Cancer CRC Screening

1
Understanding Those Who Do and Do Not Plan to Get
Colorectal Cancer (CRC) Screening

• Costanza ME, White MJ, Stark JR, Stoddard AM,
  Avrunin JS, Luckmann R, and Clemow L
• University of Massachusetts Medical School
• Worcester, MA

2
Facts about CRC

• 2nd leading cause of cancer-specific deaths for
  men and women in the U.S.
• 57,000 CRC deaths in 2003

3
Facts about CRC Screening

• CRC screening reduced mortality by gt 30
• lt 50 of U.S. men and women over age 50 are
  current with screening guidelines
• CRC screening recommendations are more complex
  than those for other cancers (e.g., breast,
  cervical)

4
ACS Preferred CRC Screening Guidelines(Beginning
at age 50 for those at average risk)

• Annual fecal occult blood test (FOBT) and
  sigmoidoscopy every 5 years
• Colonoscopy every 10 years
• Double-contrast barium enema every 5-10 years

5
Factors that Predict Adherence to the Guidelines

• Basic knowledge about CRC screening
• Individual risk
• Lack of barriers to screening (i.e.
  embarrassment, fear of pain or abnormal results)
• Intention to be screened useful for tailoring
  interventions

6
Methods

• Baseline mailed survey for a RCT of telephone
  counseling to increase CRC screening
• Theoretical Framework Weinsteins Precaution
  Adoption Process Model (PAPM), a stage-based
  model of health behavior
• Study Participants
• 2,934 male female patients from 37 primary care
  practices
• 50-75 years old
• Had visited their PCP during the past 2 years

7
Methods

• Survey Measures
• CRC screening history and screening intention
• PAPM stage
• Pros and Cons
• Perceived vulnerability and worry
• Sociodemographic and other characteristics
• Data Analysis
• Frequency distributions, cross classifications
  logistic regression
• Bivariate multivariate associations to
  develop a main effects model

8
Survey Response 69
9
Characteristics of Study Sample (n1370)
10
Characteristics of Study Sample (n1370)
11
Characteristics of Study Sample (n1370)
12
Characteristics of Study Sample (n1370)
13
Factors Associated with Intention to Get CRC
Screening
plt.0001
14
Factors Associated with Intention to Get CRC
Screening
plt.0001
15
Factors Associated with Intention to Get CRC
Screening
plt.0001
16
Factors Associated with Intention to Get CRC
Screening
plt.0001
17
Factors Associated with Intention to Get CRC
Screening(Mean)
18
Multivariable Logistic Regression(Odds Ratio,
overall p-Value)
19
Discussion

• The study sample is highly educated and not very
  diverse
• Men and women are evenly distributed by stage
• MD recommendation is powerful in motivating
  patients to action

20
Discussion

• Increasing positive trends were seen in
• Perceived vulnerability increases at least
  10-fold between each stage closer to action
• Pros Cons score increases significantly from
  unaware, unengaged or relapsed group to
  action/maintenance indicating a growing positive
  perception of CRC screening

21
Discussion

• Implications for an intervention to accelerate
  the adoption of CRC screening
• Those current with screening (36) and those who
  intend to be screened (26) may require only a
  postcard reminder
• Those not intending to get screened may benefit
  from an intervention tailored to PAPM stage

22
Discussion

• A tailored intervention could focus on
• Increasing their knowledge about CRC CRC
  screening
• Addressing their barriers cons to screening
• Encouraging them to get screened using
  motivational interviewing

23
Discussion

• Public Health Implications
• Those who are unaware, unengaged, undecided or
  who have relapsed or decided not to be screened
  represent a significant number of people between
  50-75 years of age in the U.S. population
• Accelerating CRC screening adoption will reduce
  mortality morbidity from this disease