Reducing Barriers to Colorectal Cancer Screening (EDGE II)
|Principal Investigator||Dorothy Lane, MD, MPH|
|Co-Investigator||Catherine Messina, PhD, Mary Cavanagh, MD, MPH|
Aims: To determine to what extent the use of colorectal services can be increased through interventions.
Overview: This project is testing the combined and independent effects on colorectal cancer screening of the use of barrier specific telephone counseling for women and men and an individualized continuing medical education intervention for their physicians, exploring and addressing the interaction between public and physician barriers. The in-office physician intervention is designed to improve the use of office systems and to develop skills in fecal occult blood (FOBT testing), risk communication and behavioral counseling. It includes random population sample surveys of men and women 50-80 years of age, and primary care physicians practicing in the study towns on Long Island. This project is a sequel to a prior NCI grant targeted at improving breast cancer screening, which employed similar interventions successfully.
BACKGROUND: The availability of several effective screening options for colorectal cancer (CRC) screening calls for involving patients in decision making about CRC screening. The current study examined (1) participant characteristics associated with their preferences for participation in CRC screening decision making, (2) correspondence between participant preferences for decision making and their usual participation in decision making, and (3) associations between participant decision-making preferences and CRC screening practices and attitudes.
METHODS: Data were obtained using a random, population-based telephone survey, conducted during August 2001 and April 2002, of 2119 community-living adults aged 50 to 75 years (56% female) residing in Long Island, NY.
RESULTS: Overall, 77% reported that preferences for CRC screening decision making matched how screening decisions were usually made (simple kappa coefficient=0.67 [0.64-0.69]). Fifteen percent preferred to make screening decisions themselves, while 25% preferred to make decisions after considering their physician's opinion; nearly 50% preferred to share decision making, and 16% preferred that their physician make all screening decisions. Less education was associated with preferring that the physician make all screening decisions. Preferring physician involvement in screening decision making was associated with greater odds of citing no physician recommendation as a barrier to CRC screening, when compared to those who preferred no physician involvement. Preferring no physician involvement in decision making was associated with lower odds of reporting a recent CRC screening exam, as well as lower odds of endorsing positive attitudes and greater odds of endorsing negative attitudes toward CRC screening, when compared to participants who preferred physician involvement in decision making. Their attitudes also reflected intentions not to screen for CRC if they were asymptomatic, as well as the perception that they were not at personal risk for CRC.
CONCLUSIONS: Several factors were identified as significantly associated with preferences for decision making and deserve further exploration for their application to clinical practice.