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Abstract
Background: Screening for colorectal cancer (CRC) provides an effective strategy for early detection and prevention of the disease; however, global screening rates are still low. Purpose: This study aims at assessing the awareness of CRC risk factors, warning signs, and attitudes towards CRC guidelines and screening modalities, in order to identify the barriers to and correlates of CRC screening in the Lebanese population. Methods: A self-administered questionnaire was distributed to 371 participants in the largest health care medical center in Lebanon. A validated 12- and 9-item Cancer Awareness Measurement questionnaire was used to assess participants’ awareness of CRC risk factors and warning signs. Results: 83% and 67% of participants were not aware of CRC risk factors and warning signs, respectively, 15% have previously undergone CRC screening, 56% were aware of the necessity for screening, and 43% were willing to undergo screening. Factors affecting awareness of the necessity for CRC screening, past screening and willingness to screen included awareness of risk factors and warning signs, undergoing regular physician check-ups, having a family physician as a primary source of knowledge of CRC, and knowing a family member or friend diagnosed with CRC. Barriers to screening were related to participants’ evaluation of the screening technique and misconceptions about this disease. Conclusion: Serious active measures should be taken by health care sectors, authoritative groups, primary care physicians, and awareness campaigns to fill the gap in awareness of this disease and to alleviate the barriers and misconceptions around it.
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Lin TY, Chuang ST, Huang SF, Hsu HP, Lu LT, Guo JL. Likelihood of a fecal occult blood test uptake among older adults: comparisons between health professionals and healthcare volunteers based on the health belief model. BMC Geriatr 2019; 19:51. [PMID: 30791892 PMCID: PMC6385387 DOI: 10.1186/s12877-019-1067-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 02/13/2019] [Indexed: 12/27/2022] Open
Abstract
Background Health professionals and healthcare volunteers play a critical role in promoting uptake of the fecal occult blood test (FOBT), which is an effective screening method for colorectal cancer. However, previous studies paid less attention to investigating both groups regarding their intention to undergo the test. This study used the Health Belief Model (HBM) to explore the likelihood of an FOBT uptake among health professionals and healthcare volunteers aged 50 years or older. Methods A cross-sectional survey was conducted at public health centers in a county in northern Taiwan. Health professionals and healthcare volunteers were invited to complete the questionnaires. Overall, 391 valid questionnaires were obtained (response rate = 93.10%). Structural equation modeling was used to examine the associations among the variables based on the HBM. Results The HBM explained 45, 44, and 50% of the variance in the likelihood of undergoing an FOBT in all participants, health professionals, and healthcare volunteers, respectively. The explained variance in healthcare volunteers outweighed that of professionals by 6%. Perceived benefits and self-efficacy significantly affected the likelihood of undergoing an FOBT. Self-efficacy significantly mediated the effects of perceived severity, benefits, and barriers on the likelihood of an FOBT uptake. A borderline significant difference in structural coefficients was found across groups. Conclusions The HBM model was used to examine the likelihood of an FOBT uptake among health professionals and healthcare volunteers, and the results showed that self-efficacy was the optimal predictor of the likelihood of an FOBT uptake, followed by perceived benefits. Future multifactorial interventions to promote FOBT uptake among health professionals and healthcare volunteers aged 50–75 years could include these significant factors.
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Affiliation(s)
- Tsung-Yi Lin
- Department of Health Promotion and Health Education, National Taiwan Normal University, No.162, Sec. 1, He-ping East Road, Taipei, 10610, Taiwan
| | - Shu-Tzu Chuang
- Public Health Bureau, Yilan County, No.287, Sec. 2, Nuzhong Rd, Yilan City, Yilan County, 26051, Taiwan
| | - Su-Fei Huang
- Department of Senior Citizen Service, Mackay Junior College of Medicine, Nursing, and Management, No.92, Shengjing Rd., Beitou District, Taipei, 11260, Taiwan
| | - Hsiao-Pei Hsu
- School of Nursing, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 11221, Taiwan
| | - Li-Ting Lu
- Department of Health Management for Elderly Society, University of Kang Ning, No.137, Alley 75, Sec. 3, Kang Ning Road, Neihu District, Taipei, 11485, Taiwan
| | - Jong-Long Guo
- Department of Health Promotion and Health Education, National Taiwan Normal University, No.162, Sec. 1, He-ping East Road, Taipei, 10610, Taiwan.
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Saengow U, Birch S, Geater A, Chongsuwiwatvong V. Willingness to Pay for Colorectal Cancer Screening and Effect of Copayment in Southern Thailand. Asian Pac J Cancer Prev 2018; 19:1727-1734. [PMID: 29938473 PMCID: PMC6103562 DOI: 10.22034/apjcp.2018.19.6.1727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: The incidence rate of colorectal cancer in Thailand is increasing. Hence, the nationwide screening programme with copayment is being considered. There are two proposed screening alternatives: annual fecal immunochemical test (FIT) and once-in-10-year colonoscopy. A copayment for FIT is 60 Thai baht (THB) per test (≈ 1.7 USD); a copayment for colonoscopy is 2,300 THB per test (≈ 65.5 USD). Methods: The willingness to pay (WTP) technique, which is theoretically founded on a cost-benefit analysis, was used to assess an effect of copayment on the uptake. Subjects were patients aged 50-69 years without cancer or screening experience. WTP for the proposed tests was elicited. Results: Nearly two thirds of subjects were willing to pay for FIT. Less than half of subjects were willing to pay for colonoscopy. Among them, median WTP for both tests was greater than the proposed copayments. In a probit model, knowing CRC patient and presence of companion were associated with non-zero WTP for FIT. Presence of companion, female, and family history of cancer were associated with non-zero WTP for colonoscopy. After adjustment for starting price in the linear model, marital status, drinking behavior, and risk attitude were associated with WTP. None of factors was significant for colonoscopy. Uptake decreased as levels of copayment increased. At proposed copayments, the uptake rates of 59.8% and 21.6% were estimated for colonoscopy and FIT respectively. The demand for FIT was price inelastic; the demand for colonoscopy was price elastic. Estimates of optimal copayment were 62.1 THB for FIT and 460.2 THB for colonoscopy. At the optimal copayment, uptake rates would be 59.8% for FIT and 42.3% for colonoscopy. Conclusion(s): More subjects were willing to pay for FIT than for colonoscopy (59.0% versus 46.5%). The estimated uptake rates were 59.8% and 21.6% for colonoscopy and FIT at the proposed copayments.
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Affiliation(s)
- Udomsak Saengow
- Center of Excellence in Health System and Medical Research (CE-HSMR), Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.,School of Medicine, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.
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Tam DYS, Lo YYC, Tsui W. Knowledge, practices and expectations of preventive care: a qualitative study of patients attending government general outpatient clinics in Hong Kong. BMC FAMILY PRACTICE 2018; 19:58. [PMID: 29743033 PMCID: PMC5944064 DOI: 10.1186/s12875-018-0740-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/18/2018] [Indexed: 11/11/2022]
Abstract
Background Evidence-based preventive care recommendations have been well established, but studies have persistently reported gaps between these recommendations and general practitioners’ practices in providing preventive care. Many studies have explored factors that affect the delivery of preventive care from the perspectives of the practitioners, but relatively few have evaluated the patients’ point of view. The purpose of this study was to explore patients’ understanding of preventive care, the actions they were taking in terms of preventive health and their expectations from family doctors in providing preventive care. Methods A qualitative study was conducted based on one-on-one in-depth interviews. Twenty-eight patients without chronic illnesses were purposively recruited from government general outpatient clinics in Hong Kong. The interviews took place between November 2013 and February 2014. Results The participants’ knowledge of preventive care was limited, and their preventive practices were mostly restricted to healthy lifestyle practices. They rarely obtained individualised preventive care advice from doctors. Screening investigations were initiated after symptoms had already occurred, and the decision of what to check was arbitrary. Few of the participants knew what they wanted from their doctors in terms of preventive care. Conclusions These findings show significant gaps between evidence-based preventive recommendations and patients’ current knowledge and practice, and show the need for a wider spectrum of preventive care education and reliable sources to provide individualised and affordable preventive assessment and screening services. Most importantly, primary care providers must take a more proactive role to provide preventive services.
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Affiliation(s)
- Denise Y S Tam
- Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster, Hospital Authority, North Wing, Room 601, 6/F, Tsan Yuk Hospital, 30 Hospital Road, Hong Kong, Hong Kong.
| | - Yvonne Y C Lo
- Wellness Family Medical Practice, Room 605, Hang Seng Tsim Sha Tsui Building, 18 Carnarvon Road, Hong Kong, Hong Kong
| | - Wendy Tsui
- Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster, Hospital Authority, North Wing, Room 601, 6/F, Tsan Yuk Hospital, 30 Hospital Road, Hong Kong, Hong Kong
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Ellis EM, Erwin DO, Jandorf L, Saad-Harfouche F, Sriphanlop P, Clark N, Dauphin C, Johnson D, Klasko-Foster LB, Martinez C, Sly J, White D, Winkel G, Kiviniemi MT. Designing a randomized controlled trial to evaluate a community-based narrative intervention for improving colorectal cancer screening for African Americans. Contemp Clin Trials 2018; 65:8-18. [PMID: 29198730 PMCID: PMC5803387 DOI: 10.1016/j.cct.2017.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To describe the methodology of a 2-arm randomized controlled trial that compared the effects of a narrative and didactic version of the Witness CARES (Community Awareness, Reach, & Empowerment for Screening) intervention on colorectal cancer screening behavior among African Americans, as well as the cognitive and affective determinants of screening. METHODS Witness CARES targeted cognitive and affective predictors of screening using a culturally competent, community-based, narrative or didactic communication approach. New and existing community partners were recruited in two New York sites. Group randomization allocated programs to the narrative or didactic arm. Five phases of data collection were conducted: baseline, post-intervention, three-month, six-month, and qualitative interviews. The primary outcome was screening behavior; secondary outcomes included cognitive and affective determinants of screening. RESULTS A total of 183 programs were conducted for 2655 attendees. Of these attendees, 19.4% (N=516) across 158 programs (50% narrative; 50% didactic) were study-eligible and consented to participate. Half (45.6%) of the programs were delivered to new community partners and 34.8% were delivered at faith-based organizations. Mean age of the total sample was 64.7years and 75.4% were female. CONCLUSION The planned number of programs was delivered, but the proportion of study-eligible attendees was lower than predicted. This community-based participatory research approach was largely successful in involving the community served in the development and implementation of the intervention and study.
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Affiliation(s)
- Erin M Ellis
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, SUNY, Buffalo, NY 14214, United States.
| | - Deborah O Erwin
- Office of Cancer Health Disparities Research, Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States
| | - Lina Jandorf
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Division of Cancer Prevention and Control, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Frances Saad-Harfouche
- Office of Cancer Health Disparities Research, Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States
| | - Pathu Sriphanlop
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Division of Cancer Prevention and Control, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Nikia Clark
- Office of Cancer Health Disparities Research, Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States
| | - Cassandre Dauphin
- Office of Cancer Health Disparities Research, Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States
| | - Detric Johnson
- Office of Cancer Health Disparities Research, Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States
| | - Lynne B Klasko-Foster
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, SUNY, Buffalo, NY 14214, United States
| | - Clarissa Martinez
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Division of Cancer Prevention and Control, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Jamilia Sly
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Division of Cancer Prevention and Control, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Drusilla White
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Division of Cancer Prevention and Control, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Gary Winkel
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Division of Cancer Prevention and Control, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Marc T Kiviniemi
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, SUNY, Buffalo, NY 14214, United States
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Abstract
BACKGROUND Lung cancer screening is a recent recommendation for long-term smokers. Understanding individual health beliefs about screening is a critical component in future efforts to facilitate patient-provider conversations about screening participation. OBJECTIVE The aim of this study was to describe the development and psychometric testing of 4 new scales to measure lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, self-efficacy). METHODS In phase I, 4 scales were developed from extensive literature review, item modification from existing Breast and Colorectal Cancer Screening Health Belief Scales, focus groups with long-term smokers, and evaluation/feedback from a panel of 10 content experts. In phase II, we conducted a survey of 497 long-term smokers to assess the final scales' reliability and validity. RESULTS Phase I: content validity was established with the content expert panel. Phase II: internal consistency reliability of the scales was supported with Cronbach's α's ranging from .88 to .92. Construct validity was established with confirmatory factor analysis and testing for differences between screeners and nonscreeners in theoretically proposed directions. CONCLUSIONS Initial testing supports the scales are valid and reliable. These new scales can help investigators identify long-term smokers more likely to screen for lung cancer and are useful for the development and testing of behavioral interventions regarding lung cancer screening. IMPLICATIONS FOR PRACTICE Development of effective interventions to enhance shared decision making about lung cancer screening between patients and providers must first identify factors influencing the individual's screening participation. Future efforts facilitating patient-provider conversations are better informed by understanding the perspective of the individual making the decision.
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Hughes AG, Watanabe-Galloway S, Schnell P, Soliman AS. Rural-Urban Differences in Colorectal Cancer Screening Barriers in Nebraska. J Community Health 2016; 40:1065-74. [PMID: 25910484 DOI: 10.1007/s10900-015-0032-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Nebraska ranks 36th nationally in colorectal cancer screening. Despite recent increases in CRC screening rates, rural areas in Nebraska have consistently shown lower rates of CRC screening uptake, compared to urban areas. The objective of this study was to investigate reasons for lower CRC screening rates among Nebraska residents, especially among rural residents. We developed a questionnaire based on Health Belief Model (HBM) constructs to identify factors associated with the use of CRC screening. The questionnaire was mailed in 2014 to adults aged 50-75 years in an urban community in the east and a rural community in the west regions of the state. Multiple logistic regression models were created to assess the effects of HBM constructs, rural residence, and demographic factors on CRC screening use. Of the 1200 surveys mailed, 393 were returned (rural n = 200, urban n = 193). Rural respondents were more likely to perceive screening cost as a barrier. Rural residents were also more likely to report that CRC cannot be prevented and it would change their whole life. In multiple regression models, rural residence, perceived embarrassment, and perceived unpleasantness about screening were significantly associated with reduced odds of receiving colonoscopy. Older age (62 years and older), having a personal doctor, and perceived risk of getting CRC were significantly associated with increased odds of receiving colonoscopy. Interventions to increase uptake of colorectal cancer screening in rural residents should be tailored to acknowledge unique perceptions of screening methods and barriers to screening.
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Affiliation(s)
- Alejandro G Hughes
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA.
| | - Paulette Schnell
- Department of Community Health, Regional West Medical Center, 3700 Avenue B, Scottsbluff, NE, 69361, USA
| | - Amr S Soliman
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
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Atkinson TM, Salz T, Touza KK, Li Y, Hay JL. Does colorectal cancer risk perception predict screening behavior? A systematic review and meta-analysis. J Behav Med 2015; 38:837-50. [PMID: 26280755 DOI: 10.1007/s10865-015-9668-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 08/07/2015] [Indexed: 01/22/2023]
Abstract
Although health behavior theories postulate that risk perception should motivate colorectal cancer (CRC) screening, this relationship is unclear. This meta-analysis aims to examine the relationship between CRC risk perception and screening behavior, while considering potential moderators and study quality. A search of six databases yielded 58 studies (63 effect sizes) that quantitatively assessed the relationship between CRC risk perception and screening behavior. Most included effect sizes (75 %) reported a positive association between CRC risk perception and screening behavior. A random effects meta-analysis yielded an overall effect size of z = 0.13 (95 % CI 0.10-0.16), which was heterogeneous (I (2) = 99 %, τ(2) = 0.01). Effect sizes from high-quality studies were significantly lower than those from lower quality studies (z = 0.02 vs. 0.16). We found a small, positive relationship between CRC risk perception and reported screening behavior, with important identified heterogeneity across moderators. Future studies should focus on high quality study design.
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Affiliation(s)
- Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
| | - Talya Salz
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
| | - Kaitlin K Touza
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
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Redwood D, Provost E, Lopez EDS, Skewes M, Johnson R, Christensen C, Sacco F, Haverkamp D. A Process Evaluation of the Alaska Native Colorectal Cancer Family Outreach Program. HEALTH EDUCATION & BEHAVIOR 2015; 43:35-42. [PMID: 26157041 DOI: 10.1177/1090198115590781] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This article presents the results of a process evaluation of the Alaska Native (AN) Colorectal Cancer (CRC) Family Outreach Program, which encourages CRC screening among AN first-degree relatives (i.e., parents, siblings, adult children; hereafter referred to as relatives) of CRC patients. Among AN people incidence and death rates from CRC are the highest of any ethnic/racial group in the United States. Relatives of CRC patients are at increased risk; however, CRC can be prevented and detected early through screening. The evaluation included key informant interviews (August to November 2012) with AN and non-AN stakeholders and program document review. Five key process evaluation components were identified: program formation, evolution, outreach responses, strengths, and barriers and challenges. Key themes included an incremental approach that led to a fully formed program and the need for dedicated, culturally competent patient navigation. Challenges included differing relatives' responses to screening outreach, health system data access and coordination, and the program impact of reliance on grant funding. This program evaluation indicated a need for more research into motivating patient screening behaviors, electronic medical records systems quality improvement projects, improved data-sharing protocols, and program sustainability planning to continue the dedicated efforts to promote screening in this increased risk population.
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Affiliation(s)
- Diana Redwood
- Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Ellen Provost
- Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | | | | | - Claudia Christensen
- Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Frank Sacco
- Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Donald Haverkamp
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, NM, USA
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Tsai MH, Xirasagar S, Li YJ, de Groen PC. Colonoscopy screening among US adults aged 40 or older with a family history of colorectal cancer. Prev Chronic Dis 2015; 12:E80. [PMID: 25996988 PMCID: PMC4454413 DOI: 10.5888/pcd12.140533] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Colonoscopy screening reduces colorectal cancer (CRC) incidence and mortality. CRC screening is recommended at age 50 for average-risk people. Screening of first-degree relatives of CRC patients is recommended to begin at age 40 or 10 years before the age at diagnosis of the youngest relative diagnosed with CRC. CRC incidence has increased recently among younger Americans while it has declined among older Americans. The objective of this study was to determine whether first-degree relatives of CRC patients are being screened according to recommended guidelines. METHODS We studied colonoscopy screening rates among the US population reporting a CRC family history using 2005 and 2010 National Health Interview Survey data. RESULTS Of 26,064 study-eligible respondents, 2,470 reported a CRC family history; of those with a family history, 45.6% had a colonoscopy (25.2% in 2005 and 65.8% 2010). The colonoscopy rate among first-degree relatives aged 40 to 49 in 2010 (38.3%) was about half that of first-degree relatives aged 50 or older (69.7%). First-degree relatives were nearly twice as likely as nonfirst-degree relatives to have a colonoscopy (adjusted odds ratio [AOR], 1.7; 95% confidence interval, 1.5-1.9), but those aged 40 to 49 were less likely to have a colonoscopy than those in older age groups (AOR, 2.6 for age 50-64; AOR, 3.6 for age ≥65). Interactions with age, insurance, and race/ethnicity were not significant. Having health insurance tripled the likelihood of screening. CONCLUSION Despite a 5-fold increase in colonoscopy screening rates since 2005, rates among first-degree relatives younger than the conventional screening age have lagged. Screening promotion targeted to this group may halt the recent rising trend of CRC among younger Americans.
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Affiliation(s)
- Meng-Han Tsai
- University of South Carolina, Columbia, South Carolina
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, 915 Greene St, Room 352, Columbia, SC 29208.
| | - Yi-Jhen Li
- University of South Carolina, Columbia, South Carolina
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Disgusted, embarrassed, annoyed: affective associations relate to uptake of colonoscopy screening. Ann Behav Med 2015; 48:112-9. [PMID: 24500079 DOI: 10.1007/s12160-013-9580-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Uptake of colorectal cancer screening is lower than desired. Screening decision making research has traditionally focused on benefits and barriers to screening. This study examines the relation of affective associations with screening (feelings and emotions associated with screening) to colonoscopy screening uptake. METHODS Participants were 103 African American community adults. Participants completed a structured interview assessing perceived benefits of and barriers to colonoscopy screening, affective associations with colonoscopy, colonoscopy screening behavior, and intentions for future screening. RESULTS Higher positive and lower negative affective associations with screening were both significant predictors of colonoscopy uptake. Affective associations fully mediated the relation of perceived benefits and barriers to screening uptake. Affective associations were associated with intentions for future screening. CONCLUSIONS Incorporation of affective associations into models of screening decision making and intervention approaches to address screening compliance has utility for advancing our understanding of screening adherence as well as increasing screening rates.
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12
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Perdue DG, Chubak J, Bogart A, Dillard DA, Garroutte EM, Buchwald D. A comparison of colorectal cancer screening uptake among average-risk insured American Indian/Alaska Native and white women. J Health Care Poor Underserved 2014; 24:1125-35. [PMID: 23974386 DOI: 10.1353/hpu.2013.0139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION American Indian and Alaska Native (AI/AN) women have among the lowest rates of colorectal cancer (CRC) screening. Whether screening disparities persist with equal access to health care is unknown. METHODS Using administrative data from 1996-2007, we compared CRC screening events for 286 AI/AN and 14,042 White women aged 50 years and older from a health maintenance organization in the Pacific Northwest of the U.S. RESULTS The proportion of AI/AN and White women screened for CRC at age 50 was similar (13.3% vs. 14.0%, p =.74). No differences were seen in the type of screening test. Time elapsed to first screening among AI/AN women who were not screened at age 50 did not differ from White women (hazard ratio 1.0, 95% confidence interval 0.8-1.3). CONCLUSIONS Uptake for CRC screening was similar among insured AI/AN and White women, suggesting that when access to care is equal, racial disparities in screening diminish.
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Ait Ouakrim D, Lockett T, Boussioutas A, Hopper JL, Jenkins MA. Screening participation for people at increased risk of colorectal cancer due to family history: a systematic review and meta-analysis. Fam Cancer 2014; 12:459-72. [PMID: 23700069 DOI: 10.1007/s10689-013-9658-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We conducted a systematic review and a meta-analysis of observational studies to identify and summarise the level of colorectal cancer (CRC) screening participation for people at increased risk due to family history of the disease. Medline, Cinhal, Embase and PsychInfo databases were comprehensively searched between January 1995 and May 2012 to identify relevant articles. To be included, studies had to report on screening for people who had at least one first-degree relative with CRC and no previous personal diagnosis of the disease. Pooled screening participation levels were calculated for each screening modality. Seventeen studies, accounting for a total of 13,269 subjects with a family history of CRC met the inclusion criteria. Seven studies, including a total of 6,901 subjects had a pooled faecal occult blood testing screening participation (at least once) of 25 % (95 % CI 12-38). Five studies including a total of 5,091 subjects had a pooled sigmoidoscopy-based screening participation (at least once) of 16 % (95 % CI 7-27). Seven studies including a total of 9,965 subjects had pooled participation colonoscopy-based screening (at least once) of 40 % (95 % CI 26-54). There was a significant level of screening heterogeneity between studies. This review identified a substantial underuse of CRC screening for people at increased risk of developing the disease. It highlights the potential opportunity that exists for increasing screening participation among this segment of the population and the need to adjust the current CRC screening policies towards that objective.
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Affiliation(s)
- Driss Ait Ouakrim
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC, 3010, Australia,
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Llanos AA, Pennell ML, Young GS, Tatum CM, Katz ML, Paskett ED. No association between colorectal cancer worry and screening uptake in Appalachian Ohio. J Public Health (Oxf) 2014; 37:322-7. [PMID: 24850101 DOI: 10.1093/pubmed/fdu031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Limited data are available on the association between colorectal cancer (CRC) worry and CRC screening uptake, particularly in rural and underserved populations where there is an excess burden of CRC. METHODS Between September 2009 and March 2010, we conducted a cross-sectional study among a randomly selected sample of Appalachian Ohio residents aged 51-75 years (n= 1084). We also reviewed their medical records. Multivariable-adjusted models examined the association between CRC worry and screening by medical record review, assessed effect modification by CRC worry and determined the correlates of higher CRC worry. RESULTS Approximately 50% of participants were adherent to CRC screening guidelines. There was no significant association between higher CRC worry and screening adherence [odds ratio (OR) = 1.32, 95% confidence interval (CI): 0.86-2.02]. CRC worry did not modify the association between any covariate and screening adherence. Participants who were unemployed/disabled (OR = 2.15, 95% CI: 1.34-3.45) and had higher CRC risk perception (OR = 3.49, 95% CI: 2.19-5.56) had higher odds of moderate-to-extreme worry. CONCLUSIONS These findings highlight the need for meaningful exploration of why higher CRC worry is not associated with adherence to CRC screening, particularly in rural, medically underserved populations. Development and implementation of interventions to increase CRC screening in such areas is a significant public health priority.
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Affiliation(s)
- Adana A Llanos
- Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA Department of Epidemiology, RBHS-School of Public Health and the Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Michael L Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Gregory S Young
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Cathy M Tatum
- Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mira L Katz
- Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, OH, USA Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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15
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Taniguchi T, Hirai K, Sumi R, Hayashi N, Maeda K, Ito T. Predictors of colonoscopy use one year after colonoscopy: prospective study of surveillance behavior for colorectal cancer. Health Psychol Behav Med 2014; 2:283-295. [PMID: 25750782 PMCID: PMC4346036 DOI: 10.1080/21642850.2014.889573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 01/28/2014] [Indexed: 02/02/2023] Open
Abstract
We hypothesized that perceived risk of colorectal cancer (CRC) and CRC worry would be the main predictors of surveillance behavior in patients undergoing colonoscopy. We therefore assessed factors predicting colonoscopy use for re-examination one year after colonoscopy. Patients who had undergone colonoscopy and were scheduled for re-examination one year later were recruited. Patients were administered questionnaires after baseline colonoscopy assessing demographic factors, perceived risk, CRC worry, cancer preventability, knowledge of CRC and results of colonoscopy. We confirmed whether participants underwent colonoscopy re-examinations one year later (follow-up). Finally, 56 participants completed the research and were used in the final analysis (response rate = 65.1%). We found that 37.5% of the participants who underwent baseline colonoscopy underwent follow-up colonoscopy one year later. Follow-up colonoscopy was not significantly associated with any psychological variables, but was significantly associated with educational status (postsecondary) (odds ratio [OR] = 7.10, 95% confidence interval [CI] = 1.83-27.56) and the results of baseline colonoscopy in patients who did not undergo polypectomy but had remaining polyps (OR = 4.26, 95% CI = 1.02-17.84). Additionally, significant differences in cancer threat-related variables were observed among groups of patients who, during baseline colonoscopy, underwent polypectomy but had no remaining polyps, had polyps removed with some polyps remaining, or did not undergo polypectomy but had remaining polyps (p < .05), with the latter group having a significant relationship with repeat colonoscopy. Cancer threat-related variables were not predictive of repeat colonoscopy after one year. In contrast, patient educational status and the colonoscopy results were predictors. We also found a non-linear relationship between high CRC threat and inhibition of the screening behavior in that the CRC threat functions as motivation for the surveillance behavior of colonoscopy.
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Affiliation(s)
- Toshiatsu Taniguchi
- Department of Psychiatry, Tottori Seikyo Hospital , 458 Suehiroonsenn-cho, Tottori 680-0841 , Japan ; Department of Complementary and Alternative Medicine, Osaka University Graduate School of Medicine , 2-2 Yamadaoka, Suita , Osaka 565-0871 , Japan
| | - Kei Hirai
- Department of Complementary and Alternative Medicine, Osaka University Graduate School of Medicine , 2-2 Yamadaoka, Suita , Osaka 565-0871 , Japan
| | - Ryoko Sumi
- Department of Complementary and Alternative Medicine, Osaka University Graduate School of Medicine , 2-2 Yamadaoka, Suita , Osaka 565-0871 , Japan
| | - Noriyuki Hayashi
- Department of Complementary and Alternative Medicine, Osaka University Graduate School of Medicine , 2-2 Yamadaoka, Suita , Osaka 565-0871 , Japan
| | - Kazuhisa Maeda
- Department of Complementary and Alternative Medicine, Osaka University Graduate School of Medicine , 2-2 Yamadaoka, Suita , Osaka 565-0871 , Japan
| | - Toshinori Ito
- Department of Complementary and Alternative Medicine, Osaka University Graduate School of Medicine , 2-2 Yamadaoka, Suita , Osaka 565-0871 , Japan
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16
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Concern and risk perception: effects on osteoprotective behaviour. J Osteoporos 2014; 2014:142546. [PMID: 25276471 PMCID: PMC4172925 DOI: 10.1155/2014/142546] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/13/2014] [Accepted: 08/27/2014] [Indexed: 11/17/2022] Open
Abstract
This study aimed to determine the effect that level of concern for osteoporosis, as well as self-perceived risk of osteoporosis and fracture, has on supplementation use, seeking medical advice, bone mineral density (BMD) testing, and antiosteoporosis medication (AOM) use. Study subjects were 1,095 female Australian participants of the Global Longitudinal study of Osteoporosis in Women (GLOW) untreated for osteoporosis at baseline. Study outcomes from self-administered questionnaires included calcium and vitamin D supplementation, self-reported seeking of medical advice regarding osteoporosis, BMD testing, and AOM use in the last 12 months at the late assessment. Logistic regression was used in the analysis. Concern significantly increased the likelihood of seeking medical advice and, however, had no significant impact on screening or treatment. Heightened self-perceived risks of osteoporosis and fracture both significantly increased the likelihood of seeking medical advice and BMD testing while elevated self-perceived risk of fracture increased AOM use. Supplementation use was not significantly associated with concern levels and risk perception. Concern and risk perceptions to osteoporosis and fracture were significantly associated with certain bone-protective behaviours. However, the disconnect between perceived osteoporosis risk and AOM use illustrates the need to emphasize the connection between osteoporosis and fracture in future education programs.
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17
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Flander L, Speirs-Bridge A, Rutstein A, Niven H, Win AK, Ait Ouakrim D, Hopper JL, Macrae F, Keogh L, Gaff C, Jenkins M. Perceived versus predicted risks of colorectal cancer and self-reported colonoscopies by members of mismatch repair gene mutation-carrying families who have declined genetic testing. J Genet Couns 2013; 23:79-88. [PMID: 23748873 DOI: 10.1007/s10897-013-9614-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 05/22/2013] [Indexed: 01/13/2023]
Abstract
People carrying germline mutations in mismatch repair genes are at high risk of colorectal cancer (CRC), yet about half of people from mutation-carrying families decline genetic counselling and/or testing to identify mutation status. We studied the association of quantitative measures of risk perception, risk prediction and self-reported screening colonoscopy in this elusive yet high-risk group. The sample of 26 participants (mean age 43.1 years, 14 women) in the Australasian Colorectal Cancer Family Registry were relatives of mutation carriers; had not been diagnosed with any cancer at the time of recruitment and had declined an invitation to attend genetic counselling and/or testing. A structured elicitation protocol captured perceived CRC risk over the next 10 years. Self-reported colonoscopy screening was elicited during a 45-minute semi-structured interview. Predicted 10-year CRC risk based on age, gender, known mutation status and family history was calculated using "MMRpro." Mean perceived 10-year risk of CRC was 31 % [95 % CI 21, 40], compared with mean predicted risk of 4 % [2, 7] (p < 0.001); this was independent of age and sex (p = 0.9). Among those reporting any medical advice and any screening colonoscopy (n = 18), those with higher risk perception had less frequent colonoscopy (Pearson's r = 0.49 [0.02, 0.79]). People who decline genetic testing for CRC susceptibility mutations perceive themselves to be at substantially higher risk than they really are. Those with high perceived risk do not undertake screening colonoscopy more often than those who perceive themselves to be at average risk.
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Affiliation(s)
- Louisa Flander
- Centre for Molecular, Environmental, Genetic & Analytic Epidemiology, The University of Melbourne, Melbourne, VIC, 3010, Australia,
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18
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Gender differences in attitudes impeding colorectal cancer screening. BMC Public Health 2013; 13:500. [PMID: 23706029 PMCID: PMC3672022 DOI: 10.1186/1471-2458-13-500] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 04/08/2013] [Indexed: 01/13/2023] Open
Abstract
Background Colorectal cancer screening (CRCS) is the only type of cancer screening where both genders reduce risks by similar proportions with identical procedures. It is an important context for examining gender differences in disease-prevention, as CRCS significantly reduces mortality via early detection and prevention. In efforts to increase screening adherence, there is increasing acknowledgment that obstructive attitudes prevent CRCS uptake. Precise identification of the gender differences in obstructive attitudes is necessary to improve uptake promotion. This study randomly sampled unscreened, screening - eligible individuals in Ontario, employing semi-structured interviews to elicit key differences in attitudinal obstructions towards colorectal cancer screening with the aim of deriving informative differences useful in planning promotions of screening uptake. Methods N = 81 participants (49 females, 32 males), 50 years and above, with no prior CRCS, were contacted via random-digit telephone dialing, and consented via phone-mail contact. Altogether, N = 4,459 calls were made to yield N = 85 participants (1.9% response rate) of which N = 4 participants did not complete interviews. All subjects were eligible for free-of-charge CRCS in Ontario, and each was classified, via standard interview by CRCS screening decision-stage. Telephone-based, semi-structured interviews (SSIs) were employed to investigate gender differences in CRCS attitudes, using questions focused on 5 attitudinal domains: 1) Screening experience at the time of interview; 2) Barriers to adherence; 3) Predictors of Adherence; 4) Pain-anxiety experiences related to CRCS; 5) Gender-specific experiences re: CRCS, addressing all three modalities accessible through Ontario’s program: a) fecal occult blood testing; b) flexible sigmoidoscopy; c) colonoscopy. Results Interview transcript analyses indicated divergent themes related to CRCS for each gender: 1) bodily intrusion, 2) perforation anxiety, and 3) embarrassment for females and; 1) avoidant procrastination with underlying fatalism, 2) unnecessary health care and 3) uncomfortable vulnerability for males. Respondents adopted similar attitudes towards fecal occult blood testing, flexible sigmoidoscopy and colonoscopy, and were comparable in decision stage across tests. Gender differences were neither closely tied to screening stage nor modality. Women had more consistent physician relationships, were more screening-knowledgeable and better able to articulate views on screening. Men reported less consistent physician relationships, were less knowledgeable and kept decision-making processes vague and emotionally distanced (i.e. at ‘arm’s length’). Conclusions Marked differences were observed in obstructive CRCS attitudes per gender. Females articulated reservations about CRCS-associated distress and males suppressed negative views while ambiguously procrastinating about the task of completing screening. Future interventions could seek to reduce CRCS-related stress (females) and address the need to overcome procrastination (males).
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Courtney RJ, Paul CL, Carey ML, Sanson-Fisher RW, Macrae FA, D'Este C, Hill D, Barker D, Simmons J. A population-based cross-sectional study of colorectal cancer screening practices of first-degree relatives of colorectal cancer patients. BMC Cancer 2013; 13:13. [PMID: 23305355 PMCID: PMC3556153 DOI: 10.1186/1471-2407-13-13] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 12/27/2012] [Indexed: 12/14/2022] Open
Abstract
Background The aim of this study was to determine the proportions and predictors of first-degree relatives (FDRs) of colorectal cancer (CRC) patients (i) ever receiving any CRC testing and (ii) receiving CRC screening in accordance with CRC screening guidelines. Methods Colorectal cancer patients and their FDRs were recruited through the population-based Victorian Cancer Registry, Victoria, Australia. Seven hundred and seven FDRs completed telephone interviews. Of these, 405 FDRs were deemed asymptomatic and eligible for analysis. Results Sixty-nine percent of FDRs had ever received any CRC testing. First-degree relatives of older age, those with private health insurance, siblings and FDRs who had ever been asked about family history of CRC by a doctor were significantly more likely than their counterparts to have ever received CRC testing. Twenty-five percent of FDRs “at or slightly above average risk” were adherent to CRC screening guidelines. For this group, adherence to guideline-recommended screening was significantly more likely to occur for male FDRs and those with a higher level of education. For persons at “moderately increased risk” and “potentially high risk”, 47% and 49% respectively adhered to CRC screening guidelines. For this group, guideline-recommended screening was significantly more likely to occur for FDRs who were living in metropolitan areas, siblings, those married or partnered and those ever asked about family history of CRC. Conclusions A significant level of non-compliance with screening guidelines was evident among FDRs. Improved CRC screening in accordance with guidelines and effective systematic interventions to increase screening rates among population groups experiencing inequality are needed. Trial Registration Australian and New Zealand Clinical Trial Registry: ACTRN12609000628246
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Affiliation(s)
- Ryan J Courtney
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, Australia.
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20
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Brittain K, Taylor JY, Loveland-Cherry C, Northouse L, Caldwell CH. Family Support and Colorectal Cancer Screening among Urban African Americans. J Nurse Pract 2012; 8:522-533. [PMID: 23086216 PMCID: PMC3474367 DOI: 10.1016/j.nurpra.2011.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer death among African Americans. Less than 50% of African Americans have had CRC screening. This study examined the relationships between family support and influence, cultural identity, CRC beliefs, and a screening informed decision among 129 urban African Americans. Family support (p < .01) significantly predicted CRC beliefs and CRC beliefs significantly predicted informed decision (p < .01). Based on study results, practitioners should routinely assess family support and CRC beliefs with African Americans patients. This may improve patient-provider shared decision-making satisfaction and CRC screening adherence among African American patients.
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Affiliation(s)
- Kelly Brittain
- College of Nursing, Michigan State University, East Lansing
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21
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The Family Health Promotion Project (FHPP): design and baseline data from a randomized trial to increase colonoscopy screening in high risk families. Contemp Clin Trials 2011; 33:426-35. [PMID: 22101228 DOI: 10.1016/j.cct.2011.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 11/04/2011] [Accepted: 11/05/2011] [Indexed: 12/24/2022]
Abstract
Colorectal cancer (CRC) is a significant cause of mortality and morbidity in the United States, much of which could be prevented through adequate screening. Consensus guidelines recommend that high-risk groups initiate screening earlier with colonoscopy and more frequently than average risk persons. However, a large proportion of high risk individuals do not receive regular colonoscopic screening. The Family Health Promotion Project (FHPP) is a randomized-controlled trial to test the effectiveness of a telephone-based counseling intervention to increase adherence to risk-appropriate colonoscopy screening in high risk individuals. Unaffected members of CRC families from two national cancer family registries were enrolled (n=632) and randomized to receive either a single session telephone counseling intervention using Motivational Interviewing techniques or a minimal mail-out intervention. The primary endpoint, rate of colonoscopy screening, was assessed at 6, 12 and 24 months post-enrollment. In this paper, we describe the research design and telephone counseling intervention of the FHPP trial, and report baseline data obtained from the two high risk cohorts recruited into this trial. Results obtained at baseline confirm the need for interventions to promote colonoscopy screening among these high risk individuals, as well as highlighting several key opportunities for intervention, including increasing knowledge about risk-appropriate screening guidelines, and providing both tailored risk information and barriers counseling.
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22
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Kiviniemi MT, Bennett A, Zaiter M, Marshall JR. Individual-level factors in colorectal cancer screening: a review of the literature on the relation of individual-level health behavior constructs and screening behavior. Psychooncology 2011; 20:1023-33. [PMID: 21954045 PMCID: PMC3038178 DOI: 10.1002/pon.1865] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 09/10/2010] [Accepted: 09/16/2010] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Compliance with colorectal cancer screening recommendations requires considerable conscious effort on the part of the individual patient, making an individual's decisions about engagement in screening an important contributor to compliance or noncompliance. The objective of this paper was to examine the effectiveness of individual-level behavior theories and their associated constructs in accounting for engagement in colorectal cancer screening behavior. METHODS We reviewed the literature examining constructs from formal models of individual-level health behavior as factors associated with compliance with screening for colorectal cancer. All published studies examining one or more constructs from the health belief model, theory of planned behavior, transtheoretical model, or social cognitive theory and their relation to screening behavior or behavioral intentions were included in the analysis. RESULTS By and large, results of studies supported the theory-based predictions for the influence of constructs on cancer screening behavior. However, the evidence base for many of these relations, especially for models other than the health belief model, is quite limited. CONCLUSIONS Suggestions are made for future research on individual-level determinants of colorectal cancer screening.
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Affiliation(s)
- Marc T Kiviniemi
- Department of Health Behavior, University at Buffalo, New York 14124, USA.
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Santos EM, Lourenço MT, Rossi BM. Risk perception among Brazilian individuals with high risk for colorectal cancer and colonoscopy. Hered Cancer Clin Pract 2011; 9:4. [PMID: 21798032 PMCID: PMC3199898 DOI: 10.1186/1897-4287-9-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 07/28/2011] [Indexed: 12/31/2022] Open
Abstract
Background Risk perception is considered a motivating factor for adopting preventive behaviors. This study aimed to verify the demographic characteristics and cancer family history that are predictors of risk perception and to verify if risk perception is a predictor of colonoscopy adherence. Methods Individuals with a family colorectal cancer history as indicated by a proband with cancer were interviewed by telephone. They responded to a questionnaire covering demographic characteristics, colonoscopy history and four questions on risk perception. Tests of multiple linear regression and logistic regression were used to identify associations between dependent and independent variables. Results The 117 participants belonged to 62 families and had a mean age of 45.2 years. The majority of these individuals were female (74.4%) and from families who met the Amsterdam Criteria (54.7%). The average risk perception was 47.6%, with a median of 50%. The average population perception of individual risk was 55.4%, with a median of 50%. Variables associated with a higher risk perception were age, gender, religion, school level, income, and death of a family member. The variable predicting colonoscopy was receiving medical information regarding risk (odds ratio OR 8.40). Conclusions We found that family cancer history characteristics (number of relatives with cancer, risk classification) are associated with adequate risk perception. Risk perception does not predict colonoscopy in this sample. The only variable that predicted colonoscopy was receiving medical information recommending screening.
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Affiliation(s)
- Erika M Santos
- Graduation Program, Antonio Prudente Foundation, Sao Paulo, Brazil
| | | | - Benedito M Rossi
- Graduation Program, Antonio Prudente Foundation, Sao Paulo, Brazil
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Glenn BA, Herrmann AK, Crespi CM, Mojica CM, Chang LC, Maxwell AE, Bastani R. Changes in risk perceptions in relation to self-reported colorectal cancer screening among first-degree relatives of colorectal cancer cases enrolled in a randomized trial. Health Psychol 2011; 30:481-91. [PMID: 21744967 PMCID: PMC3201806 DOI: 10.1037/a0024288] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This secondary data analysis was conducted to evaluate the applicability of the Risk Reappraisal Hypothesis, which has been proposed to explain the influence of performing a health behavior on perceived risk. Data were collected in the context of a randomized trial, which found that an individually tailored, multicomponent intervention was successful in increasing colorectal cancer (CRC) screening among first-degree relatives of CRC cases. METHOD The ethnically diverse study sample (N = 841; 29% Latino, 21% African American, 20% Asian) consisted of adult siblings and children (40-80 years) of CRC cases, identified through the California Cancer Registry. Data were collected at baseline and at 6- and 12-month follow-up. Changes in self-reported risk perception (perceived likelihood of developing CRC) were examined over the study period in relation to study condition and screening status. RESULTS Greater increases in perceived risk were observed among intervention versus control-group participants over the study period, but increases were limited to intervention participants who had not been screened. We also examined trajectories of perceived risk in relation to timing of screening receipt (e.g., before 6 months, 6-12 months, never). Continued upward shifts in risk were observed during the study period among intervention participants not screened during the study. In contrast, participants screened by 6 months displayed a reduction or leveling off in perceived risk between 6- and 12-month follow-up. CONCLUSION Results provide support for the applicability of the Risk Reappraisal Hypothesis within a high-risk sample enrolled in a CRC screening promotion trial. Future research is needed to explore the impact of short-term risk reductions on future CRC screening behavior.
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Affiliation(s)
- Beth A Glenn
- Division of Cancer Prevention & Control Research, School of Public Health & Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA 90095-6900, USA.
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Taouqi M, Ingrand I, Beauchant M, Migeot V, Ingrand P. Determinants of participation in colonoscopic screening by siblings of colorectal cancer patients in France. BMC Cancer 2010; 10:355. [PMID: 20602807 PMCID: PMC2910691 DOI: 10.1186/1471-2407-10-355] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 07/06/2010] [Indexed: 12/24/2022] Open
Abstract
Background Targeted colonosocopic screening is recommended for first-degree relatives of colorectal cancer patients diagnosed before the age of 60 and offers the possibility of reducing morbidity and mortality, but participation remains too low. The objective of this study was to determine in a French population the factors that affect siblings' participation in screening, notably those relating to the individuals, their medical care, their family and their social network. Methods A cross sectional survey was conducted in siblings of index patients having undergone surgery for colorectal cancer between 1999 and 2002 in two French counties. Siblings were contacted during 2007 and 2008 through the index patient. The factors affecting participation in colonoscopic screening were studied by logistic regression taking into account family cluster effect. Results 172 siblings of 74 index cases were included. The declared rate of undergoing at least one colonoscopy among siblings was 66%; 95%CI 59-73%. Five variables were independently associated with colonoscopic screening: perceiving fewer barriers to screening (OR = 3.2; 95%CI 1.2-8.5), having received the recommendation to undergo screening from a physician (OR = 4.9; 1.7-13.7), perceiving centres practising colonoscopy as more accessible (OR = 3.2, 1.3-7.8), having discussed screening with all siblings (OR = 3.9; 1.6-9.6) and being a member of an association (OR = 2.6; 1.0-6.6). Conclusions The factors independently associated with participation in CRC screening by an individual at increased risk belonged to each of four dimensions relating to his individual psychosocial characteristics, to his relationship with a physician, within the family and social environment. The relevance of these results to clinical practice may help to improve compliance to recommendations in a global preventive strategy including all stages of the information pathway from the physician to the index patient and his relatives.
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Affiliation(s)
- Myriam Taouqi
- Public Health, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, 86005 Poitiers Cedex, France
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Claassen L, Henneman L, Janssens ACJW, Wijdenes-Pijl M, Qureshi N, Walter FM, Yoon PW, Timmermans DRM. Using family history information to promote healthy lifestyles and prevent diseases; a discussion of the evidence. BMC Public Health 2010; 10:248. [PMID: 20465810 PMCID: PMC2875210 DOI: 10.1186/1471-2458-10-248] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 05/13/2010] [Indexed: 12/12/2022] Open
Abstract
Background A family history, reflecting genetic susceptibility as well as shared environmental and behavioral factors, is an important risk factor for common chronic multifactorial diseases such as cardiovascular diseases, type 2 diabetes and many cancers. Discussion The purpose of the present paper is to discuss the evidence for the use of family history as a tool for primary prevention of common chronic diseases, in particular for tailored interventions aimed at promoting healthy lifestyles. The following questions are addressed: (1) What is the value of family history information as a determinant of personal disease risk?; (2)How can family history information be used to motivate at-risk individuals to adopt and maintain healthy lifestyles in order to prevent disease?; and (3) What additional studies are needed to assess the potential value of family history information as a tool to promote a healthy lifestyle? Summary In addition to risk assessment, family history information can be used to personalize health messages, which are potentially more effective in promoting healthy lifestyles than standardized health messages. More research is needed on the evidence for the effectiveness of such a tool.
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Affiliation(s)
- Liesbeth Claassen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.
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Ashida S, Wilkinson AV, Koehly LM. Motivation for health screening: evaluation of social influence among Mexican-American adults. Am J Prev Med 2010; 38:396-402. [PMID: 20307808 PMCID: PMC2844878 DOI: 10.1016/j.amepre.2009.12.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 10/20/2009] [Accepted: 12/07/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Americans of Mexican origin are at high risk for developing cardiovascular disease. PURPOSE This study aimed to evaluate the associations between the presence of social network members who encourage screening and individuals' motivation to undergo three types of health screening: blood cholesterol, blood pressure, and blood glucose. The distinct roles of encouragers from different generations (older, same, and younger) were evaluated. METHODS Adults of Mexican origin (N=452) aged 20-75 years from 162 households in Houston TX were included in this cross-sectional study by completing surveys in 2008 regarding their intentions to screen, health behaviors, illness beliefs, social networks, and family health history in either English or Spanish. Data were analyzed in 2009. RESULTS About one third of the participants reported having at least one same-generation network member who encouraged screening; smaller proportions reported having at least one older- (17% to 19%) and one younger-generation (11% to 12%) encourager. The presence of at least one older-generation encourager was associated with higher levels of intention to screen for all three screenings controlling for sociodemographic characteristics and illness beliefs. Having at least one same-generation encourager was associated with higher levels of intention to screen for blood cholesterol. CONCLUSIONS Social influence may play an important role in motivating individuals to engage in screenings. Network-based intervention involving older individuals to provide encouragement to younger network members should be explored as a means to increase motivation to screen among this population.
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Affiliation(s)
- Sato Ashida
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland 20892, USA.
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Kiviniemi MT, Hay JL, James AS, Lipkus IM, Meissner HI, Stefanek M, Studts JL, Bridges JFP, Close DR, Erwin DO, Jones RM, Kaiser K, Kash KM, Kelly KM, Craddock Lee SJ, Purnell JQ, Siminoff LA, Vadaparampil ST, Wang C. Decision making about cancer screening: an assessment of the state of the science and a suggested research agenda from the ASPO Behavioral Oncology and Cancer Communication Special Interest Group. Cancer Epidemiol Biomarkers Prev 2010; 18:3133-7. [PMID: 19900944 DOI: 10.1158/1055-9965.epi-18-11-aspo] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Marc T Kiviniemi
- Department of Health Behavior, University at Buffalo, Buffalo, New York 14222, USA.
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Salz T, Brewer NT, Sandler RS, Weiner BJ, Martin CF, Weinberger M. Association of health beliefs and colonoscopy use among survivors of colorectal cancer. J Cancer Surviv 2009; 3:193-201. [PMID: 19760152 PMCID: PMC2809816 DOI: 10.1007/s11764-009-0095-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 07/30/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Clinical practice guidelines recommend ongoing testing (surveillance) for colorectal cancer survivors because they remain at risk for both local recurrences and second primary tumors. However, survivors often do not receive colorectal cancer surveillance. We used the Health Belief Model (HBM) to identify health beliefs that predict intentions to obtain routine colonoscopies among colorectal cancer survivors. METHODS We completed telephone interviews with 277 colorectal cancer survivors who were diagnosed 4 years earlier, between 2003 and 2005, in North Carolina. The interview measured health beliefs, past preventive behaviors, and intentions to have a routine colonoscopy in the next 5 years. RESULTS In bivariate analyses, most HBM constructs were associated with intentions. In multivariable analyses, greater perceived likelihood of colorectal cancer (OR = 2.00, 95% CI = 1.16-3.44) was associated with greater intention to have a colonoscopy. Survivors who already had a colonoscopy since diagnosis also had greater intentions of having a colonoscopy in the future (OR = 9.47, 95% CI = 2.08-43.16). CONCLUSIONS Perceived likelihood of colorectal cancer is an important target for further study and intervention to increase colorectal cancer surveillance among survivors. Other health beliefs were unrelated to intentions, suggesting that the health beliefs of colorectal cancer survivors and asymptomatic adults may differ due to the experience of cancer.
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Affiliation(s)
- Talya Salz
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY, 10021, USA.
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Mayer DK, Terrin NC, Menon U, Kreps GL, McCance K, Parsons SK, Mooney KH. Screening practices in cancer survivors. J Cancer Surviv 2008; 1:17-26. [PMID: 18648941 DOI: 10.1007/s11764-007-0007-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Ten percent of all new cancers are diagnosed in cancer survivors and second cancers are the sixth leading cause of cancer deaths. Little is known, however, about survivors' screening practices for other cancers. The purpose of this study was to examine the impact of a cancer diagnosis on survivors' screening beliefs and practices compared to those without a cancer history. MATERIALS AND METHODS This study examined cancer survivors' (n = 619) screening beliefs and practices compared to those without cancer (n = 2,141) using the National Cancer Institute's 2003 Health Information National Trends Survey (HINTS). RESULTS The typical participant was Caucasian, employed, married, and female with at least a high school education, having a regular health care provider and health insurance. Being a cancer survivor was significantly associated with screening for colorectal cancer but not for breast or prostate cancer screening. Screening adherence exceeded American Cancer Society recommendations, national prevalence data, and Healthy People 2010 goals for individual tests for both groups. Physician recommendations were associated with a higher level of screening but recommendations varied (highest for breast cancer and lowest for colorectal cancer screening). CONCLUSIONS Cancer survivors had different health beliefs and risk perceptions for screening compared to the NoCancer group. While there were no differences between survivors' screening for breast and prostate cancer, survivors were more likely to screen for colorectal cancer than the comparison group. Screening adherence met or exceeded recommendations for individual tests for both cancer survivors and the comparison group. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors should continue to work with their health care providers to receive age and gender appropriate screening for many types of cancers. Screening for other cancers should also be included in cancer survivorship care plans.
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Affiliation(s)
- Deborah K Mayer
- Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, 750 Washington Street #345, Boston, MA 02111, USA.
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Zheng YF, Saito T, Takahashi M, Ishibashi T, Kai I. Factors associated with intentions to adhere to colorectal cancer screening follow-up exams. BMC Public Health 2006; 6:272. [PMID: 17083746 PMCID: PMC1664561 DOI: 10.1186/1471-2458-6-272] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Accepted: 11/06/2006] [Indexed: 01/08/2023] Open
Abstract
Background To increase adherence rate to recommendations for follow-up after abnormal colorectal cancer (CRC) screening results, factors that inhibit and facilitate follow-up must be identified. The purpose of this study was to identify the factors associated with intention to adhere to CRC screening follow-up exams. Methods During a 4-week period in October 2003, this survey was conducted with 426 subjects participating in a community-based CRC screening program in Nagano, Japan. Study measures included intention to adhere to recommendation for clinical follow-up in the event of an abnormal fecal occult blood test (FOBT) result, perceived susceptibility and severity of CRC, perceived benefits and barriers related to undergoing follow-up examination, social support, knowledge of CRC risk factors, health status, previous CRC screening, personality and social demographic characteristics. Univariate and multivariate logistic regression analyses on intention to adhere to recommendations for follow-up were performed. Results Among the 288 individuals analyzed, approximately 74.7% indicated that they would definitely adhere to recommendations for follow-up. After controlling for age, gender, marital status, education, economic status, trait anxiety, bowel symptoms, family history of CRC, and previous screening FOBT, analyses revealed that lower levels of perceived barriers, higher levers of perceived benefits and knowledge of CRC risk factors were significantly associated with high intention respectively. Conclusion The results of this study suggest that future interventions should focus on reducing modifiable barriers by clarifying misperceptions about follow-up, promoting the acceptance of complete diagnostic evaluations, addressing psychological distress, and making follow-up testing more convenient and accessible. Moreover, educating the public regarding the risk factors of CRC and increasing understanding of the benefits of follow-up is also important.
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Affiliation(s)
- Ying-Fang Zheng
- Department of Social Gerontology, School of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033 Japan
| | - Tami Saito
- Department of Social Gerontology, School of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033 Japan
| | - Miyako Takahashi
- Department of Social Gerontology, School of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033 Japan
| | - Teruo Ishibashi
- Ishibashi Occupational Safety and Health Consultant Office, 337-7 Saku City, Nagano 385-0026 Japan
| | - Ichiro Kai
- Department of Social Gerontology, School of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033 Japan
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Codori AM, Waldeck T, Petersen GM, Miglioretti D, Trimbath JD, Tillery MA. Genetic counseling outcomes: perceived risk and distress after counseling for hereditary colorectal cancer. J Genet Couns 2005; 14:119-32. [PMID: 15959643 DOI: 10.1007/s10897-005-4062-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Genetic counseling may turn risk information into cancer prevention behavior by modifying health beliefs and cancer-related distress. We assessed the effect of genetic counseling on these factors in 101 adult first-degree-relatives of colorectal cancer patients from families with known or suspected hereditary nonpolyposis colorectal cancer. Before counseling and once afterward, subjects completed self-report measures of perceived lifetime risk and cancer-distress. Most persons overestimated their cancer risk, and higher perceived risk was associated with believing that colorectal cancer cannot be prevented. Individual perceived risk changed after counseling, although mean perceived risk was unchanged. After adjusting for baseline risk, older persons and those with higher estimated objective cancer risk had larger postcounseling decreases. Distress after counseling was positively correlated with baseline distress and anxiety symptoms, and inversely correlated with tolerance for ambiguity. The findings suggest counseling interventions that should increase the likelihood of screening and offer hypotheses for future research.
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Affiliation(s)
- Ann-Marie Codori
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Honda K. Factors associated with colorectal cancer screening among the US urban Japanese population. Am J Public Health 2004; 94:815-22. [PMID: 15117706 PMCID: PMC1448343 DOI: 10.2105/ajph.94.5.815] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The author examined the prevalence and predictors of colorectal cancer screening among the urban Japanese population of the United States. METHODS A sample of Japanese residents of major US metropolitan areas completed a self-administered mailed survey. RESULTS Physician recommendation, acculturation, and perceived psychological costs were consistent predictors of screening for colorectal cancer. Gender and marital status were related to screening via fecal occult blood testing; age, susceptibility, and health insurance were related to sigmoidoscopy/colonoscopy screening. CONCLUSIONS Colorectal cancer screening among the urban Japanese population could be increased with interventions seeking to promote physician recommendations for screening, alleviate perceived psychological costs among patients, and improve physician-patient communication.
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Affiliation(s)
- Keiko Honda
- Department of Epidemiology, Columbia University, 722 E. 168th Street, Room 719, New York City, NY 10032, USA.
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