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Greenberg AL, Brand NR, Zambeli-Ljepović A, Barnes KE, Chiou SH, Rhoads KF, Adam MA, Sarin A. Exploring the complexity and spectrum of racial/ethnic disparities in colon cancer management. Int J Equity Health 2023; 22:68. [PMID: 37060065 PMCID: PMC10105474 DOI: 10.1186/s12939-023-01883-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/04/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Colorectal cancer is a leading cause of morbidity and mortality across U.S. racial/ethnic groups. Existing studies often focus on a particular race/ethnicity or single domain within the care continuum. Granular exploration of disparities among different racial/ethnic groups across the entire colon cancer care continuum is needed. We aimed to characterize differences in colon cancer outcomes by race/ethnicity across each stage of the care continuum. METHODS We used the 2010-2017 National Cancer Database to examine differences in outcomes by race/ethnicity across six domains: clinical stage at presentation; timing of surgery; access to minimally invasive surgery; post-operative outcomes; utilization of chemotherapy; and cumulative incidence of death. Analysis was via multivariable logistic or median regression, with select demographics, hospital factors, and treatment details as covariates. RESULTS 326,003 patients (49.6% female, 24.0% non-White, including 12.7% Black, 6.1% Hispanic/Spanish, 1.3% East Asian, 0.9% Southeast Asian, 0.4% South Asian, 0.3% AIAE, and 0.2% NHOPI) met inclusion criteria. Relative to non-Hispanic White patients: Southeast Asian (OR 1.39, p < 0.01), Hispanic/Spanish (OR 1.11 p < 0.01), and Black (OR 1.09, p < 0.01) patients had increased odds of presenting with advanced clinical stage. Southeast Asian (OR 1.37, p < 0.01), East Asian (OR 1.27, p = 0.05), Hispanic/Spanish (OR 1.05 p = 0.02), and Black (OR 1.05, p < 0.01) patients had increased odds of advanced pathologic stage. Black patients had increased odds of experiencing a surgical delay (OR 1.33, p < 0.01); receiving non-robotic surgery (OR 1.12, p < 0.01); having post-surgical complications (OR 1.29, p < 0.01); initiating chemotherapy more than 90 days post-surgery (OR 1.24, p < 0.01); and omitting chemotherapy altogether (OR 1.12, p = 0.05). Black patients had significantly higher cumulative incidence of death at every pathologic stage relative to non-Hispanic White patients when adjusting for non-modifiable patient factors (p < 0.05, all stages), but these differences were no longer statistically significant when also adjusting for modifiable factors such as insurance status and income. CONCLUSIONS Non-White patients disproportionately experience advanced stage at presentation. Disparities for Black patients are seen across the entire colon cancer care continuum. Targeted interventions may be appropriate for some groups; however, major system-level transformation is needed to address disparities experienced by Black patients.
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Affiliation(s)
- Anya L Greenberg
- Department of Surgery, University of California San Francisco, 550 16Th Street, 6Th Floor, San Francisco, CA, 94158, USA
| | - Nathan R Brand
- Department of Surgery, University of California San Francisco, 550 16Th Street, 6Th Floor, San Francisco, CA, 94158, USA
| | - Alan Zambeli-Ljepović
- Department of Surgery, University of California San Francisco, 550 16Th Street, 6Th Floor, San Francisco, CA, 94158, USA
| | - Katherine E Barnes
- Department of Surgery, University of California San Francisco, 550 16Th Street, 6Th Floor, San Francisco, CA, 94158, USA
| | - Sy Han Chiou
- Department of Surgery, University of California San Francisco, 550 16Th Street, 6Th Floor, San Francisco, CA, 94158, USA
| | - Kim F Rhoads
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Mohamed A Adam
- Department of Surgery, University of California San Francisco, 550 16Th Street, 6Th Floor, San Francisco, CA, 94158, USA
| | - Ankit Sarin
- Department of Surgery, University of California San Francisco, 550 16Th Street, 6Th Floor, San Francisco, CA, 94158, USA.
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Colón-López V, Valencia-Torres IM, Ríos EI, Llavona J, Vélez-Álamo C, Fernández ME. Knowledge, Attitudes, and Beliefs About Colorectal Cancer Screening in Puerto Rico. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:552-561. [PMID: 35359256 PMCID: PMC10102089 DOI: 10.1007/s13187-022-02153-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 05/20/2023]
Abstract
The purpose of this study was to describe the psychosocial factors influencing participation in colorectal cancer screening (CRCS) among Puerto Rican men and women. We conducted seven focus groups in metropolitan and rural areas of Puerto Rico (PR) with men and women (using gender specific groups) aged 50 to 80 years (n = 51) who were non-adherent to CRC guidelines. The focus group guide included questions related to colorectal cancer (CRC) and CRC screening knowledge, attitudes, and beliefs. We analyzed data using a modified grounded theory approach to identify emergent themes. Focus groups revealed seven major themes that represented barriers to CRCS: (1) lack of CRC knowledge, (2) lack of knowledge about colorectal cancer screening tests as well as the required preparation, (3) embarrassment, (4) low perceived benefit of CRCS and sense of fatalism, (5) transportation (mostly among participants in rural areas), (6) lack of time, and (7) financial burden. All participants understood the benefits of CRCS once the procedure was explained. Additionally, participants reported a lack of provider recommendation for CRCS. In this group of Puerto Rican participants who were non-adherent to CRCS, there were misconceptions about CRC, screening tests available, and preparation and testing procedures. Participants' low levels of knowledge and negative attitudes concerning CRCS and low reported provider recommendation were important deterrents to screening. These findings suggest the need for educational efforts to increase knowledge and attitudes about CRCS and improved patient-provider communication to reduce missed opportunities to recommend.
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Affiliation(s)
- Vivian Colón-López
- Division of Population Health Sciences, PR Comprehensive Cancer Center, Medical , University of Puerto Rico, Sciences Campus, PMB 371, P.O. Box 70344, San Juan, PR, 00936-5067, USA.
- Health Services Administration, Evaluation Program, Graduate School of Public Health, University of Puerto Rico, PMB 371, P.O. Box 70344, San Juan, PR, 00936-5067, USA.
| | - Ileska M Valencia-Torres
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, 7000 Fannin St., Suite 2080, Houston, TX, 77030, USA
| | - Elsa I Ríos
- Division of Population Health Sciences, PR Comprehensive Cancer Center, Medical , University of Puerto Rico, Sciences Campus, PMB 371, P.O. Box 70344, San Juan, PR, 00936-5067, USA
| | - Josheili Llavona
- UPR-MDACC Partnership for Excellence in Cancer Research Program, University of Puerto Rico, PMB 371, P.O. Box 70344, San Juan, PR, 00936-5067, USA
| | - Camille Vélez-Álamo
- UPR-MDACC Partnership for Excellence in Cancer Research Program, University of Puerto Rico, PMB 371, P.O. Box 70344, San Juan, PR, 00936-5067, USA
| | - María E Fernández
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, 7000 Fannin St., Suite 2080, Houston, TX, 77030, USA
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Langston ME, Fuzzell L, Lewis-Thames MW, Khan S, Moore JX. Disparities in Health Information-Seeking Behaviors and Fatalistic Views of Cancer by Sexual Orientation Identity: A Nationally Representative Study of Adults in the United States. LGBT Health 2019; 6:192-201. [PMID: 31107153 DOI: 10.1089/lgbt.2018.0112] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose: A lack of national data makes it difficult to estimate, but LGB adults appear to have a higher risk of cancer. Although limited research exists to explain the disparity, we aimed to explore potential differences in access to and utilization of health information and in cancer-related beliefs and behaviors. Methods: We used data from the Health Information National Trends Survey 5, Cycle 1 conducted from January 25 through May 5, 2017. Using survey-weighted logistic regression, we explored potential differences in health information-seeking behavior, trusted sources of health care information, engagement with the health care system, awareness of cancer risk factors, cancer fatalism, cancer-related health behaviors, and historical cancer screening between 117 LGB and 2857 heterosexual respondents. Results: LGB respondents were more likely to report looking for information about health or medical topics than heterosexual respondents (adjusted odds ratio [aOR]: 3.12; confidence interval [95% CI]: 1.07-9.06), but less likely to seek health information first from a doctor (aOR: 0.17; 95% CI: 0.06-0.50) after adjusting for age, race, and sex. LGB persons were less likely to report that they trust receiving health or medical information from friends and family and more likely to be worried about getting cancer (aOR: 2.30; 95% CI: 1.04-5.05). Conclusions: Our findings indicate a growing need for the production of tailored cancer prevention and control materials for members of sexual minority groups. More work is needed to understand barriers that LGB populations face in accessing this health information and building informative social support networks.
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Affiliation(s)
- Marvin E Langston
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Lindsay Fuzzell
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Marquita W Lewis-Thames
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Saira Khan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Justin X Moore
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Douma LN, Uiters E, Timmermans DRM. Why are the public so positive about colorectal cancer screening? BMC Public Health 2018; 18:1212. [PMID: 30376841 PMCID: PMC6208033 DOI: 10.1186/s12889-018-6106-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/10/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening is widely recommended. Earlier research showed that the general public are positive about CRC screening, as too the eligible CRC screening population. Among the eligible CRC screening population this positive perception has been shown to be associated with their perceptions of cancer, preventive health screening and their own health. It is unclear whether these concepts are also associated with the positive perception of the general public. Knowing this can provide insight into the context in which public perception concerning CRC screening is established. The aim of our study was to examine which main perceptions are associated with the public perception concerning CRC screening. METHODS An online survey was carried out in a Dutch population sample (adults 18+) among 1679 respondents (response rate was 56%). We assessed the public's perceptions concerning cancer, preventive health screening, own health, and the government, and examined their possible association with public opinion concerning CRC screening. RESULTS The public's positive attitude towards CRC screening is associated with the public's positive attitude towards preventive health screening in general, their perceived seriousness of cancer, their belief of health being important, and their trust in the government regarding national screening programmes. CONCLUSION Trust in the government and perceptions regarding the seriousness of cancer, preventive health screening and the importance of one's health seem to be important factors influencing how the public view CRC screening. The public are likely to process information about CRC screening in such a way that it confirms their existing beliefs of cancer being serious and preventive screening being positive. This makes it likely that they will notice information about the possible benefits of CRC screening more than information about its possible downsides, which would also contribute to the positive perception of CRC screening.
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Affiliation(s)
- Linda N. Douma
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT The Netherlands
- National Institute for Public Health and the Environment (RIVM), Postbus 1, Bilthoven, 3720 BA The Netherlands
| | - Ellen Uiters
- National Institute for Public Health and the Environment (RIVM), Postbus 1, Bilthoven, 3720 BA The Netherlands
| | - Danielle R. M. Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT The Netherlands
- National Institute for Public Health and the Environment (RIVM), Postbus 1, Bilthoven, 3720 BA The Netherlands
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Ajeesh S, Luis R. A Comprehensive Electronic Health Record Based Patient Navigation Module Including Technology Driven Colorectal Cancer Outreach and Education. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:627-633. [PMID: 28188568 DOI: 10.1007/s13187-017-1184-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The purpose of this concept paper is to propose an innovative multifaceted patient navigation module embedded in the Electronic Health Record (EHR) to address barriers to efficient and effective colorectal cancer (CRC) care. The EHR-based CRC patient navigation module will include several patient navigation features: (1) CRC screening registry; (2) patient navigation data, including CRC screening data, outcomes of patient navigation including navigation status (CRC screening referrals, fecal occult blood test (FOBT) completed, colonoscopy scheduled and completed, cancelations, reschedules, and no-shows); (3) CRC counseling aid; and 4) Web-based CRC education application including interactive features such as a standardized colonoscopy preparation guide, modifiable CRC risk factors, and links to existing resources. An essential component of health informatics is the use of EHR systems to not only provide a system for storing and retrieval of patient health data but can also be used to enhance patient decision-making both from a provider and patient perspective.
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Affiliation(s)
- Sunny Ajeesh
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Rustveld Luis
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.
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Thamarasseril S, Bhuket T, Chan C, Liu B, Wong RJ. The Need for an Integrated Patient Navigation Pathway to Improve Access to Colonoscopy After Positive Fecal Immunochemical Testing: A Safety-Net Hospital Experience. J Community Health 2018; 42:551-557. [PMID: 27796633 DOI: 10.1007/s10900-016-0287-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Colorectal cancer (CRC) is a leading cause of cancer-related deaths in the United States. Delays in access to colonoscopy following positive fecal immunochemical test (FIT) contribute to increased CRC incidence and mortality. To evaluate intervals from positive FIT result to receipt of colonoscopy among underserved safety-net populations. We retrospectively evaluated all average CRC risk adults who had positive FIT results from 2012 to 2015 at an ethnically diverse safety-net hospital system. Interval from positive FIT to receipt of colonoscopy was evaluated with Kaplan Meier methods and multivariate Cox proportional hazards models. Among 467 patients with positive FIT (48.4 % men, 39.5 % black, 22.5 % white, 17.4 % Asian, 9.7 % Hispanic, mean age 59.5 ± 9.8 years), mean time from positive FIT to receipt of colonoscopy was 220.5 days (SD 158.5). Compared to men, there was a trend towards longer time from FIT positive to colonoscopy among women (237.1 vs. 198.7 days, p = 0.07). No race/ethnicity-specific disparities in time to colonoscopy were observed. Compared to 2012-2013, there was a 27.2 % reduction in time from FIT positive to colonoscopy in 2014-2015 (173.9 vs. 238.8 days, p < 0.01). Among patients undergoing colonoscopy, 46.3 % had adenomatous polyps, 27.4 % had high risk adenomatous polyps, and 5.6 % had CRC. Among an ethnically diverse safety-net hospital system, improvements in access to colonoscopy after positive FIT were observed. However, patients still waited nearly 6 months from time of positive FIT to undergoing colonoscopy. Delays in receipt of colonoscopy are complex and reflect system-level and individual patient-level barriers.
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Affiliation(s)
- Sreedevi Thamarasseril
- Department of Medicine, Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA
| | - Taft Bhuket
- Department of Medicine, Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA
| | - Chuck Chan
- Department of Medicine, Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA
| | - Benny Liu
- Department of Medicine, Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA
| | - Robert J Wong
- Department of Medicine, Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA.
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Lumpkins CY, Mabachi N, Lee J, Pacheco C, Greiner KA, Geana M. A Prescription for Internet Access: Appealing to Middle-Aged and Older Racial and Ethnic Minorities Through Social Network Sites to Combat Colorectal Cancer. HEALTH COMMUNICATION 2017; 32:916-920. [PMID: 27435103 DOI: 10.1080/10410236.2016.1195679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The popularity and usage of social media networks or SNS (social networking sites) among American Internet users age 50 and over doubled between 2009 and 2010 and has steadily climbed. Part of this increased access may be the result of older adults who are living with a chronic disease and are reaching out for online support. Colorectal cancer (CRC) risk is among those concerns, particularly among middle-age and older minority populations where disparities exist. This exploratory study investigates information seeking behavior related to cancer factors (e.g. testing for colon cancer, cancer fatalism) and current social media usage among racial and ethnic minority groups (African American and Latinos) and Whites age 50 and older. The secondary data from the 2012 Health Information National Trends Survey (HINTS) was analyzed to compare these populations. Results show that African Americans and Latinos were only slightly more likely to use social network sites to seek out cancer information compared to Whites. However, Whites were more likely to use the Internet to seek health information compared to African Americans and Latinos. In this sample, Whites were also more likely to be informed by a physician about CRC testing (p <.01). Whites were also more fatalistic about CRC (p<.001) and more likely to have self-reported receiving a positive diagnosis (p <.001). Implications of this study suggest that use of both traditional health information sources (physician) and the Internet (social media networks, Internet sites) have increased among older Americans and can serve as critical channels for cancer information and education.
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Affiliation(s)
- Crystal Y Lumpkins
- a Department of Family Medicine Research Division , University of Kansas Medical Center
| | - Natabhona Mabachi
- a Department of Family Medicine Research Division , University of Kansas Medical Center
| | - Jaehoon Lee
- b Institute for Measurement, Methodology, Analysis and Policy , Texas Tech University
| | | | - K Allen Greiner
- a Department of Family Medicine Research Division , University of Kansas Medical Center
| | - Mugur Geana
- d William Allen White School of Journalism and Mass Communications , University of Kansas
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Sepulveda-Pacsi AL, Hiraldo G, Frederickson K. Cancer Worry Among Urban Dominican Women: A Qualitative Study. J Transcult Nurs 2016; 29:30-37. [PMID: 27758840 DOI: 10.1177/1043659616672062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Two thirds of respondents of a recent survey, primarily self-identified urban immigrant Dominican females, indicated that cancer was the health problem they worried about the most. PURPOSE The purpose of this qualitative study was to gain a greater understanding of the cancer worry experienced by Dominican women. DESIGN Giorgi's descriptive existential phenomenological framework and methodology guided the study. SETTING Washington Heights/Inwood community, New York City, New York. PARTICIPANTS Thirty-eight urban Dominican immigrant women were included in the study. METHOD Data were gathered using focus group interviews. All interviews were digitally recorded, transcribed verbatim from Spanish to English. The transcripts were analyzed using Giorgi's existential phenomenological data analysis process. FINDINGS Four essences unfolded: Cancer as Destiny, Faith, Influential Relationships, and Knowledge Acquisition. CONCLUSION New knowledge was generated on the contextual factors that influence cancer worry among a major Hispanic subgroup. Implications for nursing research and practice are described.
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Sanders M, Fiscella K, Veazie P, Dolan JG, Jerant A. Does patient time spent viewing computer-tailored colorectal cancer screening materials predict patient-reported discussion of screening with providers? HEALTH EDUCATION RESEARCH 2016; 31:555-562. [PMID: 27343254 PMCID: PMC4945861 DOI: 10.1093/her/cyw032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 05/18/2016] [Indexed: 06/06/2023]
Abstract
The main aim is to examine whether patients' viewing time on information about colorectal cancer (CRC) screening before a primary care physician (PCP) visit is associated with discussion of screening options during the visit. We analyzed data from a multi-center randomized controlled trial of a tailored interactive multimedia computer program (IMCP) to activate patients to undergo CRC screening, deployed in primary care offices immediately before a visit. We employed usage time information stored in the IMCP to examine the association of patient time spent using the program with patient-reported discussion of screening during the visit, adjusting for previous CRC screening recommendation and reading speed.On average, patients spent 33 minutes on the program. In adjusted analyses, 30 minutes spent using the program was associated with a 41% increase in the odds of the patient having a discussion with their PCP (1.04, 1.59, 95% CI). In a separate analysis of the tailoring modules; the modules encouraging adherence to the tailored screening recommendation and discussion with the patient's PCP yielded significant results. Other predictors of screening discussion included better self-reported physical health and increased patient activation. Time spent on the program predicted greater patient-physician discussion of screening during a linked visit.Usage time information gathered automatically by IMCPs offers promise for objectively assessing patient engagement around a topic and predicting likelihood of discussion between patients and their clinician.
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Affiliation(s)
- Mechelle Sanders
- Departments of Family Medicine and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin Fiscella
- Departments of Family Medicine and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Peter Veazie
- Department of Public Health Science, University of Rochester Medical Center, Rochester, NY, USA
| | - James G Dolan
- Department of Public Health Science, University of Rochester Medical Center, Rochester, NY, USA
| | - Anthony Jerant
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
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Cruz-Correa M, Cordero F, Betancourt JP, Diaz-Algorri Y, Lopez SM, Rivera M, Mosquera R, Carlo-Chevere V, Rodriguez-Quilichini S. Implementation and Outcomes of a Community-Based Educational Program for Colorectal Cancer Prevention in Hispanics. JOURNAL OF FAMILY MEDICINE AND DISEASE PREVENTION 2016; 2. [PMID: 30288455 DOI: 10.23937/2469-5793/1510042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives Colorectal cancer (CRC) is the 2nd most diagnosed cancer and leading cause of cancer death in Puerto Rico. However, CRC screening rates remain low. The aim of this study was to test the effectiveness of a Train-the-Trainers' (TTT) program to develop trainers capable of educating others within their communities about CRC prevention. Methods The TTT program consisted of didactics and seminars to capacitate participants to become trainers in CRC prevention. This project was evaluated using three components: (1) training workshops; (2) community educational sessions; and (3) the participant's experience as a trainer. Pre - and post-tests on CRC screening knowledge were given to TTT participants. Program effectiveness was determined by the pre- and post-tests, number of workshop participants completing a community educational session within three months of training and the number of community members reached. Results Among the 115 total participants, 97 participants took the pre- and post-test. There was a significant difference in the scores for the pre-test (M = 10.56, SD = 2.57) and the post-test (M = 11.43, SD = 1.83) given; t (96) = -4.68, p < 0.001. A total of 955 community members were reached. Participants from the community educational sessions (n = 680) evaluated the program. 77.7% of those participants expressed intent to undergo colonoscopy screening in the future. Conclusions TTT was effective in preparing trainers in CRC prevention. Participants increased their knowledge about CRC prevention and successfully reached members of their community. Utilization of community trainers is an effective alternative to increase CRC education and awareness in Hispanic communities, which may positively impact CRC screening rates in this population.
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Affiliation(s)
- Marcia Cruz-Correa
- University of Puerto Rico Comprehensive Cancer Center, USA.,University of Puerto Rico School of Medicine, USA.,Puerto Rico Colorectal Cancer Coalition, USA
| | | | | | | | - Sofia M Lopez
- University of Puerto Rico Comprehensive Cancer Center, USA
| | - Mirza Rivera
- University of Puerto Rico Comprehensive Cancer Center, USA.,Graduate School of Public Health, University of Puerto Rico, USA
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Woudstra AJ, Dekker E, Essink-Bot ML, Suurmond J. Knowledge, attitudes and beliefs regarding colorectal cancer screening among ethnic minority groups in the Netherlands - a qualitative study. Health Expect 2015; 19:1312-1323. [PMID: 26576015 PMCID: PMC5139054 DOI: 10.1111/hex.12428] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Research has shown that ethnic minority groups are less likely to participate in colorectal cancer (CRC) screening than the majority population and hence less likely to be diagnosed at an early stage when treatment is potentially more successful. OBJECTIVE To explore knowledge, attitudes and beliefs regarding CRC and CRC screening among ethnic minority groups in the Netherlands. DESIGN We conducted qualitative interviews with 30 first-generation immigrants born in Turkey, Morocco and Surinam. We based the topic guide on the health belief model. Framework analysis was used to analyse our data. RESULTS Although knowledge of CRC and CRC screening was limited, all respondents felt susceptible to CRC. CRC screening was perceived to mainly benefit those individuals with poor health and symptoms. Although most respondents had a positive attitude towards CRC screening, knowledge about its potential harms was limited and self-efficacy to participate was low. Adult children acted as important mediators in providing access to information. The language barrier and low literacy formed serious barriers to informed participation in CRC screening. CONCLUSION To ensure that all eligible individuals, including ethnic minority groups, have equal opportunities to informed participation in screening, targeted communication strategies should be developed, such as oral and visual channels, and face-to-face communication in the mother tongue. This will help ethnic minority groups to make an informed decision about participation in CRC screening.
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Affiliation(s)
- Anke J Woudstra
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marie-Louise Essink-Bot
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeanine Suurmond
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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12
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Rodríguez VM, Gyure ME, Corona R, Bodurtha JN, Bowen DJ, Quillin JM. What women think: cancer causal attributions in a diverse sample of women. J Psychosoc Oncol 2015; 33:48-65. [PMID: 25398057 DOI: 10.1080/07347332.2014.977419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Women hold diverse beliefs about cancer etiology, potentially affecting their use of cancer preventive behaviors. Research has primarily focused on cancer causal attributions survivors and participants from non-diverse backgrounds hold. Less is known about attributions held by women with and without a family history of cancer from a diverse community sample. Participants reported factors they believed cause cancer. Open-ended responses were coded and relations between the top causal attributions and key factors were explored. Findings suggest certain socio-cultural factors play a role in the causal attributions women make about cancer, which can, in turn, inform cancer awareness and prevention messages.
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Affiliation(s)
- Vivian M Rodríguez
- a Department of Psychiatry and Behavioral Sciences , Memorial Sloan Kettering Cancer Center , New York , NY , USA
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Carethers JM. Screening for colorectal cancer in African Americans: determinants and rationale for an earlier age to commence screening. Dig Dis Sci 2015; 60:711-21. [PMID: 25540085 PMCID: PMC4369177 DOI: 10.1007/s10620-014-3443-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/15/2014] [Indexed: 02/07/2023]
Abstract
Colorectal cancer (CRC) screening is a cost-effective approach to reduce morbidity, mortality, and prevalence of CRC in populations. Current recommendations for asymptomatic populations begin screening at age 50 years, after which ~95% of cancers occur. Determinants that modify timing and frequency for screening include: personal/family history of adenomas or CRC, age of onset of lesions, and presence or potential to harbor high-risk conditions like inflammatory bowel disease (IBD), familial adenomatous polyposis (FAP), or Lynch syndrome. Although race, like family history, is heritable, it has not engendered inclusion in systematic screening recommendations despite multiple studies demonstrating disparity in the incidence and mortality from CRC, and the potential for targeted screening to reduce disparity. African Americans, when compared to Caucasians, have lower CRC screening utilization, younger presentation for CRC, higher CRC prevalence at all ages, and higher proportion of CRCs before age 50 years (~11 vs. 5%); are less likely to transmit personal/family history of adenomas or CRC that may change screening age; show excess of high-risk proximal adenomas, matched with 7-15% excess right-sided CRCs that lack microsatellite instability; show higher frequencies of high-risk adenomas for every age decile; and demonstrate genetic biomarkers associated with metastasis. These epidemiological and biological parameters put African Americans at higher risk from CRC irrespective of socioeconomic issues, like IBD, FAP, and Lynch patients. Including race as a factor in national CRC screening guidelines and commencing screening at an age earlier than 50 years seems rational based on the natural history and aggressive behavior in this population.
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Affiliation(s)
- John M. Carethers
- Division of Gastroenterology, Department of Internal Medicine1, University of Michigan, Ann Arbor, MI
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