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Understanding Those Who Do and Do Not Plan to Get Colorectal Cancer (CRC) Screening. Costanza ME, White MJ, Stark JR, Stoddard AM, Avrunin JS, Luckmann R, and Clemow L University of Massachusetts Medical School Worcester, MA. Facts about CRC.
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Understanding Those Who Do and Do Not Plan to Get Colorectal Cancer (CRC) Screening Costanza ME, White MJ, Stark JR, Stoddard AM, Avrunin JS, Luckmann R, and Clemow L University of Massachusetts Medical School Worcester, MA
Facts about CRC • 2nd leading cause of cancer-specific deaths for men and women in the U.S. • 57,000 CRC deaths in 2003
Facts about CRC Screening • CRC screening reduced mortality by > 30% • < 50% of U.S. men and women over age 50 are current with screening guidelines • CRC screening recommendations are more complex than those for other cancers (e.g., breast, cervical)
ACS Preferred CRC Screening Guidelines(Beginning at age 50 for those at average risk) • Annual fecal occult blood test (FOBT) and sigmoidoscopy every 5 years • Colonoscopy every 10 years • Double-contrast barium enema every 5-10 years
Factors that Predict Adherence to the Guidelines • Basic knowledge about CRC screening • Individual risk • Lack of barriers to screening (i.e. embarrassment, fear of pain or abnormal results) • Intention to be screened – useful for tailoring interventions
Methods • Baseline mailed survey for a RCT of telephone counseling to increase CRC screening • Theoretical Framework – Weinstein’s Precaution Adoption Process Model (PAPM), a stage-based model of health behavior • Study Participants • 2,934 male & female patients from 37 primary care practices • 50-75 years old • Had visited their PCP during the past 2 years
Methods • Survey Measures • CRC screening history and screening intention • PAPM stage • Pros and Cons • Perceived vulnerability and worry • Sociodemographic and other characteristics • Data Analysis • Frequency distributions, cross classifications & logistic regression • Bivariate & multivariate associations – to develop a main effects model
Factors Associated with Intention to Get CRC Screening p=<.0001
Factors Associated with Intention to Get CRC Screening p=<.0001
Factors Associated with Intention to Get CRC Screening p=<.0001
Factors Associated with Intention to Get CRC Screening p=<.0001
Factors Associated with Intention to Get CRC Screening(Mean)
Multivariable Logistic Regression(Odds Ratio, overall p-Value)
Discussion • The study sample is highly educated and not very diverse • Men and women are evenly distributed by stage • MD recommendation is powerful in motivating patients to action
Discussion • Increasing positive trends were seen in • Perceived vulnerability: increases at least 10-fold between each stage closer to action • Pros & Cons: score increases significantly from unaware, unengaged or relapsed group to action/maintenance indicating a growing positive perception of CRC screening
Discussion • Implications for an intervention to accelerate the adoption of CRC screening • Those current with screening (36%) and those who intend to be screened (26%) may require only a postcard reminder • Those not intending to get screened may benefit from an intervention tailored to PAPM stage
Discussion • A tailored intervention could focus on • Increasing their knowledge about CRC & CRC screening • Addressing their barriers & cons to screening • Encouraging them to get screened using motivational interviewing
Discussion Public Health Implications • Those who are unaware, unengaged, undecided or who have relapsed or decided not to be screened represent a significant number of people between 50-75 years of age in the U.S. population • Accelerating CRC screening adoption will reduce mortality & morbidity from this disease