scholarly journals Individualized Colorectal Cancer Screening Discussions Between Older Adults and Their Primary Care Providers: A Cross-Sectional Study

2018 ◽  
Vol 3 (1) ◽  
pp. 238146831876517
Author(s):  
Christine E. Kistler ◽  
Carol Golin ◽  
Anupama Sundaram ◽  
Carolyn Morris ◽  
Alexandra F. Dalton ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Older Adults ◽  
Primary Care ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Thematic Analysis ◽  
Patient Characteristics ◽  
Cross Sectional ◽  
Crc Screening ◽  
Screening Intentions

Introduction. Discussions of colorectal cancer (CRC) screening with older adults should be individualized to maximize appropriate screening. Our aim was to describe CRC screening discussions and explore their associations with patient characteristics and screening intentions. Methods. Cross-sectional survey of 422 primary care patients aged ≥70 years and eligible for CRC screening, including open-ended questions about CRC screening discussions. Primary outcomes were the frequency with which CRC screening discussions occurred, who had those discussions, and the domains that emerged from thematic analysis of participants’ brief reports of their discussions. We also examined the associations between 1) patient characteristics and whether a screening discussion occurred and 2) the domains discussed and what screening decisions were made. Results. Of 422 participants, 209 reported having discussions and 201 responded to open-ended questions about CRC discussions. In a regression analysis, several factors were associated with increased odds of having a discussion: participants’ preference to pursue screening (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.3, 3.9), good health (OR 2.9, 95% CI 1.7, 4.8), and receipt of the decision aid (OR 2.1, 95% CI 1.4, 3.2). Our thematic analysis identified five domains related to discussion content and three related to discussion process. The CRC screening–related information domain was the most commonly discussed content domain, and the timing/frequency domain was associated with increased odds of intent to pursue screening. Decision-making role, the most commonly discussed process domain, was associated with increased odds of the intent to forgo CRC screening. Conclusions and Relevance. CRC screening discussions varied by type of participant and content. Future work is needed to determine if interventions focused on specific domains alters the appropriateness of participants’ colorectal cancer screening intentions.

scholarly journals Development of a multilevel intervention to increase colorectal cancer screening in Appalachia

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Aaron J. Kruse-Diehr ◽  
Jill M. Oliveri ◽  
Robin C. Vanderpool ◽  
Mira L. Katz ◽  
Paul L. Reiter ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
The United States ◽  
Advisory Board ◽  
Community Advisory Board ◽  
Primary Care Clinics ◽  
Crc Screening ◽  
Multilevel Intervention

Abstract Background Colorectal cancer (CRC) screening rates are lower in Appalachian regions of the United States than in non-Appalachian regions. Given the availability of various screening modalities, there is critical need for culturally relevant interventions addressing multiple socioecological levels to reduce the regional CRC burden. In this report, we describe the development and baseline findings from year 1 of “Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) in Appalachia,” a 5-year, National Cancer Institute Cancer MoonshotSM-funded multilevel intervention (MLI) project to increase screening in Appalachian Kentucky and Ohio primary care clinics. Methods Project development was theory-driven and included the establishment of both an external Scientific Advisory Board and a Community Advisory Board to provide guidance in conducting formative activities in two Appalachian counties: one in Kentucky and one in Ohio. Activities included identifying and describing the study communities and primary care clinics, selecting appropriate evidence-based interventions (EBIs), and conducting a pilot test of MLI strategies addressing patient, provider, clinic, and community needs. Results Key informant interviews identified multiple barriers to CRC screening, including fear of screening, test results, and financial concerns (patient level); lack of time and competing priorities (provider level); lack of reminder or tracking systems and staff burden (clinic level); and cultural issues, societal norms, and transportation (community level). With this information, investigators then offered clinics a menu of EBIs and strategies to address barriers at each level. Clinics selected individually tailored MLIs, including improvement of patient education materials, provision of provider education (resulting in increased knowledge, p = .003), enhancement of electronic health record (EHR) systems and development of clinic screening protocols, and implementation of community CRC awareness events, all of which promoted stool-based screening (i.e., FIT or FIT-DNA). Variability among clinics, including differences in EHR systems, was the most salient barrier to EBI implementation, particularly in terms of tracking follow-up of positive screening results, whereas the development of clinic-wide screening protocols was found to promote fidelity to EBI components. Conclusions Lessons learned from year 1 included increased recognition of variability among the clinics and how they function, appreciation for clinic staff and provider workload, and development of strategies to utilize EHR systems. These findings necessitated a modification of study design for subsequent years. Trial registration Trial NCT04427527 is registered at https://clinicaltrials.gov and was registered on June 11, 2020.

scholarly journals Linking lab, program, and administrative data to provide comprehensive colorectal cancer screening status of patients to primary care providers in Calgary, Alberta

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Jessica Law ◽  
Jeannine Viczko ◽  
Robert Hilsden ◽  
Emily McKenzie ◽  
Mark Watt ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Primary Care Providers ◽  
Care Providers ◽  
Summary Report ◽  
Positive Screen ◽  
Crc Screening

IntroductionColorectal cancer (CRC) screening is associated with significant reductions in burden, mortality and cost. Primary care providers in Alberta do not have access to integrated CRC testing histories for patients. Providing this information will support CRC screening among patients at average and high risk, follow-up of abnormal tests, and surveillance. Objectives and ApproachCalgary Laboratory Services, Colon Cancer Screening Centre, Alberta Cancer Registry, and endoscopy data were linked to create a comprehensive CRC screening history at the patient level. Based on screening histories and the current Clinical Practice Guideline, an algorithm was created to determine CRC screening statuses with the aim of providing accurate screening rates when linked to primary care provider patient panels. Results from the linkage are designed to be incorporated into clinic and EMR workflow processes to support adherence to evidence-based screening recommendations at the point of care. ResultsA comprehensive assessment of screening status was determined by integrating Fecal Immunochemical Test (FIT) and colonoscopy data. Among a sample cohort, patients were identified as being due for screening with FIT, requiring follow-up for a positive FIT test, or requiring appropriate surveillance for a positive-screen or abnormal colonoscopy findings. A summary report, actionable list, and resources were developed to convey findings. The summary report displayed CRC screening rates for a provider’s panel. The actionable list provided CRC screening statuses for each patient aged 40 to 84 indicating patients due for screening with FIT, for follow-up of positive FIT, or for surveillance colonoscopy. The resources were developed to support quality improvement for colorectal cancer screening for patients. Conclusion/ImplicationsThe data linkages and algorithm provide comprehensive CRC screening, follow-up, and surveillance information that could support guideline-adherent screening, increase screening rates, reduce duplication or unnecessary testing, and provide primary care providers with timely and robust information to support clinical decisions for individuals inside and outside of the target screening population.

Primary Care Providers' Attitudes Towards Recommending Cancer Screening to Patients With Intellectual Disability: A Cross-Sectional Survey

Inclusion ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 185-193
Author(s):  
Genevieve Breau ◽  
Sally Thorne ◽  
Jennifer Baumbusch ◽  
T. Greg Hislop ◽  
Arminee Kazanjian
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Intellectual Disability ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Primary Care Providers ◽  
Survey Study ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract Individuals with intellectual disability (ID) obtain breast, cervical, and colorectal cancer screening at lower rates, relative to the general population. This cross-sectional survey study explored how primary care providers and trainees recommend cancer screening to patients with ID, using a standardized attitudes questionnaire and vignettes of fictional patients. In total, 106 primary care providers and trainees participated. Analyses revealed that participants' attitudes towards community inclusion predicted whether participants anticipated recommending breast and colorectal cancer screening to fictional patients. Further research is needed to explore these factors in decisions to recommend screening, and how these factors contribute to cancer screening disparities.

scholarly journals Cross-sectional adherence with the multi-target stool DNA test for colorectal cancer screening: Real-world data from a large cohort of older adults

2020 ◽  
pp. 096914132090375 ◽  
Author(s):  
Emily Weiser ◽  
Philip D Parks ◽  
Rebecca K Swartz ◽  
Jack Van Thomme ◽  
Philip T Lavin ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Older Adults ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Real World ◽  
Real World Data ◽  
Cross Sectional ◽  
Dna Test ◽  
Test Order ◽  
Stool Dna

Objective To determine cross-sectional adherence with the multi-target stool DNA test used for colorectal cancer screening in a large, fully insured Medicare population. Methods All patients aged 65–85 with a valid multi-target stool DNA test order from 1 September 2016 to 31 August 2017 identified from the Exact Sciences Laboratories (Madison, WI; sole-source national multi-target stool DNA test provider) database were evaluated for test adherence. Cross-sectional adherence, defined as multi-target stool DNA test completion within 365 days from order date, was analyzed overall and by time to adherence, as well as by available patient (age, sex, test order date, Medicare coverage type) and provider (specialty, year of first multi-target stool DNA test order, multi-target stool DNA test order frequency, and practice location) factors. Results Among 368,494 Medicare beneficiaries (64% female), overall cross-sectional adherence was 71%. Cumulative adherence rates increased more rapidly at 30 (44%) and 60 (65%) days, followed by more gradual increases at 90 (67%), 180 (70%), and 365 (71%) days. By provider specialty, primary care clinicians represented a higher percentage of multi-target stool DNA orders than gastroenterologists (88% vs. 6%), but had a lower associated patient adherence rate (71% vs. 78%). Conclusions In this large, national sample of Medicare insured older adults, nearly three-quarters of patients adhered with a multi-target stool DNA order for colorectal cancer screening. These real-world data should inform further clinical and population health applications, reimbursement model simulations, and guideline-endorsed colorectal cancer screening strategies adherence.

scholarly journals Factors Related to Non-participation in the Basque Country Colorectal Cancer Screening Programme

2020 ◽  
Vol 8 ◽  
Author(s):  
M. Solís-Ibinagagoitia ◽  
S. Unanue-Arza ◽  
M. Díaz-Seoane ◽  
L. Martínez-Indart ◽  
A. Lebeña-Maluf ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Primary Care ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Screening Programme ◽  
Basque Country ◽  
Access To Health Services ◽  
Cross Sectional ◽  
Cancer Screening Programme

Background: Despite the high participation rates in the Basque Country, colorectal cancer screening programme (Spain), there is still a part of the population that has never participated. Since it is essential to ensure equal access to health services, it is necessary to identify the determinants of health and socio-economic factors related to non-participation in the screening programme.Methods: Cross sectional descriptive study including all invited population in a complete round between 2015 and the first trimester of 2017. Health risk factors available in medical records and their control have been analyzed using univariate and multivariate analyses.Results: 515,388 people were invited at the programme with a 71.9% of fecal immunochemical test participation rate. Factors that increase the risk of non-participation are: being men (OR = 1.10, 95% CI 1.09–1.12); younger than 60 (OR = 1.18, 95% CI 1.17–1.20); smoker (OR = 1.20, 95% CI 1.18–1.22); hypertensive (OR = 1.14, 95% CI 1.12–1.15) and diabetic (OR = 1.40, 95% CI 1.36–1.43); having severe comorbidity (OR = 2.09, 95% CI 2.00–2.19) and very high deprivation (OR = 1.15, 95% CI 1.12–1.17), as well as making <6 appointments to Primary Care in 3 years (OR = 2.39, 95% CI 2.33–2.45). Still, the area under the curve (AUC) indicates that there are more factors related to non-participation.Conclusions: The participation in the Basque Country colorectal cancer-screening Programme is related to some risk factors controlled by Primary Care among others. Therefore, the involvement of these professionals could improve, not only the adherence to the CRC screening, but also other health styles and preventive interventions.

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