Predictors of colorectal cancer screening from patients enrolled in a managed care health plan

Authors

  • Melissa M. Farmer PhD,

    Corresponding author
    1. Veterans Affairs, Greater Los Angeles Health Services Research and Development Center of Excellence for the Study of Healthcare Provider Behavior, Sepulveda, California
    2. Department of Health Services, School of Public Health, University of California at Los Angeles, Los Angeles, California
    • Veterans Affairs GLA Healthcare System, 16111 Plummer Street, Sepulveda, CA 91343-2036
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    • Fax: (818) 895-5838

    • Dr. Farmer is currently funded by a Merit Review Entry Program career development award from the Veterans Affairs Health Services Research and Development program.

  • Roshan Bastani PhD,

    1. Department of Health Services, School of Public Health, University of California at Los Angeles, Los Angeles, California
    2. Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California
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  • Lorna Kwan MPH,

    1. Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California
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  • Michael Belman MD, MPH,

    1. Clinical Quality, Blue Cross of California, Woodland Hills, California
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    • Dr. Belman owns stock in Wellpoint, the parent company of Blue Cross.

  • Patricia A. Ganz MD

    1. Department of Health Services, School of Public Health, University of California at Los Angeles, Los Angeles, California
    2. Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California
    3. Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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  • Results from the first patient survey (2000) were presented at the annual meeting of the American Society of Preventive Oncology in 2001.

Abstract

BACKGROUND

Despite the growing recognition of the importance of colorectal cancer (CRC) screening in reducing cancer mortality, national screening rates are low, indicating a critical need to understand the barriers and remedies for underutilization of CRC screening tests.

METHODS

Using results from independent cross-sectional telephone surveys with patients aged ≥50 years performed before (2000; n = 498) and after (2003; n = 482) a quality improvement intervention for CRC screening within a large managed care health plan, the trends and predictors of CRC screening with fecal occult blood test (FOBT) and/or endoscopy (flexible sigmoidoscopy/colonoscopy) were examined from a patient perspective.

RESULTS

In 2000, patient reported screening rates within guidelines were 38% for any test, 23% for endoscopy, and 22% for FOBT. In 2003, screening rates increased to 50% for any test, 39% for endoscopy, and 24% for FOBT. Having discussed CRC with a doctor significantly increased the odds of being screened (FOBT: odds ratio [OR], 2.09 [95% confidence interval (95% CI), 1.47–2.96]; endoscopy: OR, 2.33 [95% CI, 1.67–3.26]; and any test: OR, 2.86 [95% CI, 2.06–3.96]), and reporting barriers to CRC in general decreased the odds of being screened (FOBT: OR, 0.76 [95% CI, 0.60–0.95]; endoscopy: OR, 0.74 [95% CI, 0.60–0.92]; and any test: OR, 0.66 [95% CI, 0.54–0.80]).

CONCLUSIONS

Although screening rates increased over the 3-year period, evidence was found of ongoing underutilization of CRC screening. The 2 strongest determinants of obtaining CRC screening were provider influence and patient barriers related to CRC screening in general, pointing to the need for multilevel interventions that target both the provider and patient. Cancer 2008. © 2008 American Cancer Society.

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