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Predictors of colorectal cancer screening from patients enrolled in a managed care health plan†
Article first published online: 11 FEB 2008
Copyright © 2008 American Cancer Society
Volume 112, Issue 6, pages 1230–1238, 15 March 2008
How to Cite
Farmer, M. M., Bastani, R., Kwan, L., Belman, M. and Ganz, P. A. (2008), Predictors of colorectal cancer screening from patients enrolled in a managed care health plan. Cancer, 112: 1230–1238. doi: 10.1002/cncr.23290
Results from the first patient survey (2000) were presented at the annual meeting of the American Society of Preventive Oncology in 2001.
- Issue published online: 3 MAR 2008
- Article first published online: 11 FEB 2008
- Manuscript Accepted: 12 DEC 2007
- Manuscript Revised: 1 OCT 2007
- Manuscript Received: 3 MAY 2007
- National Institutes of Health/National Cancer Institute. Grant Number: R01 CA75544
- American Cancer Society Clinical Research Professorship
- patient survey;
- colorectal cancer screening;
- provider influence;
- patient barriers;
- managed care
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.
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.
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]).
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.