Original Article
CME Article: Predictors of Nonadherence to Colorectal Cancer Screening among Hospitalized Women
Abstract
Objectives: Despite proven mortality benefit, disparities in colorectal cancer (CRC) screening utilization persist, especially among younger women, minorities, and low-income women, even those who are insured. The purpose of the present study is to evaluate and estimate the effects of sociodemographic and clinical variables associated with nonadherence to CRC screening among hospitalized women.Methods: A cross-sectional bedside survey was conducted to collect sociodemographic and clinical comorbidity data believed to affect CRC screening adherence of hospitalized women aged 50 to 75 years who were cancer free (except skin cancer) at enrollment. Logistic regression models were used to assess the association between these factors and nonadherence CRC screening.
Results: In total, 510 women were enrolled for participation in the study. After adjustment for sociodemographic and clinical predictors, only two variables were found to be independently associated with nonadherence to CRC screening: age younger than 60 years (odds ratio [OR] 2.62, 95% confidence interval [CI] 1.58–4.33) and nonadherence to breast cancer screening (OR 3.72, 95% CI 2.29–6.04). By contrast, hospitalized women at high risk for CRC were more likely to be compliant with CRC screening (OR 0.14, 95% CI 0.04–0.50).
Conclusions: Both younger age and behavior toward screening remain barriers to CRC screening. Hospitalization creates an environment where patients are in close proximity to healthcare resources, and strategies could be used to capitalize on this opportunity to counsel, educate, and motivate patients toward this screening that is necessary for health maintenance. Seizing on this opportunity may help improve CRC screening adherence.
Posted in: Colonic And Anorectal Disease8
This content is limited to qualifying members.
Existing members, please login first
If you have an existing account please login now to access this article or view purchase options.
Purchase only this article ($25)
Create a free account, then purchase this article to download or access it online for 24 hours.
Purchase an SMJ online subscription ($75)
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
Purchase a membership plan (fees vary)
Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.
References
1. American Cancer Society. Cancer Facts & Figures 2021. Atlanta: American Cancer Society; 2021.
2. Lin JS, Piper MA, Perdue LA, et al. Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2016;315:2576–2594.
3. Centers for Disease Control and Prevention. Vital signs: colorectal cancer screening test use—United States, 2012. MMWR Morb Mortal Wkly Rep 2013;62:881–888.
4. Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin 2014;64:104–117.
5. Siegel RL, Miller KD, Fedewa SA, et al. Colorectal cancer statistics, 2017. CA Cancer J Clin 2017;67:177–193.
6. Hall IJ, Tangka FKL, Sabatino SA, et al. Patterns and trends in cancer screening in the United States. Prev Chronic Dis 2018;15:E97.
7. Morelli V. An introduction to primary care in underserved populations: definitions, scope, and challenges. Prim Care 2017;44:1–9.
8. Zauber AG. The impact of screening on colorectal cancer mortality and incidence: has it really made a difference? Dig Dis Sci 2015;60:681–691.
9. Bretthauer M, Kaminski MF, Løberg M, et al. Population-based colonoscopy screening for colorectal cancer: a randomized clinical trial. JAMA Intern Med 2016;176:894–902.
10. Lieberman D, Ladabaum U, Cruz-Correa M, et al. Screening for colorectal cancer and evolving issues for physicians and patients: a review. JAMA 2016;316:2135–2145.
11. Seeff LC, Nadel MR, Klabunde CN, et al. Patterns and predictors of colorectal cancer test use in the adult U.S. population. Cancer 2004;100: 2093–2103.
12. Peterson SK, Vernon SW. A review of patient and physician adherence to colorectal cancer screening guidelines. Semin Colon Rectal Surg 2000;11:58–72.
13. Frederiksen B, Jørgensen T, Brasso K, et al. Socioeconomic position and participation in colorectal cancer screening. Br J Cancer 2010;103:1496–1501.
14. Wee CC, McCarthy EP, Phillips RS. Factors associated with colon cancer screening: the role of patient factors and physician counseling. Prev Med 2005;41:23–29.
15. Ko CW, Kreuter W, Baldwin LM. Persistent demographic differences in colorectal cancer screening utilization despite Medicare reimbursement. BMC Gastroenterol 2005;5:10.
16. So WK, Choi KC, Chan DN, et al. Colorectal cancer screening behaviour and associated factors among Chinese aged 50 and above in Hong Kong— a population-based survey. Eur J Oncol Nurs 2012;16:413–418.
17. US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Screening for colorectal cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2016;315:2564–2575.
18. Charlson ME, Pompei P, Ales KL, et al: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373.
19. Centers for Disease Control and Prevention. Colorectal cancer screening basic fact sheet. 2014. https://stacks.cdc.gov/view/cdc/42540.
20. Wools A, Dapper EA, de Leeuw JR. Colorectal cancer screening participation: a systematic review. Eur J Public Health 2016;26:158–168.
21. Meissner HI, Breen N, Klabunde CN, et al. Patterns of colorectal cancer screening uptake among men and women in the United States. Cancer Epidemiol Biomarkers Prev 2006;15:389–394.
22. Larsen IK, Grotmol T, Almendingen K, et al. Lifestyle characteristics among participants in a Norwegian colorectal cancer screening trial. Eur J Cancer Prev 2006;15:10–19.
23. Liang SY, Phillips KA, Nagamine M, et al. Rates and predictors of colorectal cancer screening. Prev Chronic Dis 2006;3:A117.
24. Griffith KA, McGuire DB, Royak-Schaler R, et al. Influence of family history and preventive health behaviors on colorectal cancer screening in African Americans. Cancer 2008;113:276–285.
25. Bostick RM, Sprafka JM, Virnig BA, et al. Predictors of cancer prevention attitudes and participation in cancer screening examinations. Prev Med 1994;23:816–826.
26. Shapiro JA, Seeff LC, Nadel MR. Colorectal cancer-screening tests and associated health behaviors. Am J Prev Med 2001;21:132–137.
27. Nawaz H, Via C, Shahrokni A, et al. Can the inpatient hospital setting be a golden opportunity to improve colon cancer screening rates in the United States? Health Promot Pract 2014;15:506–511.
28. Khaliq W, Visvanathan K, Landis R, et al. Breast cancer screening preferences among hospitalized women. J Womens Health (Larchmt) 2013;22:637–642.
29. Khaliq W, Landis R, Wright SM. Improving breast cancer screening adherence among hospitalized women. J Womens Health (Larchmt) 2017; 26:1094–1098.
30. Cosgrove DM, Fisher M, Gabow P, et al. Ten strategies to lower costs, improve qualities, and engage patients: the view from leading health CEOs. Health Aff 2013;32:321–327.
