Modeling the decision to undergo colorectal cancer screening: insights on patient preventive decision making.
ABSTRACT Little is known about how patients decide whether or not to undergo colorectal cancer screening. Although low screening rates evidence the outcome of these decisions, the processes patients use to balance benefits, risks, and costs with their own values and preferences are unclear. To increase screening rates, and ultimately save lives, it is important for providers to be aware of how patients make screening decisions.
The purpose of this study was to identify patterns of patient colorectal cancer screening decisions that might be supported by health care providers.
In this study, we focused on people from Central Kentucky--a region with historically low screening rates.
We interviewed patients using a semi-structured format. Three members of the research team independently analyzed each interview transcript for factors that influenced the decision, and a pictorial representation of each decision process, based on Kurt Lewin's theory of decision making, was constructed for each participant. The individual decision processes were compared with identify patterns.
Seventeen women and 13 men made up the sample. We discerned 7 decision patterns.
This research documents 7 patterns and identifies common driving and restraining forces.
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ABSTRACT: Women who carry BRCA1 or BRCA2 (BRCA1/2) gene mutations have up to an 88% lifetime risk of breast cancer and up to a 65% lifetime risk of ovarian cancer. Strategies to address these risks include cancer screening and risk-reducing surgery (i.e., mastectomy and salpingo-oophorectomy). We conducted a grounded theory study with 22 BRCA1/2 mutation-carrier women to understand how women make decisions about these risk-reducing strategies. Preserving the self was the overarching decision-making process evident in the participants' descriptions. This process was shaped by contextual conditions including the characteristics of health services, the nature of hereditary breast and ovarian cancer risk-reduction decisions, gendered roles, and the women's perceived proximity to cancer. The women engaged in five decision-making styles, and these were characterized by the use of specific decision-making approaches. These findings provide theoretical insights that could inform the provision of decisional support to BRCA1/2 carriers.Qualitative Health Research 10/2010; 21(4):502-19. · 2.19 Impact Factor
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ABSTRACT: Colorectal cancer (CRC) accounts for 9% of all new cancer cases worldwide and affects over 1 million people each year. Screening can reduce the mortality associated with the disease, yet participation rates are suboptimal. Compliers with CRC screening are less deprived; they have higher education than noncompliers and tend to be male, white and married. Likely reasons for nonparticipation encompass several 'modifiable' factors that could be targeted in interventions aimed at increasing participation rates. Successful intervention strategies include organizational changes, such as increasing access to fecal occult blood test (FOBT) kits, providing reminders to healthcare providers or users about screening opportunities, and educational strategies to improve awareness and attitudes towards CRC screening. Multifactor interventions that target more than one level of the screening process are likely to have larger effects. The biggest challenge for future research will be to reduce inequalities related to socio-economic position and ethnicity in the uptake of screening.Future Oncology 11/2009; 5(9):1371-88. · 2.61 Impact Factor
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ABSTRACT: Our aims were to determine clinical factors associated with colorectal cancer (CRC) screening and to evaluate the relative role of patient contact with physicians and the quality of these patient-physician interactions in affecting screening. Screening-eligible patients were identified from the Health Information National Trends Survey. Determinants of CRC screening were assessed with logistic regression, and a joint effects model that considered the frequency and quality of contact with physicians was developed to explore their influence on screening. There were 4,615 respondents of whom only 66% reported receiving CRC screening. Older age, personal history of non-CRC, family history of any cancer, high-income earners, individuals who visited their physicians ≥5 times per year, and those who rated the interactions with their physicians highly were more likely to be screened (all p < 0.05). The joint effects model revealed that quality rather than frequency of physician contact was a stronger predictor of CRC screening, but the odds of screening was highest for those who experienced both frequent and high-quality interactions with their physicians. Contact with physicians and the quality of this interaction are associated with screening behavior. Interventions to improve these provider-related factors may promote CRC screening.Cancer Causes and Control 12/2011; 22(12):1659-68. · 3.20 Impact Factor