Systematic Review: Enhancing the Use and Quality of Colorectal Cancer Screening
ABSTRACT National guideline groups recommend screening and discussion of screening options for persons at average risk for colorectal cancer (CRC). However, emerging evidence suggests that CRC screening is simultaneously underused, overused, and misused and that adequate patient-provider discussions about screening are infrequent.
To summarize evidence on factors that influence CRC screening and strategies that increase the appropriate use and quality of CRC screening and CRC screening discussions.
MEDLINE, the Cochrane Library, and the Cochrane Central Register of Controlled Trials were searched for English-language publications describing studies conducted in the United States from January 1998 through September 2009.
Two reviewers independently selected studies that addressed the study questions and met eligibility criteria.
Information on study design, setting, intervention, outcomes, and quality were extracted by one reviewer and double-checked by another. Reviewers assigned a strength-of-evidence grade for intervention categories by using criteria plus a consensus process.
Reviewers found evidence of simultaneous underuse, overuse, and misuse of CRC screening as well as inadequate clinical discussions about CRC screening. Several patient-level factors were independently associated with lower screening rates, including having low income or less education, being uninsured, being Hispanic or Asian, being less acculturated into the United States, or having limited access to care. Evidence that interventions that included patient reminders or one-on-one interactions (that is, between patients and nonphysician clinic staff), eliminated structural barriers (for example, simplifying access to fecal occult blood test cards), or made system-level changes (for example, using systematic screening as opposed to opportunistic screening) were effective in enhancing use of CRC screening was strong. Evidence on how best to enhance discussions about CRC screening options is limited. No studies focused on reducing overuse, and very few focused on misuse.
Reporting and publication bias may have affected our findings. The independent effect of individual elements of multicomponent interventions was often uncertain.
Although CRC screening is underused overall, important problems of overuse and misuse also exist. System- and policy-level interventions that target vulnerable populations are needed to reduce underuse. Interventions aimed at reducing barriers by making the screening process easier are likely to be effective. Studies aimed at reducing overuse and misuse and at enhancing the quality and frequency of discussions about CRC screening options are needed.
Agency for Healthcare Research and Quality.
- SourceAvailable from: Alexandre Pascual[Show abstract] [Hide abstract]
ABSTRACT: Introduction. – While high participation rates ensure the cost-effectiveness of colorectal cancer screening programs, it is well known that postal requests do not achieve acceptable levels of participation. Objective. – This randomized controlled study aimed to testthe impact ofindividualized phone counseling to prompt people aged 50 to 74 to take a colorectal cancer test. Method. – Two phone strategies were compared. The first involved computer-aided individualized counseling while the second was based on motivational interviewing. A total of 49,972 people were randomly assigned to a control group (CG) and to the individualized counseling (IC) and motivational interviewing (MI) telephone groups. Results. – A simple call doubled the participation rate per protocol (19.2% > 9.2%; p < .001; r = .131; OR = 2.374), and tripled it when the interview was conducted (30.4% > 9.2%; p < .001; r = .219; OR = 4.321). In an intention-to-treat analysis, the benefit of calling by phone remained even higher than postal requests (10% > 9.2%; p < .01; r = .014; OR = 1.103). However, there was no impact of the type of interview on participation rates. Conclusion. – The results are discussed for future researchRevue Européenne de Psychologie Appliquée 05/2015; 65(3):133-142. DOI:10.1016/j.erap.2015.04.002 · 0.52 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Colorectal cancer screening has been widely promoted in the United States. We investigated the association between reported exposure to screening information during the past year and screening participation and knowledge. Data from the 2012 HealthStyles Fall survey of U.S. adults were examined using adjusted logistic regression to examine the frequency of exposure to screening information as a predictor of screening participation and knowledge; analyses were limited to participants aged ≥50 years with no history of colorectal cancer or polyps (N=1,714). Nearly half of participants (44.9%) reported exposure to colorectal cancer screening information during the previous year. The most common sources of screening information were news reports, advertisements, and health care providers. Screening participation and knowledge consistently increased with the reported frequency of exposure to screening information, and these associations generally persisted when demographic variables were controlled. Compared with unexposed participants, significant gains in screening participation were associated with exposure to screening information 2-3 times (Adj. OR= 1.84, p=0.001), 4-9 times (Adj. OR= 2.00, p=0.001), and ≥10 times (Adj. OR= 3.03, p<0.001) in the adjusted model. Increasing public exposure to screening promotion messages may augment screening participation and knowledge.Preventive Medicine 12/2013; 60. DOI:10.1016/j.ypmed.2013.12.001 · 2.93 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE. : To determine whether racial/ethnic disparities in colonoscopy use vary by physician availability. DATA SOURCE. : We used 100 percent Texas Medicare claims data for 2003-2007. STUDY DESIGN. : We identified beneficiaries aged 66-79 in 2007, examined racial/ethnic differences in colonoscopy use from 2003 to 2007, and estimated the percentage of white, black, and Hispanic beneficiaries who underwent colonoscopy by level of physician availability and area income. PRINCIPAL FINDINGS. : For the 974,879 beneficiaries, colonoscopy use was higher in whites (40.7 percent) compared to blacks (35.0 percent) and Hispanics (28.7 percent, p< .001). For whites, increasing availability of colonoscopists and primary care physicians (PCPs) was associated with higher colonoscopy use. For blacks and Hispanics, colonoscopy use was unchanged or decreased with increases in colonoscopist and PCP availability. In multilevel models, the odds of colonoscopy were 20 percent lower for blacks (OR 0.80, 95 percent CI 0.79-0.82) and 32 percent lower for Hispanics (OR 0.68, 95 percent CI 0.66-0.69) compared to whites; adjusting for availability of colonoscopists or PCPs did not attenuate racial/ethnic disparities. We found greater racial/ethnic disparities in areas with greater colonoscopist and PCP availability. CONCLUSIONS. : Greater area availability of colonoscopists and PCPs is associated with increased use of colonoscopy in whites but decreased use in minorities, resulting in larger racial/ethnic disparities.Health Services Research 12/2011; 47(3 Pt 1):1137-57. DOI:10.1111/j.1475-6773.2011.01355.x · 2.49 Impact Factor