Survey of ColoRectal Cancer Education and Environment Needs
Condition: Colorectal Neoplasms; Mass Screening; Patient Compliance
MeSH terms: Colorectal Neoplasms
Study type: Observational

Summary: 
      Despite strong evidence for the effectiveness and cost-effectiveness of a variety of
      colorectal cancer (CRC) screening methods for reducing CRC mortality, current CRC screening
      rates fall far below the levels needed to significantly impact CRC mortality. Unfortunately,
      however, the existing literature on patient CRC screening behavior does not yet provide a
      sufficient evidence base for making sound recommendations regarding how to most effectively
      improve upon these rates in the VA. This study will inform future CRC screening promotion
      efforts and make important scientific contributions to existing literature by: (a)
      delineating the relative contribution of patient cognitive, environmental and background
      factors to CRC screening behavior using a multi-level, theory driven analysis approach on a
      nationally representative sample, and (b) identifying the determinants of variation in CRC
      screening behavior across vulnerable population subgroups.
    

Detailed description: 
      Background / Rationale:

      Despite strong evidence for the effectiveness and cost-effectiveness of a variety of
      colorectal cancer (CRC) screening methods for reducing CRC mortality, current CRC screening
      rates fall far below the levels needed to significantly impact CRC mortality. Unfortunately,
      however, the existing literature on patient CRC screening behavior does not yet provide a
      sufficient evidence base for making sound recommendations regarding how to most effectively
      improve upon these rates in the VA. This study will inform future CRC screening promotion
      efforts and make important scientific contributions to existing literature by: (a)
      delineating the relative contribution of patient cognitive, environmental and background
      factors to CRC screening behavior using a multi-level, theory driven analysis approach on a
      nationally representative sample, and (b) identifying the determinants of variation in CRC
      screening behavior across vulnerable population subgroups.

      Objective(s):

      The overall goal of this study was to address significant gaps in the existing evidence base
      in order to inform the development of effective patient-directed interventions to increase
      CRC screening among veterans age 50 and older. This was accomplished by using data collected
      from a mailed patient survey and theory-based analysis approaches to uncover key barriers to
      screening adherence and to identify fruitful intervention approaches for modifying them. The
      specific primary objectives of this study were to: (1) Estimate the relative effect of
      patient cognitive (knowledge, attitudes, and self-efficacy), environmental (social network
      and medical care characteristics), and background (demographics, health status, prior
      screening experiences) factors on CRC screening behavior; (2) Identify factors that
      contribute to any disparities in CRC screening behavior by race/ethnicity or other patient
      characteristics; (3) Identify from these analyses: (a) priority population subgroups to
      target in future interventions (i.e., those at the greatest risk of failing to be screened),
      and (b) priority factors to target in future interventions (i.e., those that are not only
      strongly associated with CRC screening but also prevalent in the target population and
      amenable to intervention, as well as those that are most likely to ameliorate race and other
      disparities). Secondary objectives included: (1) assessing patient values and preferences
      regarding the various CRC screening modality options, (2) estimating stage of readiness to
      adopt CRC screening in the study population, and (3) validating measures of CRC knowledge and
      self-reported screening behavior.

      Methods:

      This is an observational study based on a nationally representative, cross-sectional mailed
      survey of 3,744 male and female veterans age 50-75 who have had one or more primary care
      visits at a VA Medical facility in the past two years. The survey sample was drawn using a
      two stage procedure where we first randomly select 24 VA facilities stratified by size and
      racial mix and then select a simple random sample of 156 eligible veterans from each sampled
      facility. Prior to the national survey, a pilot survey was conducted with the purpose of
      refining both the study instruments and the study protocol. The sample consisted of 900
      randomly selected veterans from the Minneapolis VA Medical Center meeting the same sampling
      eligibility criteria used for the national mailed survey. The mailed patient questionnaire,
      made up primarily of previously validated measures, included measures of self-reported CRC
      screening behavior; patient demographic, health, social network and medical care
      characteristics; CRC screening knowledge, attitudes, social norms and self-efficacy; and
      attitudes toward medical care. Additional measures of organizational-level CRC screening
      practices from a recently completed VA facility survey were linked to the patient survey.The
      primary outcome is whether the patient is currently compliant with CRC screening guidelines
      (i.e., received either a fecal occult blood test in the past year, a sigmoidoscopy or double
      contrast barium enema in the past five years, or a colonoscopy in the past ten years). The
      primary analyses tested (using logistic regression and a multi-level, structural equation
      modeling approach) specific hypotheses about the association between this measure and patient
      background, cognitive and environmental factors and their interactions. Additional analyses
      conducted include a multinomial logistic regression to assess patient screening mode
      preferences and their determinants, and logistic and multinomial logistics regression
      analyses with interactions to determine whether and why any observed patterns in CRC
      screening behavior vary by race.

      Status:

      Completed
    

Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Primary care patients
      
Keywords: health surveys; questionnaires