Abstract B92: Patient activation increases colorectal cancer screening rates among low-income minority patients
Authors: Katz Mira L. , Broder-Oldach Benjamin , Fisher James L. , Fleming Kelly , Paskett Electra D. 
Published: June 2012

Purpose: To determine if colorectal cancer (CRC) screening information plus activating patients to ask for a CRC screening test improves CRC screening rates compared to CRC screening information only using an individual-level randomized controlled trial at one federally qualified health center (FQHC).

Methods: Patients in the intervention arm watched a video and received a brochure both focusing on CRC screening information plus communication skills training to activate them to ask for a CRC screening test. Patients in the information only arm watched a video about CRC screening. If patients agreed, their medical visits were audio taped and reviewed for informed decision making (IDM) elements. CRC screening completion was determined by medical record review (MRR) at 2 months post medical visit. Logistic regression was used to determine whether or not patients in the intervention arm were more likely to discuss CRC screening with their doctor, have a CRC screening test ordered, and complete CRC screening, after adjustment for confounding factors (e.g. demographic characteristics, co-morbidities, CRC knowledge, beliefs and attitudes). A kappa statistic was calculated for agreement of the coding of the IDM elements by the two reviewers.

Results: Patients (n=270) randomized were predominantly African American (72%), female (64%), had annual household incomes &lt;$20,000 (61%), less than a high school education (28%), no health insurance (57%), and limited health literacy skills (54%). In adjusted analyses, more patients randomized to the intervention arm completed a CRC screening test by MRR compared to patients in the CRC screening information only arm (19.6% vs. 9.9%; OR=2.35, 95%CI: 1.14, 5.56; p=0.02), were more likely to report discussing CRC screening with their provider (54.4% vs. 27.5%, OR=3.29, 95%CI: 1.95, 5.56; p&lt;0.001) and had more CRC screening tests ordered (39.1% vs. 17.6%; OR=3.40, 95%CI: 1.88, 6.15; p&lt;0.001). Among patients who had their medical visit audio taped (n=100), 48 of those visits included a CRC screening discussion. Among the 48 visits when a CRC screening discussion took place, there was good agreement between two reviewers for coding of IDM elements (kappa=.877). The following informed decision making elements were discussed: assessment of patient understanding (33%); alternatives to screening (27%); pros and cons of alternatives (10%), patient's role in decision making (10%); patient's desire for input from trusted others (10%), asking patient preference (6%), and no discussion included the uncertainties with the decision.

Conclusion: Patient activation improved CRC screening rates among low-income minority patients at a FQHC. Patientprovider CRC screening discussions, however, rarely include elements of informed decision making. Additional innovative strategies are needed to motivate the healthcare team to recommend tests to patients, as well as to assist patients to complete an ordered CRC screening test.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B92.