Abstract B107: Colorectal cancer (CRC) screening: What is discussed with patients in a federally qualified health center?
Authors: Katz Mira L. , King Justin , Eubanks Kathy , Paskett Electra D. 
Published: December 2010

Purpose: To assess the quality of CRC screening discussions based on elements of informed decision making (IDM).

Methods: Audio tapes of average-risk patients’ medical visits occurred as part of a patient-level CRC screening education intervention that activated patients to ask their providers for a CRC screening test. Audiotapes were coded by two independent trained reviewers for the presence of a CRC screening discussion. CRC screening discussions were coded for key elements of IDM. Fifteen percent of the audiotapes were randomly selected and coded by the reviewers twice to calculate inter- and intra-observer reliability.

Results: This study was part of a randomized controlled trial of two patient educational programs conducted among 269 average-risk patients and 8 providers at a federally qualified health center (FQHC). Patient characteristics included: 72% African American; 61% with annual household incomes of less than $20,000; 56% with no health insurance; 28% with less than a high school education; and 54% who read ≤8th grade level (10% ≤6th grade level). In addition, 84% of the patients reported that they preferred to have some level of input into the decision about what medical tests they undergo. Forty-five percent of the patients allowed their medical visit to be audio taped (106 visits were audio taped but 103 were reviewed because of tape recorder malfunction in 3 visits). Near the end of the study, one provider no longer allowed audio taping (n=34 patients) of the medical visits. The rate of patient agreement to be audio taped was a reflection of the different research assistants (range of acceptance by research assistants: 23% to 67%). Both reviewers documented that there was a CRC discussion in 50 of the 103 (48.5%) visits. The patient initiated the screening discussion in 39 (78%) of the 50 visits, however, four patients only mentioned it to the medical assistant who met with them prior to seeing the provider. Although CRC screening was mentioned in 50 visits, no discussion occurred in 14 of these visits. There was a low occurrence of IDM elements in the CRC screening discussions. The most common elements raised by providers were: the nature of the decision (e.g. need for screening because of age): (n=19); patient's understanding: (n=3) [assistants checked for understanding: (n=7)]; and patient test preference: (n=2). IDM elements raised by patients were: nature of the decision: (n=5); test preference: (n=4); understanding: (n=3); and uncertainties and alternatives (n=1). There was no mention of African Americans having higher CRC incidence and mortality rates in any of the visits. Two patients told the provider that by watching the video they realized that they had incorrectly completed the FOBT in past.

Conclusions: Although patients reported wanting some role in making decisions about medical tests they receive, elements of informed decision making were not consistently addressed in patients’ medical visits. This finding suggests that communication skills training for patients and providers about CRC screening is needed to reduce CRC disparities that exist among underserved populations.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B107.