Colorectal cancer screening among underserved minority population: discrepancy between physicians' recommended, scheduled, and completed tests

Abstract

Objective: This study examines the correlates of: (1) health care provider recommendation of CRC testing; (2) provider scheduling for recommended CRC testing using sigmoidoscopy, colonoscopy, or double-contrast barium enema; and (3) adherence to CRC scheduling among underserved minority populations.

Methods: Medical record and schedule logbook reviews and interviewer-administered surveys.

Setting: Large urban safety-net, outpatient primary care setting in Los Angeles County.

Participants: 306 African-American and Latino patients aged 50 years and older.

Results: A vast majority of minority patients do not receive standard CRC testing in urban safety-net primary care settings. Of those patients who were actually scheduled for sigmoidoscopy or colonoscopy, almost half completed the procedure. Completing CRC testing was associated with marital status, co-morbid chronic physical conditions, number of risk factors for colorectal cancer, and lower perceived barriers to CRC testing.

Conclusion: Effective interventions to reduce CRC mortality among underserved minority populations require an integrated approach that engages patients, providers, and health care systems.

Practice implications: Designing interventions that (1) increase physician-patient communications for removing patients' perceived barriers for CRC testing and (2) promote a non-physician-based navigator system that reinforces physicians' recommendation are strongly recommended.