Colorectal Cancer Screening Communication and Completion Among Black and Hispanic Primary Care Patients: A Cross-Sectional Study.

Abstract

Colorectal cancer (CRC) screening is recommended for all adults aged 45-75 years. However, CRC screening and outcome disparities exist by race and ethnicity. To describe self-reported CRC screening communication and completion among Black and Hispanic patients and examine the association between patient demographics, distrust, patient-centered communication (PCC), and health literacy with CRC screening history. Cross-sectional study examining differences in CRC screening communication and completion across participant characteristics using bivariate analyses (chi-square and trend tests) and multivariable logistic regression to identify factors associated with CRC screening history. Black and Hispanic patients with a recent visit at seven primary care clinics in Washington, DC, and Maryland were identified from the electronic medical record. A 10-min survey assessed CRC screening. Measures included demographics (age, race, sex, education, insurance), health literacy, PCC scale (1-4; 4, always), and distrust in the healthcare system (1-4; higher, greater distrust). Of 913 patients we contacted, 278 (30%) agreed to participate, 204 (70%) completed the survey, and 157 (77%) were non-Hispanic Black. Respondents reported that CRC screening was never discussed (13.7%), recommended but not completed (36.3%), they were previously screened but not up to date (15.2%), and up to date (34.8%). In bivariate analyses, older age (p = 0.01), higher health literacy (p = 0.01), and PCC (p = 0.007) were associated with greater chances of CRC screening. Significant differences were also found by race (p < 0.001) and preferred language (p < 0.001). In the multivariable model, older age (OR = 1.08; p < 0.001), non-Hispanic Black (OR = 2.27; p = 0.003), higher health literacy (OR = 1.30; p = 0.04), and PCC (OR = 1.48; p = 0.02) were associated with CRC screening history. Differences in self-reported screening history were documented by age, race, health literacy, and PCC. Tailoring outreach to younger, Hispanic, and lower health literate populations and improving PCC may improve CRC screening uptake and guideline-adherence.