Monitoring of Colorectal Cancer Screening Adherence Among African American Patients of North Florida Community Health Centers.

Abstract

In the United States, colorectal cancer (CRC) mortality rates are higher in African Americans compared to non-Hispanic whites, partly due to advanced stage cancer diagnosis. Timely CRC screening helps to increase CRC early detection and survival in this population. The objective of this monitoring study was to survey African American patients of Community Health Centers (CHC) in north Florida and to monitor CRC screening adherence (either stool-based or colonoscopy) after they had completed a clinical trial testing a screening education intervention. Seventy-nine African American patients who were between the ages of 45 and 64 years old at the time of initial trial recruitment completed a 24-month follow-up survey, and 44% reported stool-based CRC screening in the last year. Results from the general estimating equations (GEE) model found there was a statistically significant difference in CRC screening adherence by study arm at 24 months where the intervention group was less likely to be up to date than the usual care control (OR = 0.60, 95% CI 0.43-0.83). Married or partnered participants (OR = 1.52, 95% CI 1.31-1.77) and employed participants (OR = 1.34, 95% CI 1.17-1.53) were more likely to be adherent to screening, but female participants were less likely to be adherent (OR = 0.76, 95% CI 0.70-0.82). Participants with higher mistrust in doctors were less likely to have completed screening (OR = 0.93, 95% CI 0.88-0.99). The findings suggest the importance of screening outreach to unmarried, unemployed, female African Americans. The results of this monitoring study indicate one-on-one cancer education with a community health advisor and education on the availability and functionality of electronic patient portals have potential for increasing adherence to recommended CRC screening. The study has implications for measuring CRC screening adherence in community settings.