April 7-9, 2022 • Hyatt Regency • Lexington, KY
Communication Strategies to Promote Comprehensive Well-being
Communication Strategies to Promote Comprehensive Well-being
Abstract: Patient Experiences of Discrimination as a Predictor of Colorectal Cancer Screening: What Does It Mean?
BACKGROUND: Cancer prevention approaches such as age-based colorectal cancer (CRC) screening effectively reduce cancer burden and death, yet screening rates lag behind national benchmarks. Patient-provider communication (PPC) about CRC, specifically whether a provider recommends screening, is associated with screening completion. However, communication of these recommendations can be inconsistent to certain patient subgroups, contributing to low screening rates. Further, experiences of discrimination can influence PPC quality and participation in healthy behaviors such as cancer screening which requires patient consent and behavioral follow-through. To inform the development of cancer communication strategies to promote disease prevention, this study explored determinants of receiving a provider recommendation and CRC screening completion. METHODS: Between September-November 2020, US adults (N=918), who were over the age of 50 (64% female, Mage = 64, 88% White) were recruited through an online panel and outreach (e.g., flyers) within the local community to participate in an online survey about their CRC screening experiences. In addition to demographics (e.g., age, education), participants were asked to self-report on experiences of discrimination (e.g., treated with less courtesy or respect, being threatened or harassed), family cancer history, provider recommendation for CRC screening, and screening completion. Multivariable logistic regression models examined predictors of provider recommendation and screening completion. RESULTS: Among this sample of screening-eligible US adults, receiving a provider recommendation significantly influenced screening completion (OR: 10.0, CI: 6.6,15.0, p < .001). Experiences of discrimination did not affect receiving a recommendation; however, they were significantly associated with screening completion (OR: 1.4, CI: 1.1,1.9, p = .01). Further, older adults were more likely to receive a recommendation (OR: 1.0, CI: 1.0,1.1, p < .001), as were those with more education (OR: 1.7, CI: 1.2,2.3, p = .002), and a family history of cancer (OR: 2.0, CI: 1.5,2.8 p < .001). CONCLUSIONS: Although CRC screening is now recommended for all US adults aged 45-75, investments are needed to improve screening rates among patient subgroups. This study offers unique findings by suggesting that experiences of discrimination are positively associated with participation in healthy behavior and underscore that recommendations are not sufficient for screening completion. The heightened stress response resulting from discrimination may lead patients to screen for CRC as a response strategy independent of a recommendation. With a large number of White participants, these findings also suggest that discrimination based on factors other than race, such as age and gender, may influence screening decisions. Further, this study suggests differential access to provider recommendations for CRC screening. Communication strategies developed to promote equity in CRC screening should focus on improving recommendation consistency and eliminating the multilevel sources of discrimination, especially for younger and less educated patients who are newly eligible and more likely to lack knowledge about screening. Future research is needed to explore these relationships among adults aged 45-49 years made eligible for screening by the May 2021 shift in guidelines.