Research ArticleOriginal Research

Physician Recommendation and Patient Adherence for Colorectal Cancer Screening

Shawna V. Hudson, Jeanne M. Ferrante, Pamela Ohman-Strickland, Karissa A. Hahn, Eric K. Shaw, Jennifer Hemler and Benjamin F. Crabtree
The Journal of the American Board of Family Medicine November 2012, 25 (6) 782-791; DOI: https://doi.org/10.3122/jabfm.2012.06.110254

Article Figures & Data

Tables

  • Table 1. Characteristics of the Study Sample*
    CharacteristicsTotal NPercent
    Total sample975100.0
    Sex
        Male38039.0
        Female59561.0
    Age
        50–64 years62764.3
        ≥65 years34835.7
    Marital status
        Married61162.7
        Not married36437.3
    Education level
        Less than college58660.1
        College degree or graduate school38939.9
    Race
        White69471.2
        Black17718.2
        Hispanic616.3
        Other434.4
    Smoking status
        Nonsmoker86688.8
        Current smoker10911.9
    Family history of colorectal cancer
        Positive family history868.8
        Negative family history88991.2
    Insurance
        Medicare33033.9
        Medicaid545.5
        Private50351.6
        Other or none889.0

    • ↵* We recruited 1437 patients; however, patients who were missing data for any one of these characteristics or who reported a history of colorectal cancer or colorectal problems were removed from the analysis, resulting in a working sample size of 975.

  • Table 2. Receipt of and Adherence to Physician Recommendations for Colorectal Cancer Screening: Bivariate Results
    Study PopulationReceived Physician RecommendationsAdherence to Physician Recommendations
    All Patients n = 975 (100%)Recommended Patients n = 799 (82%)
    VariableNNo. (%) Screened or RecommendedBivariate P ValueNNo. (%) ScreenedBivariate P Value
    Sex.013.442
        Male380326 (85.8)326239 (73.3)
        Female59547. (79.5)473335 (70.8)
    Age.624<.0001
        50–64 years627511 (84.1)511337 (65.9)
        ≥65 years348288 (82.8)288237 (82.3)
    Marital status.022.0002
        Married611514 (84.1)514392 (76.3)
        Unmarried364285 (78.3)285182 (63.9)
    Education level.003.064
        Less than college586463 (79.0)463321 (69.3)
        College or graduate school389336 (86.4)336253 (75.3)
    Race.183.477
        Black177140 (79.1)14097 (69.3)
        Hispanic6147 (77.1)4738 (80.9)
        Other4332 (74.4)3222 (68.8)
        White694580 (83.6)580417 (71.9)
    Smoking status.001<.0001
        Nonsmoker866722 (83.4)722539 (74.7)
        Smoker10977 (70.6)7735 (45.5)
    Family history of colorectal cancer.459.074
        No family history889726 (81.7)726515 (70.9)
        Family history8673 (84.9)7359 (80.8)
    Insurance.025<.0001
        Medicare330267 (80.9)267218 (81.7)
        Medicaid5443 (79.6)4321 (48.8)
        Private503426 (84.7)426290 (68.1)
        Other or none8863 (71.6)6345 (71.4)
    Body mass index.463.024
        Normal323265 (82.0)265202 (76.2)
        Overweight370297 (80.3)297197 (66.3)
        Obese282237 (84.0)237175 (73.8)
    Length of time as a patient.745.628
        <5 years526433 (82.3)433308 (71.1)
        ≥5 years449366 (81.5)366266 (72.7)
    Number of visits in past 2 years.523.817
        <8 visits657542 (82.5)542388 (71.6)
        ≥8 visits318257 (80.8)257186 (72.4)
    Comorbidity score.530.711
        09377 (82.8)7758 (75.3)
        1244193 (79.1)193133 (68.9)
        2352295 (83.8)295213 (72.2)
        3286234 (81.8)234170 (72.7)
  • Table 3. Receipt of and Adherence to Physician Recommendations for Colorectal Cancer Screening: Multivariate Results Using Backward Stepwise Regression Including Adjusted OR*
    Study PopulationReceived Physician RecommendationsAdherence to Physician Recommendations
    All Patients (n = 975)Recommended Patients (n=799)
    VariableMultivariate† OR (95% CI)Multivariate† OR (95% CI)
    Wald P ValueWald P Value
    Sex1.465—
    (1 df)(1.013–2.117)
        Male versus female.0425
    Age—0.397
    (1 df)(0.270–0.585)
        50–64 years versus ≥65 years<.0001
    Marital status—1.972
    (1 df)(1.603–2.421)
        Married versus unmarried<.0001
    Education level0.6580.682
    (1 df)(0.450–0.963)(0.477–0.976)
        Less than college versus college or graduate school.0311.0365
    Race—1.434
    (3 df)(0.949–2.167)
        Black versus white.0871
        Hispanic versus white2.315
    (1.072–4.997)
    .0325
        Other versus white0.958
    (0.446–2.059)
    .9128
    Family history of colorectal cancer0.6770.556
    (1 df)(0.426–1.075)(0.291–1.062)
        No family history versus family history.0979.0754
    Smoking status1.8762.592
    (1 df)(1.240–2.840)(1.517–4.430)
        Nonsmoker versus smoker.0029.0005

    • Body mass index, insurance, comorbidity score, number of visits in the last 2 years, and length of time in the practice had a P value of >.10 for both models.

    • ↵* Adjusted for use of an electronic medical record, intervention status, year of the study, and variables as shown in the table.

    • ↵† Multivariate models created using backward stepwise regression with an exit α level of 0.10.

    • —, eliminated from multivariate model using backward stepwise regression; CI, confidence interval; OR, odds ratio.

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