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Improving Colorectal Cancer Screening Among the Medically Underserved: A Pilot Study within a Federally Qualified Health Center

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Abstract

Background

Colorectal cancer screening rates remain low, especially among low-income and racial/ethnic minority groups.

Objective

We pilot-tested a physician-directed strategy aimed at improving rates of recommendation and patient colorectal cancer screening completion at 1 federally qualified health center serving low-income, African-American and Hispanic patients. Colonoscopy was specifically targeted.

Design

Single arm, pretest–posttest design.

Setting

Urban.

Patients

154 screening-eligible, yet nonadherent primary care patients receiving care at an urban, federally qualified health center.

Intervention

1) manually tracking screening-eligible patients, 2) mailing patients a physician letter and brochure before medical visits, 3) health literacy training to help physicians improve their communication with patients to work to resolution, and 4) establishing a “feedback loop” to routinely monitor patient compliance.

Measurement

Chart review of whether patients received a physician recommendation for screening, and completion of any colorectal cancer screening test 12 months after intervention. Physicians recorded patients’ qualitative reasons for noncompliance, and a preliminary cost-effectiveness analysis for screening promotion was also conducted.

Results

The baseline screening rate was 11.5%, with 31.6% of patients having received a recommendation from their physician. At 1-year follow-up, rates of screening completion had increased to 27.9 percent (p < .001), and physician recommendation had increased to 92.9% (p < .001). Common reasons for nonadherence included patient readiness (60.7%), competing health problems (11.9%), and fear or anxiety concerning the procedure (8.3%). The total cost for implementing the intervention was $4,676 and the incremental cost-effectiveness ratio for the intervention was $106 per additional patient screened by colonoscopy.

Conclusions

The intervention appears to be a feasible means to improve colorectal cancer screening rates among patients served by community health centers. However, more attention to patient decision making and education may be needed to further increase screening rates.

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Acknowledgments

Dr. Wolf is supported by a Centers for Disease Control and Prevention Career Development Award (K01 EH000067-01).

Conflict of Interest

Dr. Wolf has received research funding from Pfizer Pharmaceuticals for health literacy-related intervention studies. No other conflicts are identified with authors of this manuscript.

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Authors and Affiliations

  1. Access Community Health Network, Chicago, IL, USA

    Kishore Khankari MD, Mickey Eder PhD, Linda Diamond-Shapiro AM, MBA & Dan Makundan MD

  2. Health Literacy and Learning Program, Center for Communication and Medicine, Institute for Healthcare Studies, and Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA

    Chandra Y. Osborn PhD, Gregory Makoul PhD, Marla Clayman PhD, MPH, Silvia Skripkauskas BA & Michael S. Wolf PhD, MPH

  3. Health Literacy and Learning Program, Institute for Healthcare Studies &, Division of General Internal Medicine Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St., Suit 200, Chicago, IL, 60611, USA

    Michael S. Wolf PhD, MPH

Authors
  1. Kishore Khankari MD
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  2. Mickey Eder PhD
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  3. Chandra Y. Osborn PhD
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  4. Gregory Makoul PhD
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  5. Marla Clayman PhD, MPH
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  6. Silvia Skripkauskas BA
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  7. Linda Diamond-Shapiro AM, MBA
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  9. Michael S. Wolf PhD, MPH
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Corresponding author

Correspondence to Michael S. Wolf PhD, MPH.

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Khankari, K., Eder, M., Osborn, C.Y. et al. Improving Colorectal Cancer Screening Among the Medically Underserved: A Pilot Study within a Federally Qualified Health Center. J GEN INTERN MED 22, 1410–1414 (2007). https://doi.org/10.1007/s11606-007-0295-0

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  • DOI: https://doi.org/10.1007/s11606-007-0295-0

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