‘Provider recommendation critical’ to colonoscopy uptake for non-Hispanic Black adults
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Key takeaways:
- Provider recommendation for colonoscopy was the strongest incentive for young adults across all racial/ethnic groups to undergo screening.
- This was most influential for non-Hispanic Black patients.
WASHINGTON — Provider recommendation was a major influencer for colonoscopy screening for young adults at average risk for colorectal cancer, especially non-Hispanic Black patients, according to data presented at Digestive Disease Week.
“Screening rates are low among Black and Native American individuals, which happen to be the groups that have the highest incidence and mortality from disease,” Rebecca Ekeanyanwu, MHS, from Meharry Medical College in Nashville, Tennessee, told Healio. “Additionally, screening rates are lower than the national average among Latino and Asian individuals. A provider-patient relationship is vital in increasing colorectal cancer screening uptake in minority individuals.”
To assess which factors were most influential in prompting adults aged 45 to 49 years at average risk for CRC to take part in screening, Ekeanyanwu and colleagues surveyed members of a 2022 study that compared four screening outreach strategies: fecal immunochemical test (FIT)-only choice, colonoscopy-only choice, FIT or colonoscopy choice, or mailed FIT outreach.
“In particular, we were interested in the differences in preferences by race and ethnicity,” Ekeanyanwu noted. “The hope is that we can utilize these motivational factors to promote colorectal cancer screening uptake among minority individuals in future intervention studies.”
The researchers electronically surveyed former study participants (n = 3,206; 46.9% non-Hispanic white; 14.9% Hispanic; 13.6% non-Hispanic Asian; 4.1% non-Hispanic Black) with a series of open-ended and multiple-choice questions to highlight which factors helped or hindered their participation in cancer screening. Ekeanyanwu and colleagues then evaluated survey responses, comparing which factors affected screening participation overall and by race/ethnicity for those who did and did not opt for screening.
According to survey results, among respondents who participated in colonoscopy screening, the most significant influence was provider recommendation. However, the value of provider recommendation for colonoscopy was more significant among non-Hispanic Black participants vs. non-Hispanic white participants (56.1% vs. 42.3%, P = .034).
“Our study revealed that provider recommendation was a major facilitator for screening by colonoscopy in all racial/ethnic groups, and especially among non-Hispanic Black individuals,” Ekeanyanwu said.
The researchers noted that polyp removal via colonoscopy represented less of an incentive for non-Hispanic Black patients (12.1%) compared with non-Hispanic white (23.6%) and non-Hispanic Asian patients (28.9%), as was adherence to the 10-year screening (21.2% vs. 33.9%; P = .048). Additionally, Ekeanyanwu and colleagues reported that, among surveyed participants who chose FIT screening, its convenience was a major contributor across all racial/ethnic groups.
“Our study is evidence that provider recommendation is critical for colonoscopy screening uptake,” researcher Folasade P. May, MD, PhD, MPhil, director of the Melvin and Bren Simon Gastroenterology Quality Improvement Program at UCLA Health and associate professor of medicine at David Geffen School of Medicine at UCLA, told Healio. “Provider recommendation has been shown to be an important predictor of screening in older adults in prior studies; however, it is novel that we saw the same level of provider influence with young adults.”
Regarding next steps, May highlighted that more data are needed to establish why young adults choose not to undergo screening with any of the modalities currently available, as well as to understand the discrepancy between participants who expressed an interest in screening and selected a test, but ultimately failed to complete it.
“Their answers may provide us with clarity on whether we need to clarify misconceptions about colorectal cancer screening tests, implement different types of interventions or fine-tune existing screening programs that are already in place within our health system,” she said. “It is important that physicians discuss all aspects of colorectal cancer screening modalities with their patients to maximize participation in screening and improve overall screening rates.”
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Ekeanyanwu R, et al. To screen or not to screen: Why young people choose to participate in colorectal cancer screening. Presented at: Digestive Disease Week; May 18-21, 2024; Washington (hybrid).
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