title: FOBT completion in FQHCs: impact of physician recommendation, FOBT information, or receipt of the FOBT kit.
abstract: OBJECTIVE
  To determine the effect of common components of primary care-based colorectal cancer (CRC) screening interventions on fecal occult blood test (FOBT) completion within rural and urban community clinics, including: (1) physician's spoken recommendation, (2) providing information or education about FOBTs, and (3) physician providing the FOBT kit; to determine the relative effect of these interventions; and to compare the effect of each intervention between rural and urban clinics.
  
  
  METHODS
  We conducted structured interviews with patients aged 50 years and over receiving care at community clinics that were noncompliant with CRC screening. Self-report of ever receiving a physician's recommendation for screening, FOBT information or education, physician providing an FOBT kit, and FOBT completion were collected.
  
  
  RESULTS
  Participants included 849 screening-eligible adults; 77% were female and 68% were African American. The median age was 57; 33% lacked a high school diploma and 51% had low literacy. In multivariable analysis, all services were predictive of rural participants completing screening (physician recommendation: P = .002; FOBT education: P = .001; physician giving FOBT kit: P < .0001). In urban clinics, only physician giving the kit predicted FOBT completion (P < .0001). Compared to urban patients, rural patients showed a stronger relationship between FOBT completion and receiving a physician recommendation (risk ratio [RR]: 5.3 vs. 2.1; P = .0001), receiving information or education on FOBTs (RR: 3.8 vs 1.9; P = .0002), or receiving an FOBT kit from their physician (RR: 22.3 vs. 10.1; P = .035).
  
  
  CONCLUSIONS
  Participants who receive an FOBT kit from their physician are more likely to complete screening.
authors: Department of Medicine and Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71130, USA. tdavis1@lsuhsc.edu
authors: Terry C
authors: TC
authors: Davis
authors: Connie L
authors: CL
authors: Arnold
authors: Alfred W
authors: AW
authors: Rademaker
authors: Daci J
authors: DJ
authors: Platt
authors: Julia
authors: J
authors: Esparza
authors: Dachao
authors: D
authors: Liu
authors: Michael S
authors: MS
authors: Wolf
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D055088:Early Detection of Cancer; D005260:Female; D005380:Financing, Government; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D011320:Primary Health Care; D019035:Rural Health Services; D057566:Self Report; D019037:Urban Health Services