title: More comprehensive discussion of CRC screening associated with higher screening.
abstract: OBJECTIVE
  Examine association of comprehensiveness of colorectal cancer (CRC) screening discussion by primary care physicians (PCPs) with completion of CRC screening.
  
  
  METHODS
  Observational study in Kaiser Permanente Northwest, a group-model health maintenance organization.
  
  
  METHODS
  A total of 883 participants overdue for CRC screening received an automated telephone call (ATC) between April and June 2009 encouraging CRC screening. Between January and March 2010, participants completed a survey on PCPs' discussion of CRC screening and patient beliefs regarding screening.
  
  
  METHODS
  receipt of CRC screening (assessed by electronic medical record [EMR], 9 months after ATC). Primary independent variable: comprehensiveness of CRC screening discussion by PCPs (7-item scale). Secondary independent variables: perceived benefits of screening (4-item scale assessing respondents' agreement with benefits of timely screening) and primary care utilization (EMR; 9 months after ATC). The independent association of variables with CRC screening was assessed with logistic regression.
  
  
  RESULTS
  Average scores for comprehensiveness of CRC discussion and perceived benefits were 0.4 (range 0-1) and 4.0 (range 1-5), respectively. A total of 28.2% (n = 249) completed screening, 84% of whom had survey assessments after their screening date. Of screeners, 95.2% completed the fecal immunochemical test. More comprehensive discussion of CRC screening was associated with increased screening (odds ratio [OR] = 1.51, 95% confidence interval [CI] = 1.03-2.21). Higher perceived benefits (OR = 1.46, 95% CI = 1.13-1.90) and 1 or more PCP visits (OR = 5.82, 95% CI = 3.87-8.74) were also associated with increased screening.
  
  
  CONCLUSIONS
  More comprehensive discussion of CRC screening was independently associated with increased CRC screening. Primary care utilization was even more strongly associated with CRC screening, irrespective of discussion of CRC screening.
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Mosen
authors.forename: Adrianne C
authors.initials: AC
authors.lastname: Feldstein
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Perrin
authors.forename: A Gabriella
authors.initials: AG
authors.lastname: Rosales
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Liles
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Schneider
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Meyers
authors.forename: Jennifer
authors.initials: J
authors.lastname: Elston-Lafata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009922:Oregon; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care; D012017:Referral and Consultation; D017010:Reminder Systems