Colorectal cancer screening among the homeless population of New York City shelter-based clinics.
OBJECTIVE
We determined colorectal cancer (CRC) screening rates, predictors, and barriers in 2 major New York City shelter-based clinics.


METHODS
We extracted screening rates, sociodemographic characteristics, and factors associated with homelessness from medical records of domiciled and homeless patients aged 50 years and older (n = 443) with at least 3 clinic visits between 2010 and 2012.


RESULTS
The majority of patients were African American or Hispanic, 76% were male, and 60.7% were homeless (mean = 2.4 years; SD = 2.8 years). Domiciled patients were more likely than homeless patients to be screened (41.3% vs 19.7%; P < .001). Homeless and domiciled patients received equal provider counseling, but more homeless patients declined screening (P < .001). In logistic regression, gender, race, duration of homelessness, insurance status, substance and alcohol abuse, chronic diseases, and mental health were not associated with screening, but housing, provider counseling, and older age were.


CONCLUSIONS
Proposed interventions to improve CRC screening include respite shelter rooms for colonoscopy prepping, patient navigators to help navigate the health system and accompany patients to and from the procedure, counseling at all clinical encounters, and tailored patient education to address misconceptions.
Ramin Asgary is with the Department of Medicine, New York University School of Medicine, New York, NY. Victoria Garland and Blanca Sckell are with the Department of Community Medicine, Lutheran Family Health Centers, New York, NY. Andrea Jakubowski is with the Department of Medical Education, Mount Sinai School of Medicine, New York, NY.
Ramin
R
Asgary
Victoria
V
Garland
Andrea
A
Jakubowski
Blanca
B
Sckell
D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000208:ethnology; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006798:Housing; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D044469:Racial Groups / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D013997:Time Factors