title: Patient trust in physician influences colorectal cancer screening in low-income patients.
abstract: BACKGROUND
  Colorectal cancer (CRC) screening is effective but underutilized. Although physician recommendation is an important predictor of screening, considerable variation in CRC screening completion remains.
  
  
  OBJECTIVE
  To characterize the influence of patient trust in care providers on CRC screening behavior.
  
  
  METHODS
  Data were collected as part of a cluster-randomized CRC screening intervention trial performed in the San Francisco Community Health Network from March 2007 to January 2012 (analysis, Spring 2012). All study participants received a recommendation to complete CRC screening from their primary care provider (PCP). Included participants were aged 50-79 years, not current with screening, and completed the Wake Forest Trust Scale (WFTS) measuring trust in PCPs and doctors in general. Primary outcome was CRC screening completion (colonoscopy or fecal occult blood testing) within 12 months following enrollment. Multivariable association adjusted for race/ethnicity, language, and other sociodemographics was estimated using generalized estimating equations with logit link and binomial distribution.
  
  
  RESULTS
  WFTS response was 70.3% (701). Most participants (83%) were Latino, Asian, or black. Most had income <$30,000 (96%) and public health insurance (86%). Higher trust in PCP was associated with screening completion (OR=1.11, 95% CI=1.03, 1.17), but trust in doctors was not (OR=1.02, 95% CI=0.82, 1.28). Race, language, and other sociodemographic factors were not significant in multivariable analysis.
  
  
  CONCLUSIONS
  After controlling for traditional factors, trust in PCP remained the only significant driver of CRC screening completion in low-income patients. Interventions to promote CRC screening may be improved by including efforts to enhance patient trust in PCP.
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Shivani
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Health Services, University of Washington School of Public Health and Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Alison T
authors.initials: AT
authors.lastname: Brenner
authors.affiliation: Division of General Internal Medicine and Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California.
authors.forename: Neda
authors.initials: N
authors.lastname: Ratanawongsa
authors.affiliation: Department of Health Services, University of Washington School of Public Health and Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington. Electronic address: jinadomi@medicine.washington.edu.
authors.forename: John M
authors.initials: JM
authors.lastname: Inadomi
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000523:psychology; D008875:Middle Aged; D009780:Occult Blood; D010342:Patient Acceptance of Health Care; D010817:Physician-Patient Relations; D011203:Poverty; D012495:San Francisco; D035502:Trust / Q000523:psychology*
references.citation: Am J Prev Med. 2006 Mar;30(3):204-10
references.pmid: 16476635
references.citation: Ann Intern Med. 2013 Jan 1;158(1):55-9
references.pmid: 23108285
references.citation: Health Educ Res. 2005 Apr;20(2):137-48
references.pmid: 15314036
references.citation: Health Serv Res. 2002 Feb;37(1):187-202
references.pmid: 11949920
references.citation: BMC Fam Pract. 2004 Nov 16;5:26
references.pmid: 15546482
references.citation: Cancer. 2006 Sep 1;107(5):959-66
references.pmid: 16865681
references.citation: Cancer. 2009 Nov 1;115(21):5048-59
references.pmid: 19637357
references.citation: N Engl J Med. 2012 Jun 21;366(25):2345-57
references.pmid: 22612596
references.citation: Milbank Q. 2001;79(4):613-39, v
references.pmid: 11789119
references.citation: Prev Med. 2004 Jul;39(1):56-63
references.pmid: 15207986
references.citation: J Immigr Minor Health. 2008 Apr;10(2):119-26
references.pmid: 17574545
references.citation: Psychooncology. 2011 Aug;20(8):862-70
references.pmid: 20597065
references.citation: Lancet. 1996 Nov 30;348(9040):1472-7
references.pmid: 8942775
references.citation: BMC Public Health. 2009 Sep 25;9:363
references.pmid: 19781085
references.citation: Cancer Pract. 2000 Jan-Feb;8(1):32-7
references.pmid: 10732537
references.citation: Lancet. 1996 Nov 30;348(9040):1467-71
references.pmid: 8942774
references.citation: BMC Fam Pract. 2008 Sep 03;9:49
references.pmid: 18768086
references.citation: Am J Prev Med. 2012 Dec;43(6):573-83
references.pmid: 23159252
references.citation: Prev Med. 2010 Sep-Oct;51(3-4):329-31
references.pmid: 20600255
references.citation: Arch Intern Med. 2012 Apr 9;172(7):575-82
references.pmid: 22493463
references.citation: Qual Health Res. 2009 Jun;19(6):778-89
references.pmid: 19363141
references.citation: J Am Board Fam Med. 2008 Sep-Oct;21(5):414-26
references.pmid: 18772296
references.citation: Am J Prev Med. 2012 Apr;42(4):390-7
references.pmid: 22424252
references.citation: BMC Health Serv Res. 2005 Oct 03;5:64
references.pmid: 16202125
references.citation: Am J Prev Med. 2014 Mar;46(3):273-80
references.pmid: 24512866
references.citation: Patient Educ Couns. 2012 Jan;86(1):120-6
references.pmid: 21458195
references.citation: Am Fam Physician. 2007 Sep 15;76(6):774-5
references.pmid: 17910291
references.citation: J Gen Intern Med. 2000 Jul;15(7):509-13
references.pmid: 10940139
references.citation: Prev Med. 2004 Jun;38(6):777-85
references.pmid: 15193898
references.citation: N Engl J Med. 2000 Nov 30;343(22):1603-7
references.pmid: 11096167
references.citation: Ann Intern Med. 2000 Nov 21;133(10):761-9
references.pmid: 11085838
references.citation: Ann Intern Med. 2010 May 18;152(10):668-76
references.pmid: 20388703
references.citation: Asian Pac J Cancer Prev. 2010;11(4):1125-31
references.pmid: 21133636
references.citation: MMWR Morb Mortal Wkly Rep. 2011 Jul 8;60(26):884-9
references.pmid: 21734636
references.citation: J Psychosoc Oncol. 2008;26(2):63-86
references.pmid: 18285301
references.citation: JAMA. 2012 Apr 18;307(15):1583-4
references.pmid: 22511682
references.citation: JAMA Intern Med. 2013 Feb 11;173(3):210-8
references.pmid: 23277199