title: Physician counseling on colorectal cancer screening and receipt of screening among Latino patients.
abstract: BACKGROUND
  Latinos have lower rates of colorectal cancer (CRC) screening and later stage diagnosis than Whites, which may be partially explained by physician communication factors.
  
  
  OBJECTIVE
  We assessed associations between patient-reported physician counseling regarding CRC screening and receipt of CRC screening among Latino primary care patients.
  
  
  METHODS
  This was a cross-sectional telephone survey.
  
  
  METHODS
  The participants of this study were Latino primary care patients 50 years of age or older, with one or more visits during the preceding year.
  
  
  METHODS
  We developed patient-reported measures to assess whether physicians provided explanations of CRC risks and tests, elicited patients' barriers to CRC screening, were responsive to patients' concerns about screening, and encouraged patients to be screened. Outcomes were patient reports of receipt of endoscopy (sigmoidoscopy or colonoscopy) and fecal occult blood test (FOBT) within recommended guidelines.
  
  
  RESULTS
  Of 817 eligible patients contacted, 505 (62 %) completed the survey; mean age was 61 years (SD 8.4), 69 % were women, and 53 % had less than high school education. Forty-six percent reported obtaining endoscopy (with or without FOBT), 13 % reported FOBT only, and 41 % reported no CRC screening. In bivariate analyses, physician explanations, elicitation of barriers, responsiveness to concerns, and greater encouragement for screening were associated with receipt of endoscopy (p < 0.001), and explanations (p < 0.05) and encouragement (p < 0.001) were associated with FOBT. Adjusting for covariates, physician explanations (OR = 1.27; 95 % CI 1.03, 1.58) and greater physician encouragement (OR = 6.74; 95 % CI 3.57, 12.72) were associated with endoscopy; patients reporting quite a bit/a lot of physician encouragement had six times higher odds of obtaining the FOBT as those reporting none/a little encouragement (OR = 6.54; 95 % CI 2.76, 15.48).
  
  
  CONCLUSIONS
  Among primarily lower-socioeconomic status Latino patients, the degree to which patients perceived that physicians encouraged CRC screening was more strongly associated with screening than with providing risk information, eliciting barriers, and responding to their concerns about screening.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, and Medical Effectiveness Research Center for Diverse Populations, University of California San Francisco (UCSF), 3333 California Street, Suite 335, San Francisco, CA, 94118-0856, USA, anapoles@ucsf.edu.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Nápoles
authors.forename: Jasmine
authors.initials: J
authors.lastname: Santoyo-Olsson
authors.forename: Anita L
authors.initials: AL
authors.lastname: Stewart
authors.forename: Jill
authors.initials: J
authors.lastname: Olmstead
authors.forename: Steven E
authors.initials: SE
authors.lastname: Gregorich
authors.forename: Georgianna
authors.initials: G
authors.lastname: Farren
authors.forename: Ruben
authors.initials: R
authors.lastname: Cabral
authors.forename: Andrew
authors.initials: A
authors.lastname: Freudman
authors.forename: Eliseo J
authors.initials: EJ
authors.lastname: Pérez-Stable
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D003430:Cross-Sectional Studies; D037001:Directive Counseling / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods* / Q000523:psychology; D005260:Female; D006630:Hispanic or Latino / Q000208:ethnology* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations