Correlates of Patient Intent and Preference on Colorectal Cancer Screening.
BACKGROUND
Information is limited on patient characteristics that influence their preference among screening options and intent to be screened for colorectal cancer (CRC). A mechanistic pathway to intent and preference was examined through a formal mediation analysis.


METHODS
From 2012 to 2014, a total of 570 adults aged 50-75 years were recruited from 15 primary care practices in Metro Detroit for a trial on decision aids for CRC screening. Confirmatory factor, regression, and mediation analyses were performed in 2015-2016 on baseline cross-sectional data. Main outcomes were patient intent and preference. Perceived risk and self-efficacy were secondary outcomes. Covariates included demographic information, health status, previous CRC screening experience, patient attitudes, and knowledge.


RESULTS
Mean age was 57.7 years, 56.1% were women, and 55.1% white and 36.6% black. Women had 32% and 41% lower odds than men of perceiving CRC to be high/moderate risk (OR=0.68, 95% CI=0.47, 0.97, p=0.03) and having high self-efficacy (OR=0.59, 95% CI=0.42, 0.85, p=0.006), respectively. Whites had 63% and 47% lower odds than blacks of having high self-efficacy (OR=0.37, 95% CI=0.25, 0.57, p<0.001) and intent to undergo CRC screening (OR=0.53, 95% CI=0.34, 0.84, p=0.007), respectively. Younger age, higher knowledge, lower level of test worries, and medium/high versus low self-efficacy increased the odds of intent of being screened. Self-efficacy, but not perceived risk, significantly mediated the association between race, attitude, and test worries and patient screening intent.


CONCLUSIONS
Self-efficacy mediated the association between race, attitude, and test worries and patient intent.
Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.
Masahito
M
Jimbo
Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan. Electronic address: anandas@med.umich.edu.
Ananda
A
Sen
Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.
Melissa A
MA
Plegue
Department of Medicine, University of Michigan and Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan.
Sarah T
ST
Hawley
Center for Ethics and Humanities in the Life Sciences and Department of Medicine, Michigan State University, East Lansing, Michigan.
Karen
K
Kelly-Blake
Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.
Mary
M
Rapai
Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.
Minling
M
Zhang
Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.
Yuhong
Y
Zhang
Department of Family and Community Medicine, Penn State Hershey Medical Center, Hershey, Pennsylvania.
Mack T
MT
Ruffin
D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000523:psychology; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D033182:Intention; D008297:Male; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D057240:Patient Preference