Clearer info could up cancer screening in blacks

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Better doctor-patient communication may improve colon cancer screening rates among African Americans, results of a North Carolina study suggest.

“Good communication between patients and providers is important to increase the rates of completed cancer screening tests within recommended guidelines,” study author Dr. Mira L. Katz of The Ohio State University told AMN Health.

"Both patients and providers should strive to improve their communication skills for better patient outcomes,” she added. “Patients should be comfortable asking questions regarding their physician’s recommendations and physicians need to check to make sure patients really understand their recommendations.”

Regular screening is known to reduce the incidence and death rate for colorectal cancer—the third most common cancer among men and women in the US—but surveys have found that many adults continue to go without such screening.

Previous researchers have found that one of the strongest predictors for whether people will undergo a colonoscopy or other screening test for colorectal cancer is if they have been advised to do so by their healthcare provider.

To explore the relationship between patient-provider communication and colorectal cancer screening, Katz and her team conducted focus groups and surveys of 397 African-American men and women, aged 50 years and older, from 12 North Carolina churches.

The majority (75 percent) of study participants, mostly women, rated their quality of communication with their healthcare provider as “good,” reporting that they “always” or “almost all the time” were involved in making medical decisions, believed their health provider understood their health needs and received enough information from their provider.

These church members were nearly three times more likely to undergo colon cancer screening in the recommended time period than those who described their communication with their healthcare provider as “poor,” the researchers report in the BMC Public Health journal.

Experts recommend that men and women aged 50 years and older have either a test for blood in stool every year; or a flexible sigmoidoscopy exam, in which the first part of the bowel is inspected via an optical tube inserted into the rectum, once every five year; or a colonoscopy, in which the entire colon is examined, every 10 years.

Less than half of the study participants said their provider had recommended such screening, however, and less than a third said they had undergone such screening, study findings indicate.

In other findings, most (57 percent) of the men and women had adequate knowledge of colon cancer, although many incorrectly thought that men had a higher risk of the condition or were unaware that physical activity decreases a person’s risk. Still, those with more knowledge about colon cancer were more likely to have been screened.

Only 42 percent of study participants said they had adequate knowledge about colon cancer and good communication with their health care provider.

Overall, the findings suggest “that not only do patients need to be informed about their colorectal cancer risk and the importance of screening tests, but that having good communication with their healthcare provider may also be important,” the authors write.

They added that specific new strategies are needed to promote better communication and trust among African Americans, who have a history of fear and mistrust of the medical community.

“If new prevention strategies for the African American population are developed, then there may be a chance at reducing the disparities associated with colon cancer and race,” they conclude.

Katz added that her goal in researching cancer prevention and control “is to make sure that individuals truly understand the benefit of undergoing colorectal cancer screening.” People cannot be expected to undergo cancer screening if they do not understand their risk of cancer or the purpose of the screening test, she said.

SOURCE: BMC Public Health, December 15 online, 2004.

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