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Factors Influencing Choices for Colorectal Cancer Screening Among Previously Unscreened African and Caucasian Americans: Findings from a Triangulation Mixed Methods Investigation

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Abstract

We investigated factors that influence choice of colorectal cancer (CRC) screening test and assessed the most- and least-preferred options among fecal occult blood testing (FOBT), flexible sigmoidoscopy, colonoscopy, and double contrast barium enema among adults with varied race, gender, and geographic region demographics. Mixed methods data collection consisted of 10 focus group interviews and a survey of the 93 focus group participants. Participants were ≥50 years of age and reported not having been screened for colorectal cancer in the last ten years. Analyses examined differences by race, gender, and geographic location. Participants had modest knowledge about CRC and there were fewer correct answers to knowledge questions by African Americans. Participants recognized value of early detection, and identified health symptoms and their doctor’s recommendation as influential for obtaining CRC screening. They chose colonoscopy and FOBT as the most preferred tests, while barium enema was least preferred. The analysis revealed intra-group variations in preference, though there were no significant differences by race, gender, or location. Openness of discussing this sensitive topic, lack of knowledge about colorectal cancer and screening costs, and diversity of preferences expressed within study groups suggest the importance of patient-physician dialogue about colorectal cancer screening options. New approaches to promoting colorectal cancer screening need to explore methods to facilitate patients establishing and expressing preferences among the screening options.

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Acknowledgements

The authors wish to thank all the participants for their precious time and participation. Debra Power of Power Marketing provided invaluable assistance with data collection. The investigators additionally thank the sponsors who made this research possible. This research was supported by funding from the Michigan Department of Community Health and National Cancer Institute. Dr. Fetters’ participation was also made possible in part by the generous support of the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program and the Jitsukokai Medical Foundation. Dr. Ruffin’s participation was also made possible by support from the National Cancer Institute (K24-CA80846-010).

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Authors and Affiliations

  1. Department of Family Medicine, University of Michigan Health System, 1018 Fuller Street, Ann Arbor, MI, 48104-1213, USA

    Mack T. Ruffin IV, Masahito Jimbo & Michael D. Fetters

  2. Department of Educational Psychology, University of Nebraska-Lincoln, 241 Teachers College Building, Lincoln, NE, 68588, USA

    John W. Creswell

Authors
  1. Mack T. Ruffin IV
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  2. John W. Creswell
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  3. Masahito Jimbo
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  4. Michael D. Fetters
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Correspondence to Michael D. Fetters.

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Ruffin, M.T., Creswell, J.W., Jimbo, M. et al. Factors Influencing Choices for Colorectal Cancer Screening Among Previously Unscreened African and Caucasian Americans: Findings from a Triangulation Mixed Methods Investigation. J Community Health 34, 79–89 (2009). https://doi.org/10.1007/s10900-008-9133-5

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  • DOI: https://doi.org/10.1007/s10900-008-9133-5

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