ASPO Abstracts
Multi-level factors reported in colorectal cancer screening adherence studies reflect evolving challenges and opportunities in different care settings: A systematic review
Category: Cancer Health Disparities
Conference Year: 2022
Abstract Body:
PurposeThis study utilizes data from a systematic literature review to explore commonly reported factors influencing colorectal cancer (CRC) screening adherence across care settings.MethodsPubMed, Embase, and CENTRAL trial databases were searched on 10/23/2020 for studies published in 01/01/1950-12/31/2020 on factors that impact CRC screening adherence among average-risk adults in the U.S. Iterative thematic coding of extracted data identified multi-level predictors of adherence (test, patient, provider, site, & neighborhood) and five study settings (primary care, specialty care, integrated system, safety net, & regional cross-sectional surveys). This subanalysis included studies defining adherence as test completion within a study-defined timeframe (n=28) and grouped them as recent (2017-2021, n=6) or older (1990-2016, n=22).ResultsAcross settings, 72.9% of predictors were patient factors, primarily demographics and perceived importance of screening. The most common factors by level were convenience (test), age (patient), provider recommendation (provider), programmatic screening (site), and federal poverty level (neighborhood). The proportion of each multi-level predictor varied by setting. For example, the breakdown for integrated care was 79.2% patient, 11.7% provider, 5.2% site, and 3.9% test factors, whereas safety net was 71.4% patient, 16.7% test, and 11.9% site factors. The proportion of neighborhood factors doubled and site factors tripled in recent studies, driven by changes in specialty care and safety net settings, respectively. Patient health status & behavior factors were more common in recent studies (33.3% vs 17.8%), especially in integrated care. In addition to continued support for programmatic screening, recent studies advocated for incorporating patient preferences and culturally-competent materials to increase adherence.ConclusionsWhile the breakdown of multi-level factors differed by setting, patient factors were the most common predictors of adherence. The diversity of factors reflect key differences in study settings and offer insights into the populations they serve. Recent studies highlight the growing importance of site and neighborhood factors, and encourage more inclusive strategies to reach national CRC screening goals.
Keywords: Colorectal cancer Cancer screening Adherence Health care settings