Dataset Information

Physician-office vs home uptake of colorectal cancer screening using FOBT/FIT among screening-eligible US adults.

ABSTRACT: BACKGROUND:Guidelines of the American Cancer Society and US Preventive Services Task Force specify that colorectal cancer (CRC) screening using guaiac-based fecal occult blood test (FOBT)/fecal immunochemical test (FIT) should be done at home. We therefore examined the prevalence and correlates of CRC screening using FOBT/FIT in physicians' office vs at home. METHODS:Analysis of 9493 respondents 50-75 years old from the Cancer Control Supplement of the 2015 National Health Interview Survey was conducted. Weighted multivariable logistic regression was used to identify the determinants of in-office vs home use of FOBT/FIT for CRC screening. RESULTS:Of the overall sample of screening-eligible adults (n = 9403), only 937 (10.4%) respondents underwent CRC screening using FOBT/FIT within the past year; among this screening population, 279 (28.3%) respondents were screened in-office. We found that sociodemographic factors alone, not CRC risk factors, determined whether FOBT/FIT would be used in-office or at home. Hispanics had greater odds of being screened in-office using FOBT/FIT (aOR: 2.04; 95% CI: 1.05-3.99). Compared with those 50-59 years old, respondents 70-75 years old were less likely to be screened in-office using FOBT/FIT (aOR: 0.44, 95% CI: 0.25-0.79). Similarly, individuals residing in the Western region of the country had lower odds of in-office FOBT/FIT (aOR: 0.26; 95% CI: 0.11-0.58). CONCLUSION:Amid low overall uptake rates of FOBT/FIT in the United States, in-physician office testing is high, indicative of a missed opportunity for effective screening and poor adherence of physicians to national guidelines. Sociodemographic factors are determinants of uptake of FOBT/FIT at home or in-office and should be considered in designing interventions aimed at providers and the general population.

SUBMITTER: Chido-Amajuoyi OG

PROVIDER: S-EPMC6885889 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Physician-office vs home uptake of colorectal cancer screening using FOBT/FIT among screening-eligible US adults.

Chido-Amajuoyi Onyema Greg OG Sharma Anushree A Talluri Rajesh R Tami-Maury Irene I Shete Sanjay S

Cancer medicine 20191021 17

<h4>Background</h4>Guidelines of the American Cancer Society and US Preventive Services Task Force specify that colorectal cancer (CRC) screening using guaiac-based fecal occult blood test (FOBT)/fecal immunochemical test (FIT) should be done at home. We therefore examined the prevalence and correlates of CRC screening using FOBT/FIT in physicians' office vs at home.<h4>Methods</h4>Analysis of 9493 respondents 50-75 years old from the Cancer Control Supplement of the 2015 National Health Intervi ...[more]

PMID: 31637870

Similar Datasets

Project description:Despite the documented benefits of colorectal cancer screening, patient participation rates remain low. Physician recommendation has been identified as a significant predictor of screening completion.The aim of this study is to investigate how primary care physicians perceive colorectal cancer screening communication tasks, as well as to explore the form and content of actual screening discussions.The research design includes a mailed physician survey and a separate observational study in a sample of videotaped medical encounters. PARTICIPANTS AND DATA SOURCES: The participants were 270 primary care physicians who completed a mailed questionnaire (57.9% response rate) and 18 physician-patient encounters that included discussions of colorectal cancer screening.The questionnaire focused on perceived importance and accomplishment of communication tasks relevant to colorectal cancer screening. Two of the authors reviewed transcripts of videotaped physician encounters to determine whether the same communication tasks assessed in the survey were accomplished. Interrater reliability was high across all of the mutually exclusive coding categories (Kappa > .90).Physicians rated colonoscopy as the most important screening option to discuss; self-reports indicate that colonoscopy (84.8%) is more frequently mentioned than fecal occult blood test (FOBT; 49.4%), flexible sigmoidoscopy (34.1%), or computed tomography (CT) imaging (18.1%). Explaining benefits and risks, describing test procedure and frequency, eliciting patient preferences, and making a plan for screening were all viewed as very important. Self-reported accomplishment of these communication tasks was considerably higher than that observed in our separate videotape sample.Most physicians recognize and espouse the importance of recommending colorectal cancer screening to eligible patients. However, findings from both the physician survey and observational study suggest that physicians tend to overestimate the extent of discussions about screening. Interventions may be warranted to improve clinical practice.

Project description:ImportanceHome hospital care is the substitutive provision of home-based acute care services usually associated with a traditional inpatient hospital. Many home hospital models require a physician to see patients at home daily, which may hinder scalability. Whether remote physician visits can safely substitute for most in-home visits is unknown.ObjectiveTo compare remote and in-home physician care.Design, setting, and participantsThis randomized clinical trial assessed 172 adult patients at an academic medical center and community hospital who required hospital-level care for select acute conditions, including infection, heart failure, chronic obstructive pulmonary disease, and asthma, between August 3, 2019, and March 26, 2020; follow-up ended April 26, 2020.InterventionsAll patients received acute care at home, including in-home nurse or paramedic visits, intravenous medications, remote monitoring, and point-of-care testing. Patients were randomized to receive physician care remotely (initial in-home visit followed by daily video visit facilitated by the home hospital nurse) vs in-home care (daily in-home physician visit). In the remote care group, the physician could choose to see the patient at home beyond the first visit if it was felt to be medically necessary.Main outcomes and measuresThe primary outcome was the number of adverse events, compared using multivariable Poisson regression at a noninferiority threshold of 10 events per 100 patients. Adverse events included a fall, pressure injury, and delirium. Secondary outcomes included the Picker Patient Experience Questionnaire 15 score (scale of 0-15, with 0 indicating worst patient experience and 15 indicating best patient experience) and 30-day readmission rates.ResultsA total of 172 patients (84 receiving remote care and 88 receiving in-home physician care [control group]) were randomized; enrollment was terminated early because of COVID-19. The mean (SD) age was 69.3 (18.0) years, 97 patients (56.4%) were female, 77 (45.0%) were White, and 42 (24.4%) lived alone. Mean adjusted adverse event count was 6.8 per 100 patients for remote care patients vs 3.9 per 100 patients for control patients, for a difference of 2.8 (95% CI, -3.3 to 8.9), supporting noninferiority. For remote care vs control patients, the mean adjusted Picker Patient Experience Questionnaire 15 score difference was -0.22 (95% CI, -1.00 to 0.56), supporting noninferiority. The mean adjusted 30-day readmission absolute rate difference was 2.28% (95% CI, -3.23% to 7.79%), which was inconclusive. Of patients in the remote group, 16 (19.0%) required in-home visits beyond the first visit.Conclusions and relevanceIn this study, remote physician visits were noninferior to in-home physician visits during home hospital care for adverse events and patient experience, although in-home physician care was necessary to support many patients receiving remote care. Our findings may allow for a more efficient, scalable home hospital approach but require further research.Trial registrationClinicalTrials.gov Identifier: NCT04080570.

Dataset Information

Physician-office vs home uptake of colorectal cancer screening using FOBT/FIT among screening-eligible US adults.

Publications

Physician-office vs home uptake of colorectal cancer screening using FOBT/FIT among screening-eligible US adults.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets