Masahito Jimbo1, Ananda Sen2, Melissa A Plegue1, Sarah T Hawley3, Karen Kelly-Blake4, Mary Rapai1, Minling Zhang1, Yuhong Zhang1, Mack T Ruffin5. 1. Department of Family Medicine, University of Michigan, Ann Arbor, Michigan. 2. 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. 3. Department of Medicine, University of Michigan and Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan. 4. Center for Ethics and Humanities in the Life Sciences and Department of Medicine, Michigan State University, East Lansing, Michigan. 5. Department of Family and Community Medicine, Penn State Hershey Medical Center, Hershey, Pennsylvania.
Abstract
INTRODUCTION: 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.
RCT Entities:
INTRODUCTION: 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.
Authors: Caitlin C Murphy; Chul Ahn; Sandi L Pruitt; Amy E Hughes; Ethan A Halm; Samir Gupta; Noel O Santini; Katharine McCallister; Joanne M Sanders; Amit G Singal; Celette Sugg Skinner Journal: Prev Med Date: 2018-12-01 Impact factor: 4.018