Colorectal cancer screening among underserved minority population: Discrepancy between physicians’ recommended, scheduled, and completed tests

ObjectiveThis study examines the correlates of: (1) health care provider recommendation of CRC testing; (2) provider scheduling for recommended CRC testing using sigmoidoscopy, colonoscopy, or double-contrast barium enema; and (3) adherence to CRC scheduling among underserved minority populations.MethodsMedical record and schedule logbook reviews and interviewer-administered surveys. Setting: Large urban safety-net, outpatient primary care setting in Los Angeles County. Participants: 306 African-American and Latino patients aged 50 years and older.ResultsA vast majority of minority patients do not receive standard CRC testing in urban safety-net primary care settings. Of those patients who were actually scheduled for sigmoidoscopy or colonoscopy, almost half completed the procedure. Completing CRC testing was associated with marital status, co-morbid chronic physical conditions, number of risk factors for colorectal cancer, and lower perceived barriers to CRC testing.ConclusionEffective interventions to reduce CRC mortality among underserved minority populations require an integrated approach that engages patients, providers, and health care systems.Practice implicationsDesigning interventions that (1) increase physician–patient communications for removing patients’ perceived barriers for CRC testing and (2) promote a non-physician-based navigator system that reinforces physicians’ recommendation are strongly recommended.