DETERMINANTS OF PATIENT INTENT AND PREFERENCE REGARDING COLORECTAL CANCER SCREENING: BASELINE FINDINGS FROM THE DATES (DECISION AID TO TECHNOLOGICALLY ENHANCE SHARED DECISION MAKING) STUDY
Method: We performed confirmatory factor analysis, regression analysis, mediation analysis, and Classification and Regression Trees analysis on baseline patient survey data from a 2-armed randomized controlled study (R01CA152413) set in 12 community and 3 university-based primary care practices in Metro Detroit. Patients were men and women aged 50 to 75 years not current on CRC screening. Main outcomes were the patient intent to get screened for CRC and patient preference for a particular CRC screening test. Perceived risk and self-efficacy were intermediate outcomes.
Result: Data were obtained from 570 participants. Mean age was 57.7 years, 56.1% were women, and 55.1% were white and 36.6% black. Women had 32% lower odds than men to perceive CRC to be high/moderate risk [OR 0.68 (0.47-0.97), p=0.03], and 41% lower odds than men of having high self-efficacy [OR 0.59 (0.42-0.85), p=0.006]. Whites had 63% lower odds than blacks of having high self-efficacy [OR 0.37 (0.25-0.57), p<0.001], and 47% lower odds to have intent to get screened for CRC [OR 0.53 (0.34-0.84), p=0.007]. Older age, higher knowledge, lower level of test worries, and medium/high vs. low self-efficacy increased the odds of being intent on getting screened for CRC. Self-efficacy, but not perceived risk, significantly mediated the association between race, attitude, and test worries and patient intent to get screened for CRC. Neither self-efficacy nor perceived risk significantly mediated for CRC screening test preference. However, participants (n=30) who wanted neither stool blood test nor colonoscopy had about 20% lower odds of being intent on getting screened for CRC than the ones with specific [OR 0.82 (0.72-0.94), p=0.004] or non-specific [OR 0.77 (0.67- 0.89), p<0.001] test preference.
Conclusion: Age, gender, and race were significantly associated with perceived risk, self-efficacy, and intent. Self- efficacy significantly mediated the association between race, attitude, and test worries and patient intent to get screened. Having neither preference for stool blood test nor colonoscopy negatively correlated with intent.