Physician counseling for colorectal cancer screening: Impact on patient attitudes, beliefs, and behavior

Joshua J Fenton, Anthony F Jerant, Marlene M. Von Friederichs-Fitzwater, Daniel J Tancredi, Peter Franks

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Purpose: To determine how often primary care physicians address patient-level health behavioral constructs that are associated with colorectal cancer (CRC) screening and whether physician counseling addressing constructs is associated with favorable changes in patients' attitudes, beliefs, intentions, and subsequent screening. Methods: We conducted a prospective cohort study of patients eligible for CRC screening and attending routine appointments within two academic primary care clinics (50 patients, 20 primary care clinicians). Patients completed validated measures of behavioral constructs associated with CRC screening (benefits, barriers, susceptibility, self-efficacy, intention, and stage of readiness) before and after their visits. Audio-recorded discussions of CRC screening were coded for conversation addressing constructs. Bivariate and regression analyses estimated associations between discussions that did and did not address constructs and, after the visit, measures of perceived benefits, barriers, susceptibility, self-efficacy, intention, and completion of CRC screening within 6 months. Results: Physicians discussed CRC screening during 38 encounters (76%) and addressed behavioral constructs during 26 (52%). Relative to visits without CRC screening discussion, visits with discussion were associated with increased perceived susceptibility (β = 0.39; 95% CI, 0.09-0.68) and screening intention (β = 0.42; 95% CI, 0.11-0.73) after the visit but no significant change in perceived benefits, barriers, or self-efficacy. Within 6 months, 17 of 38 patients (45%) who discussed screening completed screening compared with 0 of 12 patients who did not discuss screening (P = .001). Associations between discussions and outcomes were similar whether or not counseling addressed behavioral constructs. Conclusions: These findings suggest that physician counseling is associated with increased patient perception of CRC susceptibility, greater screening intention, and completion of screening regardless of whether counseling addresses behavioral constructs.

Original languageEnglish (US)
Pages (from-to)673-681
Number of pages9
JournalJournal of the American Board of Family Medicine
Volume24
Issue number6
DOIs
StatePublished - Nov 2011

Fingerprint

Early Detection of Cancer
Counseling
Colorectal Neoplasms
Physicians
Self Efficacy
Primary Health Care
Primary Care Physicians
Health Status
Appointments and Schedules
Cohort Studies
Regression Analysis
Prospective Studies

Keywords

  • Behavioral counseling
  • Cancer research
  • Colorectal cancer screening
  • Communication

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice

Cite this

@article{693784a3d56a41cc91d6222e3f3a7571,
title = "Physician counseling for colorectal cancer screening: Impact on patient attitudes, beliefs, and behavior",
abstract = "Purpose: To determine how often primary care physicians address patient-level health behavioral constructs that are associated with colorectal cancer (CRC) screening and whether physician counseling addressing constructs is associated with favorable changes in patients' attitudes, beliefs, intentions, and subsequent screening. Methods: We conducted a prospective cohort study of patients eligible for CRC screening and attending routine appointments within two academic primary care clinics (50 patients, 20 primary care clinicians). Patients completed validated measures of behavioral constructs associated with CRC screening (benefits, barriers, susceptibility, self-efficacy, intention, and stage of readiness) before and after their visits. Audio-recorded discussions of CRC screening were coded for conversation addressing constructs. Bivariate and regression analyses estimated associations between discussions that did and did not address constructs and, after the visit, measures of perceived benefits, barriers, susceptibility, self-efficacy, intention, and completion of CRC screening within 6 months. Results: Physicians discussed CRC screening during 38 encounters (76{\%}) and addressed behavioral constructs during 26 (52{\%}). Relative to visits without CRC screening discussion, visits with discussion were associated with increased perceived susceptibility (β = 0.39; 95{\%} CI, 0.09-0.68) and screening intention (β = 0.42; 95{\%} CI, 0.11-0.73) after the visit but no significant change in perceived benefits, barriers, or self-efficacy. Within 6 months, 17 of 38 patients (45{\%}) who discussed screening completed screening compared with 0 of 12 patients who did not discuss screening (P = .001). Associations between discussions and outcomes were similar whether or not counseling addressed behavioral constructs. Conclusions: These findings suggest that physician counseling is associated with increased patient perception of CRC susceptibility, greater screening intention, and completion of screening regardless of whether counseling addresses behavioral constructs.",
keywords = "Behavioral counseling, Cancer research, Colorectal cancer screening, Communication",
author = "Fenton, {Joshua J} and Jerant, {Anthony F} and {Von Friederichs-Fitzwater}, {Marlene M.} and Tancredi, {Daniel J} and Peter Franks",
year = "2011",
month = "11",
doi = "10.3122/jabfm.2011.06.110001",
language = "English (US)",
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pages = "673--681",
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T1 - Physician counseling for colorectal cancer screening

T2 - Impact on patient attitudes, beliefs, and behavior

AU - Fenton, Joshua J

AU - Jerant, Anthony F

AU - Von Friederichs-Fitzwater, Marlene M.

AU - Tancredi, Daniel J

AU - Franks, Peter

PY - 2011/11

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N2 - Purpose: To determine how often primary care physicians address patient-level health behavioral constructs that are associated with colorectal cancer (CRC) screening and whether physician counseling addressing constructs is associated with favorable changes in patients' attitudes, beliefs, intentions, and subsequent screening. Methods: We conducted a prospective cohort study of patients eligible for CRC screening and attending routine appointments within two academic primary care clinics (50 patients, 20 primary care clinicians). Patients completed validated measures of behavioral constructs associated with CRC screening (benefits, barriers, susceptibility, self-efficacy, intention, and stage of readiness) before and after their visits. Audio-recorded discussions of CRC screening were coded for conversation addressing constructs. Bivariate and regression analyses estimated associations between discussions that did and did not address constructs and, after the visit, measures of perceived benefits, barriers, susceptibility, self-efficacy, intention, and completion of CRC screening within 6 months. Results: Physicians discussed CRC screening during 38 encounters (76%) and addressed behavioral constructs during 26 (52%). Relative to visits without CRC screening discussion, visits with discussion were associated with increased perceived susceptibility (β = 0.39; 95% CI, 0.09-0.68) and screening intention (β = 0.42; 95% CI, 0.11-0.73) after the visit but no significant change in perceived benefits, barriers, or self-efficacy. Within 6 months, 17 of 38 patients (45%) who discussed screening completed screening compared with 0 of 12 patients who did not discuss screening (P = .001). Associations between discussions and outcomes were similar whether or not counseling addressed behavioral constructs. Conclusions: These findings suggest that physician counseling is associated with increased patient perception of CRC susceptibility, greater screening intention, and completion of screening regardless of whether counseling addresses behavioral constructs.

AB - Purpose: To determine how often primary care physicians address patient-level health behavioral constructs that are associated with colorectal cancer (CRC) screening and whether physician counseling addressing constructs is associated with favorable changes in patients' attitudes, beliefs, intentions, and subsequent screening. Methods: We conducted a prospective cohort study of patients eligible for CRC screening and attending routine appointments within two academic primary care clinics (50 patients, 20 primary care clinicians). Patients completed validated measures of behavioral constructs associated with CRC screening (benefits, barriers, susceptibility, self-efficacy, intention, and stage of readiness) before and after their visits. Audio-recorded discussions of CRC screening were coded for conversation addressing constructs. Bivariate and regression analyses estimated associations between discussions that did and did not address constructs and, after the visit, measures of perceived benefits, barriers, susceptibility, self-efficacy, intention, and completion of CRC screening within 6 months. Results: Physicians discussed CRC screening during 38 encounters (76%) and addressed behavioral constructs during 26 (52%). Relative to visits without CRC screening discussion, visits with discussion were associated with increased perceived susceptibility (β = 0.39; 95% CI, 0.09-0.68) and screening intention (β = 0.42; 95% CI, 0.11-0.73) after the visit but no significant change in perceived benefits, barriers, or self-efficacy. Within 6 months, 17 of 38 patients (45%) who discussed screening completed screening compared with 0 of 12 patients who did not discuss screening (P = .001). Associations between discussions and outcomes were similar whether or not counseling addressed behavioral constructs. Conclusions: These findings suggest that physician counseling is associated with increased patient perception of CRC susceptibility, greater screening intention, and completion of screening regardless of whether counseling addresses behavioral constructs.

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