Assessing endoscopic colorectal screening adherence in an emergency department population

Colorectal cancer (CRC) has the second highest cancer-related mortality rate in the United States. However, CRC screening rates, particularly by endoscopy, are dismally low. The purpose of this study is to determine the factors associated with adherence to endoscopic screening using the emergency department (ED) population.

Structured interviews in English or Spanish were administered to 122 patients, aged > or =50 in the ED of an urban academic medical center. Questions focused on sociodemographic and medical factors, knowledge deficits and attitudes towards screening as well as psychosocial factors that may be associated with screening adherence. Compliance with current screening guidelines was measured by self-report.

The population was sociodemographically diverse. There were significant differences across ethnic groups with regards to awareness and attitudes toward screening as well participation in screening. Age >65, Spanish language during the interview, white ethnicity and having a primary care physician were significant correlates of adherence to screening colonoscopy. Once decisional balance (conspros) was entered into the model, the other factors were no longer significant. Furthermore, physician referral was the strongest correlate of adherence to endoscopic screening.

There are significant sociodemographic, medical and psychosocial barriers preventing CRC screening adherence in ED patients, yet the strongest correlate is physician referral. The ED encounter may serve as an opportunity to provide information and referral for CRC screening.