Colorectal Cancer Screening Communication and Completion Among Black and Hispanic Primary Care Patients

Colorectal cancer (CRC) screening is recommended for all adults aged 45-75 years. However, CRC screening and outcome disparities exist by race and ethnicity.

To examine factors related to Black and Hispanic patients' experiences regarding primary care provider CRC screening communication and completion.

A cross-sectional study.

Black and Hispanic patients with a recent visit at seven primary care clinics in Washington, DC, and Maryland were identified from the electronic medical record.

Participants completed a 10-minute survey on CRC screening. We also collected demographics (age, sex, education, insurance), health literacy, and responses to the Patient-Centered Communication (PCC) scale about CRC screening (PCC; range 1 to 4, 4 = Always) and Distrust in the Healthcare System (range 1 to 4, 4 = greater distrust).

Of the 913 patients we contacted, 278 (30%) agreed to participate, and 204 (70%) completed the survey. Mean age was 57 (SD=8.4), 77% were non-Hispanic Black, 62% female, 57% had a high school diploma or less, 46% had public insurance, and 20% completed the survey in Spanish. Patients reported high health literacy (Ms=4.03; SDs=1.36 & 1.47), high PCC (M=3.59; SD=0.59), and low distrust (M=2.03; SD=0.45). Patients reported that CRC screening was never discussed (13.7%), recommended but not completed (36.3%), previously screened but not up to date (15.2%), and up to date (34.8%). In the multivariate model, older age and health literacy were associated with CRC screening completion, and Hispanic ethnicity was associated with lower CRC screening.

Differences in CRC screening completion were documented by age, ethnicity, and health literacy. Tailoring outreach to younger, Hispanic, and lower health literate populations may improve CRC screening uptake and guideline-adherence.