Gender differences in colorectal cancer screening, attitudes and information preferences Joan M....

Gender differences in Gender differences in colorectal cancer screening, colorectal cancer screening, attitudes and information attitudes and information preferencespreferences

Joan M. Griffin, PhD Joan M. Griffin, PhD

Greta Friedemann-SGreta Friedemann-Sáánchez, PhDnchez, PhD

Diana Burgess, PhD Diana Burgess, PhD

Melissa Partin, PhDMelissa Partin, PhD

BackgroundBackground

Colorectal cancer is the 3Colorectal cancer is the 3rdrd most most common cancer and the 3common cancer and the 3rdrd leading leading cause of cancer deaths. cause of cancer deaths.

Adherence to screening guidelines Adherence to screening guidelines has been found to reduce mortality. has been found to reduce mortality.

Several studies have found women Several studies have found women are less likely to be adherent to are less likely to be adherent to colorectal cancer (CRC) guidelines colorectal cancer (CRC) guidelines than men. than men.

BackgroundBackground

Sources of the screening gender gap are Sources of the screening gender gap are unknown. unknown.

Some possible reasons for the gap Some possible reasons for the gap include: include:

Differences in mode preference (men Differences in mode preference (men prefer endoscopy; women prefer FOBT). prefer endoscopy; women prefer FOBT). Differences in barriers.Differences in barriers.Differences in facilitators. Differences in facilitators.

Exploratory Sequential Exploratory Sequential DesignDesign

1. Focus Groups

2. Survey

Generate Hypotheses

Develop Items

Cognitive Interviews

Qualitative Analysis

QuantAnalysis

QuantResults

Qual Results

Qualitative research Qualitative research main findings*main findings*SIMILAR PREFERENCESSIMILAR PREFERENCES

Men and women both prefer colonoscopy Men and women both prefer colonoscopy for screening. for screening.

BARRIERS/FACILITATORSBARRIERS/FACILITATORS

OverallOverall Perception that women were at lower risk for Perception that women were at lower risk for

CRC (CRC is a “male disease”)CRC (CRC is a “male disease”)

Endoscopy specificEndoscopy specific Fears of exposure, vulnerability for women. Fears of exposure, vulnerability for women.

Fear of pain for menFear of pain for men Different preferences for information about Different preferences for information about

tests.tests.**Friedemann-Sanchez, et al. 2007. Health Expectations. Friedemann-Sanchez, et al. 2007. Health Expectations.

ObjectivesObjectives

To assess gender differences in:To assess gender differences in:

CRC screening ratesCRC screening rates CRC screening mode preferences.CRC screening mode preferences. Barriers and facilitators for CRC Barriers and facilitators for CRC

screeningscreening

Hypotheses Hypotheses

SCREENING BEHAVIORSCREENING BEHAVIOR• Men will be more adherent to CRC Men will be more adherent to CRC

screening guidelines.screening guidelines.• Greater proportion of men than women Greater proportion of men than women

will screened by endoscopy (flex sig or will screened by endoscopy (flex sig or colonoscopy).colonoscopy).

SCREENING PREFERENCESSCREENING PREFERENCES• Men and women will not differ in mode Men and women will not differ in mode

preference for colonoscopy.preference for colonoscopy.

HypothesesHypotheses

BARRIERS TO SCREENINGBARRIERS TO SCREENING Women will be more likely to report Women will be more likely to report

affective barriers (embarrassment, affective barriers (embarrassment, exposure, vulnerability) to endoscopic exposure, vulnerability) to endoscopic screening procedures than menscreening procedures than men

Men will be more likely to report pain as Men will be more likely to report pain as a barrier to endoscopic screening a barrier to endoscopic screening procedures than womenprocedures than women

Women will report lower perceived risk Women will report lower perceived risk for CRCfor CRC

HypothesesHypotheses

FACILITATORS TO SCREENINGFACILITATORS TO SCREENING Women will report stronger Women will report stronger

preferences for information prior preferences for information prior to and during endoscopic to and during endoscopic procedures than men.procedures than men.

MethodsMethods

Cross-sectional, mixed mode (mail and Cross-sectional, mixed mode (mail and phone) surveyphone) survey

Male and female veterans, ages of 50-75 Male and female veterans, ages of 50-75 (600 men, 300 women)(600 men, 300 women)

Used the Minneapolis VAMC’s primary care Used the Minneapolis VAMC’s primary care services in the two years prior to the studyservices in the two years prior to the study

Those with colorectal cancer (CRC), Those with colorectal cancer (CRC), dementia or Alzheimer’s diagnoses dementia or Alzheimer’s diagnoses excludedexcluded

MeasuresMeasures

Adherence:Adherence: Self-report and VA Self-report and VA medical recordsmedical records

Preferences:Preferences: Single-item questionSingle-item questionBarriers:Barriers: Questions developed Questions developed

from qualitative from qualitative workwork and and Vernon’s perceived Vernon’s perceived risk risk for CRCfor CRC

Facilitators:Facilitators: Questions developed Questions developed from from qualitative workqualitative work

ResultsResults

WomeWomenn

MenMen p-p-valuevalue

Age (mean)Age (mean) 59.259.2 62.462.4 <0.01<0.01

Marital status (% Marital status (% married)married)

49.449.4 59.559.5 0.010.01

Income (% <$20,000)Income (% <$20,000) 34.134.1 41.241.2 NSNS

CRC family history (% CRC family history (% yes)yes)

24.924.9 20.620.6 NSNS

Overall response rate:Overall response rate: 77% 77%

(n=686, 241/300 women; 445/600 men)(n=686, 241/300 women; 445/600 men)

Demographics:Demographics:

Results-CRC adherence Results-CRC adherence determined by self-determined by self-reportreport% Guideline Adherent % Guideline Adherent (n=686)(n=686)

WomeWomenn

MenMen p-valuep-value

All modesAll modes 73.173.1 79.379.3 .08.08

FOBTFOBT 22.322.3 23.623.6 .72.72

Flex sigFlex sig 31.931.9 37.037.0 .12.12

Barium enemaBarium enema 11.411.4 17.117.1 .06.06

ColonoscopyColonoscopy 42.442.4 52.452.4 .02.02

Results-CRC adherence Results-CRC adherence determined by medical determined by medical recordrecord% Guideline Adherent % Guideline Adherent (n=686)(n=686)

WomeWomenn


All modesAll modes 49.449.4 53.53.33

NSNS

FOBTFOBT 19.119.1 20.20.22

NSNS

Flex sigFlex sig 25.325.3 27.27.22

NSNS

Barium enemaBarium enema 3.73.7 2.52.5 NSNS

ColonoscopyColonoscopy 18.318.3 20.20.22

NSNS

ResultsResults

Report to records ratio Report to records ratio

WomeWomenn



NSNS

FOBTFOBT 1.381.38 1.21.277

NSNS


NSNS



<.05<.05

ResultsResultsResults-PreferencesResults-Preferences

Mode preference % (n=686)Mode preference % (n=686)

WomeWomenn

MenMen pp<<

FOBTFOBT 29.129.1 25.825.8 NSNS

Barium EnemaBarium Enema 2.62.6 2.72.7 NSNS

Flex sigFlex sig 8.58.5 8.28.2 NSNS

ColonoscopyColonoscopy 41.041.0 39.039.0 NSNS

Don’t want to be Don’t want to be tested*tested*

5.15.1 2.52.5 .05.05

Don’t know*Don’t know* 13.713.7 21.721.7 .01 .01

Results-BarriersResults-Barriers

Affective barriers (% who strongly Affective barriers (% who strongly agree or agree)agree or agree)

WomenWomen MenMen pp<<

Worry about Worry about vulnerabilityvulnerability

36.836.8 20.120.1 .0.011

Worry about body Worry about body exposedexposed

35.135.1 13.513.5 .0.011

Tests are embarrassingTests are embarrassing 35.135.1 13.013.0 .0.011


Anxiety about pain as a barrier (% Anxiety about pain as a barrier (% who strongly agree or agree)who strongly agree or agree)

WomenWomen MenMen pp<<

Worry tests will be Worry tests will be painfulpainful

44.744.7 27.527.5 .0.011

Want medicine for pain Want medicine for pain before testbefore test

56.656.6 52.652.6 NSNS


Perceived risk (% who strongly agree Perceived risk (% who strongly agree or agree)or agree)

WomeWomenn

MenMen pp<<

Chance I might get CRC Chance I might get CRC is highis high

15.215.2 24.724.7 .01.01

Very likely I will get CRCVery likely I will get CRC 5.15.1 7.27.2 .01.01

Chance of getting Chance of getting polyps highpolyps high

15.915.9 18.718.7 NSNS

Results-FacilitatorsResults-Facilitators

Information needs (% who strongly Information needs (% who strongly agree or agree)agree or agree)

WomeWomenn

MenMen pp<<

Before exam, want to Before exam, want to learn what exam will be learn what exam will be like like

93.493.4 89.889.8 NSNS

During exam, want to During exam, want to know what is happening know what is happening at every stepat every step

78.278.2 67.267.2 .01.01

I don’t want any detailsI don’t want any details 13.113.1 15.915.9 .03.03

ConclusionsConclusionsSelf-reports of screening behavior shows a gender Self-reports of screening behavior shows a gender gap in screening; medical record data do not. gap in screening; medical record data do not.

• Gender gap in screening may be due to the fact that Gender gap in screening may be due to the fact that men are more likely to over report having been men are more likely to over report having been screened.screened.

Men and women have similar screening mode Men and women have similar screening mode preferences.preferences.

Differences in screening barriers/facilitatorsDifferences in screening barriers/facilitators• Women have more affective, anxiety-related barriers. Women have more affective, anxiety-related barriers. • Men have a higher perceived risk for developing CRC.Men have a higher perceived risk for developing CRC.• Women and men prefer different types of information Women and men prefer different types of information

before and during endoscopy exams.before and during endoscopy exams.

Future Directions for Future Directions for Research and PolicyResearch and Policy Future research examining gender Future research examining gender

differences in CRC screening should use differences in CRC screening should use medical record data. medical record data.

Need to test if strength of association Need to test if strength of association between barriers/facilitators that vary by between barriers/facilitators that vary by gender affect screening adherence. If so: gender affect screening adherence. If so: – Campaigns to promote screening should Campaigns to promote screening should

include efforts to reduce beliefs that CRC is a include efforts to reduce beliefs that CRC is a male disease. male disease.

– Issues of exposure, vulnerability and Issues of exposure, vulnerability and embarrassment prior to and during exam embarrassment prior to and during exam should be considered through patient should be considered through patient education.education.

Thank youThank you

Adherence-subsample Adherence-subsample with complete medical with complete medical recordsrecords% Guideline adherent based on self % Guideline adherent based on self report (n=345)report (n=345)

WomeWomenn



.23.23

FOBTFOBT 25.025.0 24.24.99

.98.98


.92.92

Barium enemaBarium enema 10.910.9 18.18.66

.08.08


<.01<.01

Adherence-subsample Adherence-subsample with complete medical with complete medical recordsrecords% Guideline Adherent by medical % Guideline Adherent by medical record (n=345)record (n=345)

WomeWomenn



NSNS

FOBTFOBT 18.818.8 21.21.77

NSNS


NSNS



NSNS

Gender differences in colorectal cancer screening, attitudes and information preferences Joan M....

Documents

Transcript of Gender differences in colorectal cancer screening, attitudes and information preferences Joan M....