Incidence and mortality rates for colorectal cancer (CRC) are consistently higher in African compared to Caucasian Americans. One possible explanation for this observation would be a disparity between the effectiveness of current CRC screening efforts between African and Caucasian Americans. Colonoscopy plays an integral part in all currently recommended screening strategies.
Specific aim #1 of this study is to observe and analyze possible demographic predictors of compliance with referral for outpatient colonoscopy. The hypotheses addressed by the specific aim include: Hypothesis 1.1) The fraction of patients compliant with referral for colonoscopy is significantly lower in African American compared to Caucasian American patients after controlling for covariates. Hypothesis 1.2) The fraction of patients compliant with referral for colonoscopy is significantly lower in patients from lower socioeconomic strata compared to patients from higher socioeconomic strata after controlling for covariates.
Specific aim #2 of this study is to measure and analyze the levels of knowledge about CRC, perceived risk of developing and dying from CRC, fear and fatalism concerning CRC, and perceived benefits and barriers to CRC screening in patients referred for outpatient colonoscopy using validated behavioral measurement scales. The hypotheses addressed by this specific aim include: Hypothesis 2.1) Patients not compliant with referral for colonoscopy have significantly different measured behavioral scale scores than compliant patients. Hypothesis referral for colonoscopy have significantly different measured behavioral scale scores than compliant patients. Hypothesis 2.2) African American patients have significantly different measured behavioral scale scores than patients from higher socioeconomic strata after controlling for covariates. The methods used to accomplish these specific aims will include the identification of patients through a continuous review of referrals for colonoscopy, the contacting of eligible patients by telephone, and the administration of a survey instrument containing both demographic and behavioral elements. The results of this study can be used to develop interventions to increase CRC screening compliance among African Americans and other disadvantaged groups that are tailored to their attitudes and beliefs concerning colorectal cancer, colorectal cancer screening, and colonoscopy. Furthermore, the results of this study will provide pilot data concerning the performance and variance of the behavioral scales employed for use in designing future studies.
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