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National Institutes of Health: National Cancer Institute: Division of Cancer Control and Population Sciences
Grant Details

Grant Number: 5R01CA112379-04 Interpret this number
Primary Investigator: Elston Lafata, Jennifer
Organization: Henry Ford Health System
Project Title: Physician Recommendation and Colorectal Cancer Screening
Fiscal Year: 2009
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Abstract

DESCRIPTION (provided by applicant): Data from our own efforts and those of others indicate that different physicians discuss different things when recommending cancer screening. The U.S. Preventive Services Task Force (USPSTF) while not endorsing a specific style of physician-patient interaction, recently advocated for the use of shared decision-making when making preventive service recommendations to individual patients. We propose to use a mixed-method approach that includes both qualitative and quantitative data collection and analyses to understand the use and utility of different aspects of shared decision-making when physicians recommend CRC screening in primary care. First, we will use direct observation and audio-recording of routine health maintenance visits (n=900) to characterize the nature and content of CRC screening discussions in primary care (Aim 1). Results from these qualitative efforts will be used to derive quantitative measures characterizing physician-patient discussions of CRC screening in primary care. In the second stage, we will join these qualitatively derived measures characterizing physician-patient discussions of CRC screening with automated claims/laboratory data to determine their relationship to 12-month post-visit CRC screening use (Aim 2). A combined pre- and post-visit patient survey will allow us to assess the concordance of patient preferences for screening modality, information, and participation in decision-making with what occurs in the observed visit. We will then be able to evaluate the effect of these concordances on 12-month post-visit CRC screening use (Aim 3). We will use the Henry Ford Health System (HFHS), a large integrated delivery system serving Detroit and its surrounding suburbs, as the setting for these efforts. The diversity and size of the HFHS primary care physician and patient populations combined with the comprehensive, existing automated data systems makes this an ideal environment in which to conduct the proposed work. By joining detailed accounts of the contribution of both physicians and patients to CRC screening discussions in the real world of primary care with subsequent CRC screening use and patient reported preferences, results from the proposed project will inform a new generation of interventions aimed at improving CRC screening participation. They will provide valuable information for training both physicians and patients how to effectively discuss CRC screening as well as facilitate the development of decision aides and policies for diverse populations.

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Publications

Patient-physician Colorectal Cancer Screening Discussions And Screening Use
Authors: Lafata J.E. , Divine G. , Moon C. , Williams L.K. .
Source: American Journal Of Preventive Medicine, 2006 Sep; 31(3), p. 202-9.
PMID: 16905030
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Inconsistencies In Patient Perceptions And Observer Ratings Of Shared Decision Making: The Case Of Colorectal Cancer Screening
Authors: Wunderlich T. , Cooper G. , Divine G. , Flocke S. , Oja-Tebbe N. , Stange K. , Lafata J.E. .
Source: Patient Education And Counseling, 2010 Sep; 80(3), p. 358-63.
PMID: 20667678
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Patient-rated Importance And Receipt Of Information For Colorectal Cancer Screening
Authors: Flocke S.A. , Stange K.C. , Cooper G.S. , Wunderlich T.L. , Oja-Tebbe N. , Divine G. , Lafata J.E. .
Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2011 Oct; 20(10), p. 2168-73.
PMID: 21813727
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Patient-physician Colorectal Cancer Screening Discussions: Delivery Of The 5a's In Practice
Authors: Lafata J.E. , Cooper G.S. , Divine G. , Flocke S.A. , Oja-Tebbe N. , Stange K.C. , Wunderlich T. .
Source: American Journal Of Preventive Medicine, 2011 Nov; 41(5), p. 480-6.
PMID: 22011418
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Prioritization Of Evidence-based Preventive Health Services During Periodic Health Examinations
Authors: Shires D.A. , Stange K.C. , Divine G. , Ratliff S. , Vashi R. , Tai-Seale M. , Lafata J.E. .
Source: American Journal Of Preventive Medicine, 2012 Feb; 42(2), p. 164-73.
PMID: 22261213
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Factors Associated With Patient Reports Of Positive Physician Relational Communication
Authors: Shay L.A. , Dumenci L. , Siminoff L.A. , Flocke S.A. , Lafata J.E. .
Source: Patient Education And Counseling, 2012 Oct; 89(1), p. 96-101.
PMID: 22554386
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Three Types Of Ambiguity In Coding Empathic Interactions In Primary Care Visits: Implications For Research And Practice
Authors: Stone A.L. , Tai-Seale M. , Stults C.D. , Luiz J.M. , Frankel R.M. .
Source: Patient Education And Counseling, 2012 Oct; 89(1), p. 63-8.
PMID: 22809831
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Patients With Mental Health Needs Are Engaged In Asking Questions, But Physicians' Responses Vary
Authors: Tai-Seale M. , Foo P.K. , Stults C.D. .
Source: Health Affairs (project Hope), 2013 Feb; 32(2), p. 259-67.
PMID: 23381518
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Patient-physician Colorectal Cancer Screening Discussion Content And Patients' Use Of Colorectal Cancer Screening
Authors: Lafata J.E. , Cooper G. , Divine G. , Oja-Tebbe N. , Flocke S.A. .
Source: Patient Education And Counseling, 2014 Jan; 94(1), p. 76-82.
PMID: 24094919
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Sexual Health Discussions With Older Adult Patients During Periodic Health Exams
Authors: Ports K.A. , Barnack-Tavlaris J.L. , Syme M.L. , Perera R.A. , Lafata J.E. .
Source: The Journal Of Sexual Medicine, 2014 Apr; 11(4), p. 901-8.
PMID: 24517714
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Managed Care Patients' Preferences, Physician Recommendations, And Colon Cancer Screening
Authors: Hawley S. , Lillie S. , Cooper G. , Elston Lafata J. .
Source: The American Journal Of Managed Care, 2014 Jul; 20(7), p. 555-61.
PMID: 25295401
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