The New York City Research and Improvement Networking Group (NYC RING)

Doctor Patient Relationship about Colorectal Cancer Screening

This is an observational, qualitative assessment study of the variance in doctor-patient discussion about cancer screening and its association with low-income patients’ screening outcomes.

Principal Investigator
Carma Bylund, PhD, Memorial Sloan-Kettering Cancer Center
Elisa Weiss PhD, Montefiore Medical Center

Project Timeline
Launch: January 2012

Study Overview
This study proposes to apply established communication theory to explore the variance in doctor-patient discussions about cancer screening through an observational study of consultations in which cancer screening is discussed. In line with important tenets of communication theory, both the content of the cancer screening discussion as well as the relational components of the communication will be measured in an effort to assess how communication affects adherence to screening recommendations. Colorectal cancer (CRC) screening in low-income patients will be the context for this study as disparities in CRC screening are significant and adhering to screening recommendations requires an active and measurable behavior on the part of the patient. The study aims to1) describe doctor-patient communication about CRC screening in low income populations, 2) to examine the association between doctor-patient communication about CRC screening and low-income patients’ screening outcomes, and 3) to examine how communication accommodation in CRC screening discussions affects low-income patients’ screening outcomes.
The target sample of this study will be 144 doctor-patient dyads who discuss CRC screening during the course of a clinical visit. Specifically, we expect to recruit and consent 16 doctors who will participate in the study and who, in turn, will allow us to recruit and consent their patients. We plan to obtain audio recordings of 9 consultations in which CRC screening is discussed for each of the 16 doctors. Eligibility requirements for patients will be: (1) a patient of one of 16 participating doctors; (2) between 50 and 75 years of age; (3) due for screening at the time of their visit (e.g., no colonoscopy in 10 years, no flexible sigmoidoscopy or barium enema five years, and no FOBT in the past year); (4) fluent in English; (5) coming for either an annual physical exam or chronic care follow up visit; (6) able to provide informed consent; and (7) low income. Low income will be defined for patients less than 65 years as being on Medicaid. Low income will be defined for patients 65-75 years old by insurance status; we will recruit only patients who have one of the following three types of insurance coverage: 1) Medicare and Medicaid; 2) Medicare plus pharmaceutical coverage through the New York State Elderly Pharmaceutical Coverage Program (EPIC), which has an income cap of $35,000 for singles and $50,000 for married individuals; or 3) Medicare only, with no supplemental coverage.

Contact information:
Carma Bylund, PhD, Princial Investigator, bylundlc@mskcc.org
Claudia Lechuga, claudia.lechuga@einstein.yu.edu

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