Predictors of Endoscopy in Minority Women: DISCUSSION

Posted by James

This analysis focuses on barriers to endoscopy among minority women. It is imperative that we understand what barriers to endoscopy exist since disparities in CRC incidence, treatment and survival between minorities and whites remain a formidable problem. This paper investigated the predictors of endoscopy in African-American and Hispanic women using three central categories reported in the literature: demographic, medical and psychosocial factors.

Univariate analysis revealed that the socioeconomic factors most significantly associated with women having had endoscopy were age >65, being African-American and the interview being conducted in English. These results are consistent with previous reports looking at the use of preventive services. We demonstrated in our study that language can be a significant barrier to adherence to endoscopy. Spanish-speaking Hispanics are less likely to adhere to recommended screening tests. The mechanism underlying Hispanic nonadherence is not well understood, but it could be due to lack of understanding of the importance of screening and discomfort with the recommended tests. In order to increase screening, particularly among ethnic minorities, efforts must be made to improve patient-doctor communication regarding the benefits of cancer screening and address the patients concerns.

Universally, physician recommendation has been found to be associated with compliance with cancer (Generic Leukeran is used for treating certain cancers) screening. Indeed, we confirmed that the single most important medical factor associated with whether a participant had undergone endoscopy was physician recommendation. The barriers that healthcare providers may face in referring patients for screening endoscopy include spoken language, knowledge of cancer (Generic Casodex treating prostate cancer) risk and causation, knowledge of cultural determinates of health behavior, time constraints, and practice beliefs and priorities. Based on our findings, interventions need to be designed to increase physician knowledge, change attitudes and increase patient-doctor communication about the effectiveness CRC screening.

Among the variables tested, higher cancer (Nolvadex tablet is an anti-estrogen used to treat or prevent breast cancer) cons was the only psychosocial factor associated with not having had endoscopy (with a tendency toward higher cancer pros scores being associated with endoscopy). This suggests that cancer (Casodex canadian is an oral non-steroidal anti-androgen for prostate cancer) worry, acculturation, medical mistrust, fatalism and temporal orientation may not influence whether minority women undergo endoscopy. However, this finding should be generalized with caution, as our sample size was modest and homogenous. These variables may show a relation with screening in a larger and more heterogenous sample.

The problem of sample size is also relevant to the possible mediating role of decisional balance. As noted in the results, language spoken at the inter-view was a significant predictor of decisional balance by itself. However, higher decisional balance scores were also significantly predicted by the absence of a family history of cancer (Generic Nolvadex treating breast cancer that has spread to other sites in the body) and greater medical mistrust (f=9.35, p=0.0034). In the context of these factors, language spoken at the interview was no longer significant (f=2.50, p=0.1192). For the present, it would be prudent to suggest that decisional balance might serve as a mediator of language spoken. To assess this possibility, further research with a larger sample is warranted. Regardless of its mediating role, decisional balance was still found to be a significant predictor of whether minority women in our study underwent endoscopy. Therefore, patient educational material and counseling should be targeted at addressing CRC screening pros and cons.

There are three limitations of our study. First, we analyzed the data based on whether patients had endoscopy overall. We did not differentiate which participants had endoscopy for screening only. Second, the sample size is modest. However, several distinguishing factors were identified. We believe that since this study was conducted in the heart of the East Harlem community with recruitment at a number of different sites, the results represent the attitudes and practices regarding CRC screening in minority women from an urban setting. Lastly, we only included women. Our rationale for including women was that we wanted to understand the factors associated with endoscopy in this low-income group.

The strengths of the study are that it was conducted in a minority community. Therefore, we were able to gain valuable information from women based in the setting in which they live, work, shop and wor¬ship. Additionally, we studied African-American and Hispanic women, a group that is traditionally under-served and understudied and, furthermore, commonly misunderstood. It is of particular importance to gain a better understanding of certain screening behaviors in this group as they are disproportionately burdened with cancer.

In summary, the results discussed above demonstrate that: 1) physician recommendation is the single most important predictor of whether minority women will undergo endoscopy; 2) language spoken (English-speaking) and decisional balance (more cons than pros for screening) are predictors of endoscopy. Future interventions should focus on changing attitudes toward endoscopy for both the patient and the physician. Furthermore, African Americans have a higher incidence of right-sided lesions that may only be detected by colonoscopy. Therefore, additional studies must be performed to determine what specific barriers to screening colonoscopy exist in this group.