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Predictors of colorectal screening in rural Colorado: testing to prevent colon cancer in the high plains research network.

CONTEXT
Colorectal cancer is the second leading cause of cancer death in the United States, yet screening rates are well below target levels. Rural communities may face common and unique barriers to health care, particularly preventive health care.


PURPOSE
To establish baseline attitudinal, knowledge, belief, and behavior measures on colorectal cancer screening and to identify barriers to or predictors of colorectal cancer screening.


METHODS
As part of a controlled trial using a quasi-experimental, pretest, post-test design, we conducted a baseline telephone survey of 1,050 rural eastern Colorado residents aged 50 years and older. Smaller counties were over-sampled to ensure a minimum of 30 completed interviews per county.


FINDINGS
Seventy-seven percent reported they ever had a colorectal cancer screening test and 59% were up-to-date on at least 1 test. The most important independent predictors of being up-to-date were having visited a doctor or other health care practitioner for a checkup in the past year, having personal or family history of colon polyps or cancer, and having asked for a colorectal cancer screening test. Financial concerns were reported reasons for not obtaining fecal occult blood testing by 18% and colonoscopy by 21%.


CONCLUSIONS
This study suggests that health care providers should be vigilant in counseling their patients 50 and older to have a colorectal cancer test. Community programs designed to promote colon cancer screening should encourage residents to have regular contact with their primary care physician and ask their doctor for a screening test. Additionally, programs should provide financial assistance for testing for low-income and uninsured patients.