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AGA Abstracts Mo1069 Addressing Low Colorectal Cancer Screening in African Americans: Focus Groups Reveal Insights for Developing an Effective Intervention Folasade P. May, Cynthia B. Whitman, Ksenia Varlyguina, Erica G. Bromley, Bibiana M. Martinez, Brennan M. Spiegel Background: African Americans (AAs) are disproportionately affected by high incidence and mortality from colorectal cancer (CRC). Although low screening rates amongst AAs have prompted efforts to increase uptake, previous interventions were rarely developed in concert with members of the AA community. In this study, we conducted focus groups with AAs to determine patient preferences for the content and mode of dissemination of culturally-tailored CRC screening interventions aimed at increasing screening uptake. Meth- ods: We recruited 45 to 75 year-old AAs from a large urban VA system and through Craigslist online advertisements. We divided participants into 4 focus groups, stratified by gender and CRC screening status. We used a semi-structured interview script employing open-ended elicitation and qualitative analysis software (ATLAS.TI) to code transcript data and group into a priori domains: barriers and facilitators to screening colonoscopy, sources of health and screening information, and preferred modes and content for CRC educational interventions. Results: We enrolled 38 AAs (mean age=54) into the 4 groups: screened AA males (n=7), unscreened AA males (n=6), screened AA females (n=12), and unscreened AA females (n= 13). Commonly reported barriers to colonoscopy included perceived invasiveness of the procedure, colon preparation, and financial concerns. Facilitators included poor diet/health and general desire to prevent CRC. Common sources of general health information included internet/television/radio, and medical providers. Information about colonoscopic CRC screen- ing was obtained most commonly from medical personnel or media sources. Consistent with this finding, media sources were the preferred mode of disseminating CRC screening information. Participants specifically suggested dissemination of information through com- mercials, billboards, influential personalities in the AA community, internet, and radio. AAs suggested future interventions include culturally specific information, including details about increased risk, accessing care, and the dispelling of myths. Participants also indicated their desire to receive information from their providers about all available CRC screening options rather than colonoscopy alone. Conclusions: Our findings inform the content and methods of dissemination of future public health interventions to improve CRC screening among AAs. Future interventions should utilize media outlets, emphasize increased risk among AAs, and address ethnic-specific barriers. The use of qualitative studies in implementation science assures that interventions will be appropriately patient-tailored. As healthcare reform extends health insurance options to patients who previously had limited access to care, it will be important to develop tailored interventions to maximize the uptake of newly accessible preventive services. Mo1070 Colorectal Health Disparities in a Government Healthcare System: a Retrospective Comparative Study Using Data From a A US Veterans Affairs Population Roopa Gandhi, John G. Muriithi, Ernest Wayde, Melinda Wayde, Salma Akram Background: Colorectal health disparities are a growing concern in the US. In 2010, the Patient Protection and Affordable Care Act was passed in the hope of providing access to healthcare for all Americans. The US Department of Veterans Affairs (VA) healthcare provides medical care with little or no financial barrier to veterans based on service connection and eligibility. Objective: The aim of our study was to determine colorectal cancer (CRC) stage at presentation and mortality in the Dayton VA healthcare system compared to a nationally representative sample - the Surveillance, Epidemiology, and End Results (SEER) program. Methods: We identified a cohort of 267 patients with a diagnosis of CRC from 2000-2010 at the Dayton VA Medical Center. The cohort was divided into copay exempt and copay- for- service groups. We compared age at diagnosis, stage of cancer, and one and five-year survival of each group to the national SEER database. Results: Total of 207 (78%) patients had private insurance or status that allowed for copay exemption, and 61 (22%) patients did not qualify for exemption. The average age at CRC diagnosis for all patients was 69 years. There was no statistical difference in number of patients diagnosed at each stage of cancer between the two groups. A Kaplan Meier was conducted to characterize survival among patients who were copay exempt and copay-for-service. The resulting curve showed no significant difference in five year survival between the two groups. In addition, the groups had no significant difference in five-year survival based on stage at diagnosis (Figure 2). Compared to the SEER data, our cohort had an overall lower five year survival when subgrouped by stage. Conclusions: Copay costs were not a predictor of later stage CRC at diagnosis, or a decreased survival. Our data supports that CRC stage at diagnosis has the most impact on overall survival. Figure 1- Cohort Survival Compared to SEER database *p=0.322, **p=0.791,***p=0.765 Figure 2- Five Year Survival Based on Stage at Diagnosis S-548 AGA Abstracts Mo1071 Colorectal Cancer Screening Rates in an Urban Ambulatory Clinic by Internal Medicine Residents Compared to the National Average; Identifying Barriers to Increased Colorectal Cancer Screening Manuel O. Gonzalez, Lilly M. Sadri, Alfred B. Leong, Smruti R. Mohanty, Parag Mehta Objective: Colorectal cancer (CRC) screening has proven to be a very effective tool in helping clinicians in detecting adenomatous polyps or colorectal cancer in its early stages. Despite having established CRC screening guidelines, national CRC screening rates vary between 54-75% of the at risk population depending on the screening rate in each state. An increased emphasis has been placed not only on educating the public but also in ensuring physicians in clinical training are educated on proper screening guidelines. Therefore, we investigated if an increased effort to improve internal medicine resident's education regarding CRC screening guidelines has resulted in improved CRC screening rates in an internal medicine outpatient medical resident clinic. The goal of this study is to compare our center's screening rate that to New York state average CRC screening rate and also to investigate the rate of screening among internal medicine residents based upon the level of training (PGY year I- III). Methods: We conducted a cross sectional study of patients who presented to the outpatient medical clinic of New York Methodist Hospital, Brooklyn, NY, over the span of six weeks. At the time the patient was being seen by their assigned medical residents, the patient filled out a questionnaire that collected demographics, data on the use of screening colonoscopy, fecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), influenza vac- cine, screening mammography and screening Pap smears. The data capture was integrated as part of the medical interview by the resident. This data was collected at the end of the clinic visit and logged by a clinical investigator. Results: Four hundred and eighty three charts were reviewed. The CRC screening rates were as follows: 66% for PGY-1's, 72% for PGY-2's and 77% for PGY-3's; however no statistical difference was noted between the three groups (p < 0.05). The overall CRC screening rate at our institution was 72% which was not statistically different from the New York State average (p < 0.05). However there was a statistically significant increase in CRC screening rates in Hispanics (76%, p = 0.034) and in patients within the age range of 70-79 (82%, p = 0.015). Conclusions: Overall, when compared to NY State, patients that are followed by internal medicine residents at our urban outpatient teaching clinic did not receive higher rates of CRC screening nor did rates of screening vary with level of training (PGY year). There are several strategies that have been described in literature that have been shown to increase CRC screening rates by focusing on improved training of resident physicians, testing their knowledge of current screening guidelines, and introducing computerized prompts to help guide and remind the clinician of appropriate screening practices. Table 1. Study population breakdown. Table 2. Statistical analysis comparing our CRC screening rates to the 2010 New York State screening rates as determined by the CDC.
