1. Epidemiology and Global Health

Cancer risk perception and physician communication behaviors on cervical cancer and colorectal cancer screening

  1. Diane M Harper  Is a corresponding author
  2. Madiha Tariq
  3. Asraa Alhawli
  4. Nadia Syed
  5. Minal Patel
  6. Ken Resnicow
  1. Department of Family Medicine, University of Michigan School of Medicine, United States
  2. Department of Obstetrics & Gynecology, University of Michigan School of Medicine, United States
  3. Department of Women’s Studies, University of Michigan, College of Literature, Science and the Arts, United States
  4. Arab Community Center for Economic and Social Services (ACCESS), United States
  5. Department of Health Behavior & Health Education, University of Michigan School of Public, United States
  6. Outreach and Health Disparities Research, University of Michigan Rogel Cancer Center, United States
  7. Center for Health Communications Research, University of Michigan, School of Public Health, United States
https://doi.org/10.7554/eLife.70003
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  1. Diane M Harper
  2. Madiha Tariq
  3. Asraa Alhawli
  4. Nadia Syed
  5. Minal Patel
  6. Ken Resnicow
(2021)
Cancer risk perception and physician communication behaviors on cervical cancer and colorectal cancer screening
eLife 10:e70003.
https://doi.org/10.7554/eLife.70003
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7 tables and 5 additional files

Tables

Table 1
Survey questions.
Cancer risk perception and knowledge
 Cancer is most often caused by a person’s behavior or lifestyle
 It seems like everything causes cancer
 I'd rather not know my chance of getting cancer
 There’s not much you can do to lower your chances of getting cancer
 There are so many recommendations about cancer prevention, it’s hard to know which ones to follow
 When I think about cancer, I automatically think about death
 How likely are you to get cancer in your lifetime compared to others your age?
Physician communication behavior – In the past 12 months, how often did your PCP …
 Give you the chance to ask all health-related questions
 Give you the attention you needed to your feelings/emotions
 Involve you in the decisions about your health care as much as you wanted
 Make sure you understood the things you needed to do to take care of your health
 Explain things in a way you could understand
 Spend enough time with you
 Help you deal with feelings of uncertainty about your health or health care
Table 2
Demographic descriptors of all screening populations.
Age, years (mean, SD)57.74.5
Race/ethnicityN%
 White27168.8
 African American/Black7519.0
 Other*112.8
 MENA (Middle Eastern North African)379.4
Religion
 Christian†24163.6
 Jewish143.7
 Muslim266.9
 No religion/no belief in god9825.9
Education
 High school or less8521.6
 Some college12331.2
 College graduate13835.0
 Post college education4812.2
Marital status‡
 Married/partnered23659.9
 Single15639.6
Income
 <$10,000287.1
 $10–49,99914837.6
 $50–99,99914035.5
 ≥$100,0007017.8
Any chronic condition§29173.9

  1. *Other includes Asian or other Pacific Islander, Hispanic, American Indian, and multi-race. This group was further excluded from our analyses.

    †Christian includes Chaldean, Coptic, Assyrian, Catholic, Jehovah Witness.

  2. ‡Married/partnered includes married and living as married; single includes divorced, widowed, separated, and never been married.

    §Chronic conditions include diabetes, hypertension, heart disease (heart attack, angina, congestive heart failure), lung disease (asthma, emphysema, chronic bronchitis), arthritis, depression, or cancer.

Table 3
Risk perceptions and cancer knowledge by screening categories.
Both cervical cancer and CRC screeningNeither screeningCervical cancer screening aloneCRC screening alone
N=394N=213N=52N=82N=47
Cancer risk perceptions and knowledgeN%N%N%N%
Cancer is caused by behavior or lifestyle
 Strongly/somewhat disagree12860.1%2958.0%4558.4%3063.8%
 Somewhat/strongly agree8539.9%2142.0%3241.6%1736.2%
Everything causes cancer
 Strongly/somewhat disagree7434.7%1529.4%2835.9%1634.0%
 Somewhat/strongly agree13965.3%3670.6%5064.1%3166.0%
I’d rather not know my chance of getting cancer
 Strongly/somewhat disagree16075.8%3261.5%5368.8%3880.9%
 Somewhat/strongly agree5124.2%1838.5%2431.2%919.2%
There’s not much you can do to lower your chances of getting cancer (1)
 Strongly/somewhat disagree18084.9%3567.3%5977.6%3676.6%
 Somewhat/strongly agree3215.1%1732.7%1722.4%1123.4%
There are so many recommendations about cancer prevention, it’s hard to know which ones to follow
 Strongly/somewhat disagree7434.9%1325.0%1924.7%1327.7%
 Somewhat/strongly agree13865.1%3975.0%5875.3%3472.3%
When I think about cancer, I automatically think about death (2)
 Strongly/somewhat disagree11051.9%2848.1%2633.8%1940.4%
 Somewhat/strongly agree10248.1%2751.9%5166.2%2859.6%
How likely are you to get cancer in your lifetime compared to others your age?
 Much less, less likely or about the same17783.5%4790.4%6583.3%3574.5%
 More or much more likely3516.5%59.6%1316.7%1225.5%

  1. (1) p<0.05 [H(3, N=387)=9.04].

    (2) p<0.05 [H(3, N=388)=8.22].

Table 4
Primary care physician communication behaviors associated with the screening categories.
Both cervical cancer and CRC screeningNeither screeningCervical cancer screening aloneCRC screening alone
N=394N=213N=52N=82N=47
Communication behaviors
Chance to ask all health-related questions (1)
 Always/usually19592.9%3394.3%6282.7%3786.1%
 Sometimes/never157.1%25.7%1317.3%614.0%
Give you the attention you needed to your feelings/emotions (2)
 Always/usually18890.8%3186.1%5473.0%3073.2%
 Sometimes/never199.2%513.9%2027.0%1126.8%
Involved you in the decisions about your health care as much as you wanted (3)
 Always/usually19192.7%2976.3%6081.1%3583.3%
 Sometimes/never157.3%923.7%1418.9%716.7%
Make sure you understood the things you needed to do to take care of your health (4)
 Always/usually19393.7%3694.7%6483.1%3786.1%
 Sometimes/never136.3%25.3%1316.9%614.0%
Explain things in a way you could understand
 Always/usually19293.7%3386.8%6584.4%3888.4%
 Sometimes/never136.3%513.2%1215.6%511.6%
Spend enough time with you (5)
 Always/usually18891.3%3186.1%5875.3%3479.1%
 Sometimes/never188.7%513.9%1924.7%920.9%
Help you deal with feelings of uncertainty about your health or health care (6)
 Always/usually16188.5%2887.5%5474.0%3075.0%
 Sometimes/never2111.5%412.5%1926.0%1025.0%

  1. (1) p<0.05 [H (3, N=363)=7.888].

    (2) p<0.001 [H (3, N=358)=17.98].

  2. (3) p<0.01 [H (3, N=360)=12.89].

    (4) p<0.05 [H (3, N=364)=9.207].

  3. (5) p<0.01 [H (3, N=362)=13.629].

    (6) p<0.05 [H (3, N=327)=10.49136].

Table 5
Predictors of screening by cancer risk perception and knowledge.
Both screens compared to neitherBoth compared to a cervix only
Cancer risk perception and knowledgeaORL95U95aORL95U95
There’s not much you can do to lower your chances of getting cancer
 Strongly/somewhat disagree1.651.162.351.180.851.66
 Somewhat/strongly agree1.01.0
When I think about cancer, I automatically think about death
 Strongly/somewhat disagree1.00.731.361.411.071.86
 Somewhat/strongly agree1.01.0

  1. Bold/red is significant.

    No other screening population comparison was significant.

  2. No other beliefs about cancer were significant.

    Adjusted for all cancer risk perception and knowledge questions.

Table 6
Communication behaviors predicting screening.
Both screenings compared to neitherBoth screenings compared to cervix only
Communication behavioraORL95U95aORL95U95
Did your PCP involve you in the decisions about your health care as much as you wanted
 Always/usually1.991.263.141.721.162.55
 Sometimes/never1.01.0

  1. PCP means primary care physician.

    Bold/red is significant.

  2. No other communication behavior was significant.

    No other screening population comparison was significant.

  3. Adjusted for all communication behavior questions.

Table 7
Communication behavior, age, and race predict screening.
Both screens compared to neitherBoth compared to cervix aloneCervix only compared to CRC alone
aORL95U95aORL95U95aORL95U95
Age1.050.971.141.131.061.210.840.770.93
Race/ethnicity
 White1.01.01.0
 Black1.740.873.461.761.033.000.490.201.24
 MENA0.330.150.700.300.160.564.591.1318.67
Did your PCP involve you in the decisions about your health care as much as you wanted?
 Always/usually1.961.223.151.581.042.421.010.591.73
 Sometimes/never1.01.01.0

  1. PCP means primary care physician.

    Bold/red is significant.

  2. Adjusted for age, race/ethnicity, and PCP-patient dyad decision-making.

Additional files

Supplementary file 1

Screening outcomes by total population religion and by Middle East and North African (MENA) ethnicity.

https://cdn.elifesciences.org/articles/70003/elife-70003-supp1-v1.docx
Supplementary file 2

Agreement with cancer risk perceptions and physician communication behaviors by self-declared religion.

https://cdn.elifesciences.org/articles/70003/elife-70003-supp2-v1.docx
Supplementary file 3

Cancer screenings by religion and race/ethnicity.

https://cdn.elifesciences.org/articles/70003/elife-70003-supp3-v1.docx
Reporting standard 1

STROBE statement.

https://cdn.elifesciences.org/articles/70003/elife-70003-repstand1-v1.docx
Transparent reporting form
https://cdn.elifesciences.org/articles/70003/elife-70003-transrepform-v1.docx

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  1. Diane M Harper
  2. Madiha Tariq
  3. Asraa Alhawli
  4. Nadia Syed
  5. Minal Patel
  6. Ken Resnicow
(2021)
Cancer risk perception and physician communication behaviors on cervical cancer and colorectal cancer screening
eLife 10:e70003.
https://doi.org/10.7554/eLife.70003