Predictors of Positive Colonoscopy Expectations among Patients in the Rural South – Pathway for Disparities?

Colorectal screenings, used to detect and remove pre-cancerous polyps are usually recommended every 10 years. Overall, 58.6% of adults are up-to-date with their colorectal screening, compared to the Healthy People 2020 target of 70.5%. Screening rates remain lower among some subgroups: immigrants, low income, low education, lacking insurance, and lacking a usual source of care. From an ongoing study of 4300 colonoscopy patients and caregivers, data are reported on the first 290 patients and caregivers enrolled; participants completed a survey pre-colonoscopy including items on their expectations regarding the procedure. Additionally, caregivers completed a brief post-colonoscopy survey on actual outcomes. Patients were predominantly female, White, middle- aged, employed, educated, married/partnered, with a range of incomes. Most patients (54%) expected the physician would personally tell them the results immediately post-procedure and that he/she would spend an average of 7.8 and 7.6 minutes with them pre and post procedure. Post-tests indicated that physicians gave results only 24% of the time and spent an average of 4 minutes with those patients. Multiple regression findings indicated significant associations: (1) expecting results from physician and younger age; (2) greater time with physican pre-procedure and lower education, nonwhite race, lower income, and lower perceptions of physician discrimination; (3) greater time with physican post-procedure and nonwhite race, lower income, and lower physician discrimination. At-risk patients may have higher expectations for physican treatment pre- and post-colonoscopy. To the extent that expectations are not met, future screening behaviors may be affected negatively, thus presenting an avenue for health disparities.