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Health Services Research & Development

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2009 HSR&D National Meeting Abstract

National Meeting 2009

3103 — Marital Status is an Important Predictor of Adherence to Colonoscopy

Sultan S (RORC, NF/SGVHS and University of Florida), Newlin C (Durham VAMC and Duke University Medical Center), Shah P (NF/SGVHS), Provenzale D (Durham VAMC, Duke University Medical CenterF/SGVHS, University of Florida), Beyth RJ (GRECC and RORC, University of Florida, NF/SGVHS)

Few studies have examined predictors of adherence to colonoscopy among veterans. Our objective was to determine the predictors of adherence to colonoscopy among veterans at high risk for colorectal cancer (CRC).

In this prospective, observational cohort study, subjects referred for diagnostic colonoscopy of heme-positive stool, hematochezia, anemia, or a family history of CRC, were recruited from the Durham VA Gastroenterology Clinic. The following demographic data was obtained: age, race, health literacy, marital status, educational level, family history of CRC, and personal history of any cancer. Subjects also completed a validated CRC knowledge questionnaire (total knowledge score ranged from 0-100). Health Literacy was assessed using a validated instrument (Rapid Estimate of Adult Literacy in Medicine-REALM), a 66-item word pronunciation test. The primary endpoint was adherence to colonoscopy, defined as an individual having undergone a complete colonoscopy. Chi-square statistic and T-test were used to evaluate differences between groups. Logistic regression was used to determine the independent predictors of adherence.

A total of 619 subjects completed the study. Mean age was 57.9 years and 91% of subjects were male; 54% of subjects were White and 43% were Black. Forty-four percent (274/619) of subjects had LHL. The mean knowledge score of the cohort was 78.5 +/- 1.8. Overall adherence rate was high: 527 (85%) completed their diagnostic colonoscopy. In univariate analysis, marital status (p = 0.001) and race (p = 0.06) were the only significant predictors of adherence to colonoscopy. In multivariate analysis, however, marital status was the only significant predictor of adherence (OR 2.06, 95% CI 1.30-3.06).

Marital status was a significant predictor of adherence to colonoscopy in this cohort of veterans at high risk of having CRC. This may be due to increased instrumental support (and emotional support) that may help veterans negotiate the logistics of udergoing an invasive procedure. Further studies may need to investigate the role of caregiver support in increasing adherence to colonoscopy.

In providing optimal care for veterans, more efforts may need to be targeted towards involving caregivers or significant others.

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