New study examines behavioral economics of colorectal cancer screening in underserved populations

 

Stephanie Wheeler, PhD, MPH, assistant professor of health policy and management in the UNC Gillings School of Global Public Health, and Michael Pignone, MD, MPH, professor of medicine in the UNC School of Medicine, will lead the study.

 

Titled “Colorectal Cancer Screening in Disadvantaged Communities: A Behavioral Economics Perspective,” the study will use data from Medicaid and Medicare claims linked to the N.C. Central Cancer Registry to identify specific areas in North Carolina that have low colorectal cancer screening rates, high colorectal cancer mortality rates, and predictors of low screening rates. Focusing on communities identified through this process, researchers then will analyze ways health care consumers make decisions about colorectal cancer screening through conjoint analysis and develop a simulation model to understand, rank and prioritize potential policy decisions aimed at improving colorectal cancer screening in low-income communities.

 

“Our goal is to understand more fully the numerous conjoined factors that influence decision-making around screening for colorectal cancer in underserved populations,” Wheeler said. “People living in financially constrained circumstances have many competing demands for their time and money. The risks and rewards of colorectal cancer screening may be weighed differently in underserved populations, given that many are weighing not just the benefits of screening, but also (and perhaps more importantly) the cost of a colonoscopy, distance required to travel for the appointment, time lost from work, preparations involved, and many other financial and non-financial tradeoffs.”
Colorectal cancer is the third most common cancer diagnosis and second leading cause of cancer-related death in the United States. Although overall rates of colorectal cancer screening have increased overall in recent years, screening rates for uninsured, less advantaged, less well educated, minority, and rural-dwelling individuals and communities are lower than for the rest of the population.Results from the study will be used to implement effective and efficient programs to reduce differences in screening rates between patients of varying socio-economic status. Because many North Carolinians with low incomes belong to racial/ethnic minority groups, this study also has potential to examine reasons for racial/ethnic disparities in screening and cancer outcomes.

The study, which will span a period of three years, will include male and female North Carolina residents, ages 50 to 75 years, from a variety of racial and ethnic groups, who either are uninsured or insured by Medicare and/or Medicaid. Findings are expected to influence intervention strategies at the state level.

Other UNC public health researchers involved in the study are co-investigator Kristen Hassmiller Lich, PhD, assistant professor of health policy and management (HPM), and project manager Trisha Crutchfield, an HPM alumna (MHA, 2007). Other researchers from UNC include Carmen Lewis, MD, MPH, assistant professor of medicine at the medical school; Sandra Diehl, MPH, research associate at NC SPEED, an initiative supported by UNC Lineberger Comprehensive Cancer Center and NC TraCS and Ravi Goyal, research associate at the cancer center.

 

The study is based at the UNC Center for Health Promotion and Disease Prevention (HPDP) and funded by the Prevention Research Center Program at the Centers for Disease Control and Prevention. More information is available on the HPDP website.

UNC Gillings School of Global Public Health contact: Ramona DuBose, director of communications, (919) 966-7467 or ramona_dubose@unc.edu.