Colorectal cancer screening knowledge and attitudes among providers serving American indians

Colorectal cancer (CRC) disproportionately affects American Indians and is a leading cause of mortality despite being treatable when detected early. To better understand the level of provider CRC education and awareness, a survey was administered to 33 healthcare providers serving American Indians in California. Demographic data, provider knowledge of screening guidelines, communication, and cultural competency was measured. Data was analyzed using Chi Square and Fischer's Exact Test. In screening guidelines, the majority scored high on FOBT (57.57%); however they scored lower in knowledge of flexible sigmoidoscopy (36.37%), colonoscopy (36.37%), colonography (30.30%) and double contrast barium enema (21.21%). In counseling patients, 87.87% recommended the maintenance of proper diet, 36.63% recommended regular exercise and 54.54% recommended limited intake of processed foods/red meats. In areas of CRC knowledge, more than 80% of providers answered questions correctly. Sixty-four percent recommended a colonoscopy for patients at high-risk for CRC. In cultural competency, the majority of providers did not think that American Indians would understand the need/importance for CRC screening (72.72%) and felt they would not be able to follow provider advice (54.54%). Sixty-six percent felt it unlikely American Indians would discuss CRC screening with them and 57.58% felt that there were barriers to communication with their patients. Recommendations include routine training for clinic staff in more effective screening guidelines and cultural competency. This will ensure more effective patient-provider communication and provide patients with accurate information to promote screening and increase rates.