Factors associated with colorectal cancer screening decision-making among older adults at the Comprehensive Geriatric Clinic, King Chulalongkorn Memorial Hospital, Thai Red Cross Society

Abstract

Background: The incidence of colorectal cancer (CRC) in Thailand is constantly increasing and is highest in individuals aged 60-75 years. However, the number of older individuals undergoing CRC screening remains suboptimal.

Objectives: This study aimed to identify factors associated with CRC screening decision-making among Thai older adults attending the Comprehensive Geriatric Clinic at King Chulalongkorn Memorial Hospital. The secondary objective was to identify factors associated with the choice of screening method—colonoscopy versus fecal occult blood testing (FOBT).

Methods: A cross-sectional study was conducted using a data record form at the Comprehensive Geriatrics Clinic, King Chulalongkorn Memorial Hospital in Bangkok, Thailand, from September to October 2023. Participants aged 60-75 were interviewed to collect information about factors associated with CRC screening decision-making, which were categorized into five groups: demographic, health, psychological, physician, and social factors. Participants were classified into two groups based on their intention to undergo CRC screening. The factors preliminarily associations using the Chi-square test and the Mann-Whitney U test. The factors with a P < 0.2 were then analysed by a binary logistic regression for identifying factors that were significantly associated with the decision to undergo CRC screening as primary outcome and the choice of method as secondary outcome.

Results: A total of 424 valid responses were obtained, with 320 respondents intending to undergo CRC screening. The binary logistic regression analysis revealed significant associations between CRC screening decision and the following factors: high risk for CRC (aOR 6.05, 95%CI 2.42 15.13), positive attitude towards cancer screening (aOR 3.65, 95%CI 2.19 6.10), recognition of the importance of early detection (aOR 2.33, 95%CI 1.32 4.11), and being divorced, as compared to being married (aOR 0.06, 95%CI 0.01 0.49). The decision to undergo colonoscopy for the CRC screening was associated with an education level of having at least a bachelor’s degree (aOR 0.43, 95%CI 0.24 0.75), being single, as compared to being married (aOR 2.08, 95%CI 1.20 3.58), and concerns about physical discomfort from CRC screening (aOR 0.41, 95%CI 0.19 0.90).

Conclusion: Factors associated with CRC screening decision-making uptake amongst older adults, attending a geriatric clinic in a tertiary care hospital in Bangkok, that can be promoted include having a positive attitude towards cancer screening and the recognition of the importance of early detection. Therefore, raising awareness and highlighting the importance of cancer screening may help increase the rates of CRC screening in Thailand in the future.