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Gender and Ethnic Differences in Colorectal Cancer Screening Embarrassment and Physician Gender Preferences
Purpose/Objectives: To examine colorectal cancer (CRC) screening embarrassment among men and women from three ethnic groups and the associated physician gender preference by patient gender and ethnicity.
Design: Cross-sectional, purposive sampling.
Setting: Urban community in Brooklyn, NY.
Sample: A purpose-derived, convenience sample of 245 European American, African American, and immigrant Jamaican men and women (aged 45-70 years) living in Brooklyn, NY.
Methods: Participants provided demographics and completed a comprehensive measure of CRC screening embarrassment.
Main Research Variables: Participant gender and ethnicity, physician gender, and CRC screening embarrassment regarding feces or the rectum and unwanted physical intimacy.
Findings: As predicted, men and women both reported reduced fecal and rectal embarrassment and intimacy concern regarding same-gender physicians. As expected, Jamaicans reported greater embarrassment regarding feces or the rectum compared to European Americans and African Americans; however, in contrast to expectations, women reported less embarrassment than men. Interactions indicated that rectal and fecal embarrassment was particularly high among Jamaican men.
Conclusions: Men and women have a preference for same-gender physicians, and embarrassment regarding feces and the rectum shows the most consistent ethnic and gender variation.
Implications for Nursing: Discussing embarrassment and its causes, as well as providing an opportunity to choose a same-gender physician, may be promising strategies to reduce or manage embarrassment and increase CRC screening attendance.
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References
American Cancer Society. (2009). Cancer facts and figures 2009. Atlanta, GA: Author.
Barber, K.R., Shaw, R., Folts, M., Taylor, D.K., Ryan, A., Hughes, M., … Abbott, R.R. (1998). Differences between African American and Caucasian men participating in a community-based prostate cancer screening program. Journal of Community Health, 23, 441-451. doi:10.1023/A:1018758124614
Bleiker, E.M., Menko, F.H., Taal, B.G., Kluijt, I., Wever, L.D., Gerritsma, M.A., … Aaronson, N.K. (2005). Screening behavior of individuals at high risk for colorectal cancer. Gastroenterology, 128, 280-287. doi:10.1053/j.gastro.2004.11.002
Bosworth, H.B., Rockey, D.C., Paulson, E.K., Niedzwiecki, D., Davis, W., Sanders, L.L., … Halvorsen, R. (2006). Prospective comparison of patient experience with colon imaging tests. American Journal of Medicine, 119, 791-799. doi:10.1016/j.amjmed.2006.02.013
Brown, W.M., & Consedine, N.S. (2004). Just how happy is the happy puppet? An emotion signaling and kinship theory perspective on the behavioral phenotype of children with Angelman Syndrome. Medical Hypotheses, 63, 377-385. doi:10.1016/j.mehy.2004.05.010
Clavarino, A.M., Janda, M., Hughes, K.L., Del Mar, C., Tong, S., Stanton, W.R., … Newman, B. (2004). The view from two sides: A qualitative study of community and medical perspectives on screening for colorectal cancer using FOBT. Preventive Medicine, 39, 482-490. doi:10.1016/j.ypmed.2004.05.015
Consedine, N.S., Adjei, B.A., Ramirez, P.M., & McKiernan, J.M. (2008). An object lesson: Source determines the relations that trait anxiety, prostate cancer worry, and screening fear hold with prostate screening frequency. Cancer Epidemiology, Biomarkers and Prevention, 17, 1631-1639. doi:10.1158/1055-9965.EPI-07-2538
Consedine, N.S., Christie, M.A., & Neugut, A.I. (2009). Physician, affective, and cognitive variables differentially predict "initiation" versus "maintenance" PSA screening profiles in diverse groups of men. British Journal of Health Psychology, 14, 303-322. doi:10.1348/135910708X327626
Consedine, N.S., Horton, D., Ungar, T., Joe, A.K., Ramirez, P., & Borrell, L. (2007). Fear, knowledge, and efficacy beliefs differentially predict the frequency of digital rectal exam versus prostate specific antigen screening in ethnically diverse samples of older men. American Journal of Men's Health, 1(1), 29-43. doi:10.1177/1557988306293495
Consedine, N.S., Krivoshekova, Y.S., & Harris, C.R. (2007). Bodily embarrassment and judgment concern as separable factors in the measurement of medical embarrassment: Psychometric development and links to treatment-seeking outcomes. British Journal of Health Psychology, 12, 439-462. doi:10.1348/135910706X118747
Consedine, N.S., Ladwig, I., Reddig, M.K., & Broadbent, E.A. (2011). The many faeces of colorectal cancer screening embarrassment: Preliminary psychometric development and links to screening outcome. British Journal of Health Psychology, 16, 559-579. doi:10.1348/135910710X530942
Consedine, N.S., Magai, C., & Bonanno, G.A. (2002). Moderators of the emotion inhibition-health relationship: A review and research agenda. Review of General Psychology, 6, 204-228.
Consedine, N.S., Magai, C., & Conway, F. (2004). Predicting ethnic variation in adaptation to later life: Styles of socioemotional functioning and constrained heterotypy. Journal of Cross-Cultural Gerontology, 19, 97-131. doi:10.1023/B:JCCG.0000027847.16659.b0
Consedine, N.S., Magai, C., & Neugut, A.I. (2004). The contribution of emotional characteristics to breast cancer screening among women from six ethnic groups. Preventive Medicine, 38, 64-77. doi:10.1016/j.ypmed.2003.09.030
Consedine, N.S., Magai, C., Spiller, R., Neugut, A.I., & Conway, F. (2004). Breast cancer knowledge and beliefs in subpopulations of African American and Caribbean women. American Journal of Health Behavior, 28, 260-271.
Consedine, N.S., Morgenstern, A.H., Kudadjie-Gyamfi, E., Magai, C., & Neugut, A.I. (2006). Prostate cancer screening behavior in men from seven ethnic groups: The fear factor. Cancer Epidemiology, Biomarkers and Prevention, 15, 228-237. doi:10.1158/1055-9965.EPI-05-0019
Consedine, N.S., & Moskowitz, J.T. (2007). The role of discrete emotions in health outcomes: A critical review. Applied and Preventive Psychology, 12(2), 59-75. doi:10.1016/j.appsy.2007.09.001
Consedine, N.S., Strongman, K.T., & Magai, C. (2003). Emotions and behaviour: Data from a cross-cultural recognition study. Cognition and Emotion, 17, 881-902.
Denberg, T.D., Melhado, T.V., Coombes, J.M., Beaty, B.L., Berman, K., Byers, T.E., … Ahnen, D.J. (2005). Predictors of nonadherence to screening colonoscopy. Journal of General Internal Medicine, 20, 989-995. doi:10.1111/j.1525-1497.2005.00164.x
Farraye, F.A., Wong, M., Hurwitz, S., Puleo, E., Emmons, K., Wallace, M.B., & Fletcher, R.H. (2004). Barriers to endoscopic colorectal cancer screening: Are women different from men? American Journal of Gastroenterology, 99, 341-349. doi:10.1111/j.1572-0241.2004.04045.x
Fidler, H., Hartnett, A., Cheng Man, K., Derbyshire, I., & Sheil, M. (2000). Sex and familiarity of colonoscopist: Patient preferences. Endoscopy, 32, 481-482. doi:10.1055/s-2000-645
Frijda, N.H. (1994). Emotions are functional, most of the time. In P. Ekman & R.J. Davidson (Eds.), The nature of emotion: Fundamental questions (pp. 112-122). New York, NY: Oxford University Press.
Goldman, R.E., Diaz, J.A., & Kim, I. (2009). Perspectives of colorectal cancer risk and screening among Dominicans and Puerto Ricans: Stigma and misperceptions. Qualitative Health Research, 19, 1559-1568. doi:10.1177/1049732309349359
Grimm, S.D., & Church, A.T. (1999). A cross-cultural study of response biases in personality measures. Journal of Research in Personality, 33, 415-441. doi:10.1006/jrpe.1999.2256
Guessous, I., Dash, C., Lapin, P., Doroshenk, M., Smith, R.A., & Klabunde, C.N. (2010). Colorectal cancer screening barriers and facilitators in older persons. Preventive Medicine, 50(1-2), 3-10. doi: 10.1016/j.ypmed.2009.12.005
Harewood, G.C., Wiersema, M.J., & Melton, L.J., III. (2002). A prospective, controlled assessment of factors influencing acceptance of screening colonoscopy. American Journal of Gastroenterology, 97, 3186-3194. doi:10.1111/j.1572-0241.2002.07129.x
Higuchi, M., & Fukada, H. (2002). A comparison of four causal factors of embarrassment in public and private situations. Journal of Psychology, 136, 399-406. doi:10.1080/00223980209604166
Higuchi, M., & Fukada, H. (2008). Comparison of four factors related to embarrassment in nontypical situations. Psychological Reports, 102(1), 328-334. doi:10.2466/pr0.102.1.328-334
Holt, C.L., Shipp, M., Eloubeidi, M., Clay, K.S., Smith-Janas, M.A., Janas, M.J., … Fouad, M.N. (2009). Use of focus group data to develop recommendations for demographically segmented colorectal cancer educational strategies. Health Education Research, 24, 876-889. doi:10.1093/her/cyp024
Inadomi, J.M. (2008). Taishotoyama Symposium Barriers to colorectal cancer screening: Economics, capacity and adherence. Journal of Gastroenterology and Hepatology, 23(Suppl. 2), S198-S204. doi:10.1111/j.1440-1746.2008.05556.x
Kelly, K.M., Phillips, C.M., Jenkins, C., Norling, G., White, C., Jenkins, T., … Dignan, M. (2007). Physician and staff perceptions of barriers to colorectal cancer screening in Appalachian Kentucky. Cancer Control, 14, 167-175.
Keltner, D., & Anderson, C. (2000). Saving face for Darwin: The functions and uses of embarrassment. Current Directions in Psychological Science, 9, 187-192. doi:10.1111/1467-8721.00091
Kerssens, J.J., Bensing, J.M., & Andela, M.G. (1997). Patient preference for genders of health professionals. Social Science and Medicine, 44, 1531-1540. doi:10.1016/S0277-9536(96)00272-9
Kinchen, K.S., Burgio, K., Diokno, A.C., Fultz, N.H., Bump, R., & Obenchain, R. (2003). Factors associated with women's decisions to seek treatment for urinary incontinence. Journal of Women's Health, 12, 687-698. doi:10.1089/154099903322404339
Klabunde, C.N., Vernon, S.W., Nadel, M.R., Breen, N., Seeff, L.C., & Brown, M.L. (2005). Barriers to colorectal cancer screening: A comparison of reports from primary care physicians and average-risk adults. Medical Care, 43, 939-944. doi:10.1097/01.mlr.0000173599.67470.ba
Lazarus, R.S. (1991). Emotion and adaptation. New York, NY: Oxford University Press.
Leadley, J. (2009). Women in U.S. academic medicine: Statistics and benchmarking report 2008-2009. Washington, DC: Association of American Medical Colleges.
Lee, J.W., Jones, P.S., Mineyama, Y., & Zhang, X.E. (2002). Cultural differences in responses to a Likert scale. Research in Nursing and Health, 25, 295-306. doi:10.1002/nur.10041
Levin, B., Lieberman, D.A., McFarland, B., Smith, R.A., Brooks, D., Andrews, K.S., … Winawer, S.J. (2008). Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A joint guideline from the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA: A Cancer Journal for Clinicians, 58, 130-160. doi:10.3322/CA.2007.0018
Magai, C., Consedine, N., Neugut, A.I., & Herschman, D.L. (2007). Common psychosocial factors underlying breast cancer screening and breast cancer treatment adherence: A conceptual review and synthesis. Journal of Women's Health, 16(1), 11-23.
McAlearney, A.S., Reeves, K.W., Dickinson, S.L., Kelly, K.M., Tatum, C., Katz, M.L., & Paskett, E.D. (2008). Racial differences in colorectal cancer screening practices and knowledge within a low-income population. Cancer, 112, 391-398. doi:10.1002/cncr.23156
Menees, S.B., Inadomi, J.M., Korsnes, S., & Elta, G.H. (2005). Women patients' preference for women physicians is a barrier to colon cancer screening. Gastrointestinal Endoscopy, 62, 219-223. doi: 10.1016/S0016-5107(05)00540-7
Miller, R.S. (1995). Embarrassment and social behavior. In J.P. Tangney & K.W. Fischer (Eds.), Self-conscious emotions: The psychology of shame, guilt, embarrassment, and pride (pp. 322-339). New York, NY: Guilford.
Nicholson, F.B., & Korman, M.G. (2005). Acceptance of flexible sigmoidoscopy and colonoscopy for screening and surveillance in colorectal cancer prevention. Journal of Medical Screening 12, 89-95. doi:10.1258/0969141053908294
O'Malley, A.S., Beaton, E., Yabroff, K.R., Abramson, R., & Mandelblatt, J. (2004). Patient and provider barriers to colorectal cancer screening in the primary care safety-net. Preventive Medicine, 39, 56-63. doi: 10.1016/j.ypmed.2004.02.022
Peterson, N.B., Murff, H.J., Ness, R.M., & Dittus, R.S. (2007). Colorectal cancer screening among men and women in the United States. Journal of Women's Health, 16(1), 57-65. doi:10.1089/jwh.2006.0131
Rajapaksa, R.C., Macari, M., & Bini, E.J. (2007). Racial/ethnic differences in patient experiences with and preferences for computed tomography colonography and optical colonoscopy. Clinical Gasteroenterology and Hepatology, 5, 1306-1312. doi:10.1016/j.cgh.2007.05.023
Rawl, S.M., Menon, U., Champion, V.L., Foster, J.L., & Skinner, C.S. (2000). Colorectal cancer screening beliefs. Focus groups with first-degree relatives. Cancer Practice, 8(1), 32-37. doi:10.1046/j.1523-5394.2000.81006.x
Robb, K.A., Solarin, I., Power, E., Atkin, W., & Wardle, J. (2008). Attitudes to colorectal cancer screening among ethnic minority groups in the UK. BMC Public Health, 8, 34. doi:10.1186/1471-2458-8-34
Schneider, A., Kanagarajan, N., Anjelly, D., Reynolds, J.C., & Ahmad, A. (2009). Importance of gender, socioeconomic status, and history of abuse on patient preference for endoscopist. American Journal of Gastroenterology, 104, 340-348. doi:10.1038/ajg.2008.96
Shaw, C., Williams, K., Assassa, P.R., & Jackson, C. (2000). Patient satisfaction with urodynamics: A qualitative study. Journal of Advanced Nursing, 32, 1356-1363. doi:10.1046/j.1365-2648.2000.01627.x
Shinn, E., Basen-Engquist, K., Le, T., Hansis-Diarte, A., Bostic, D., Martinez-Cross, J., … Follen, H. (2004). Distress after an abnormal Pap smear result: Scale development and psychometric validation. Preventive Medicine, 39, 404-412. doi:10.1016/j.ypmed.2004.02.004
Varadarajulu, S., Petruff, C., & Ramsey, W.H. (2002). Patient preferences for gender of endoscopists. Gastrointestinal Endoscopy, 56, 170-173. doi:10.1016/S0016-5107(02)70173-9
Von Wagner, C., Knight, K., Halligan, S., Atkin, W., Lilford, R., Morton, D., & Wardle, J. (2009). Patient experiences of colonoscopy, barium enema and CT colonography: A qualitative study. British Journal of Radiology, 82(973), 13-19. doi: 10.1259/bjr/61732956
Walsh, J.M., Kaplan, C.P., Nguyen, B., Gildengorin, G., McPhee, S.J., & Pérez-Stable, E.J. (2004). Barriers to colorectal cancer screening in Latino and Vietnamese Americans compared with non-Latino white Americans. Journal of General Internal Medicine, 19, 156-166. doi:10.1111/j.1525-1497.2004.30263.x
Winawer, S., Fletcher, R., Rex, D., Bond, J., Burt, R., Ferrucci, J., … Simmang, C. (2003). Colorectal cancer screening and surveillance: Clinical guidelines and rationale—Update based on new evidence. Gastroenterology, 124, 544-560. doi:10.1053/gast.2003.50044
Winterich, J.A., Quandt, S.A., Grzywacz, J.G., Clark, P.E., Miller, D.P., Acuña, J., & Arcury, T.A. (2009). Masculinity and the body: How African American and White men experience cancer screening exams involving the rectum. American Journal of Men's Health, 3, 300-309. doi: 10.1177/1557988308321675