When Doctors Talk, Patients Get Screened: Communication Gaps Drive Colorectal Cancer Disparities

A routine checkup can be the moment a life-saving test gets scheduled — or the moment it slips through the cracks. New research published in the Journal of General Internal Medicine suggests that for Black and Hispanic patients in the United States, what happens in that conversation may matter as much as any clinical guideline. A cross-sectional study led by Jessica N. Rivera Rivera of the MedStar Health Research Institute and colleagues found that among 204 Black and Hispanic primary care patients surveyed in Washington, DC, and Maryland, only about one in three reported being up to date with colorectal cancer screening, and the quality of communication with their doctors was one of the strongest predictors of whether screening had actually happened.

Colorectal cancer is the kind of disease that modern medicine should be winning against. Screening tests — colonoscopy, stool-based tests such as fecal immunochemical tests, and multi-target stool DNA assays — can catch precancerous polyps before they turn malignant or detect tumors at early, highly treatable stages. Professional guidelines recommend screening for all adults aged 45 to 75 years. Yet the benefits of these tools have never been distributed evenly. National surveillance data and studies cited by the authors show persistent racial and ethnic disparities in screening completion and in colorectal cancer outcomes, with Black Americans experiencing higher incidence and mortality rates than white Americans, and Hispanic populations facing distinct barriers rooted in language, access, and trust.

To understand what drives those gaps at the level of the individual clinic visit, the research team identified Black and Hispanic patients who had a recent visit at seven primary care clinics in Washington, DC, and Maryland, using the electronic medical record. From 913 patients they contacted, 278 agreed to participate and 204 completed a roughly ten-minute survey, about 77 percent of whom were non-Hispanic Black. The survey captured demographics including age, race, sex, education, and insurance status, along with three psychosocial measures that have long been suspected of shaping screening behavior: health literacy, patient-centered communication, and distrust in the healthcare system.

The patient-centered communication measure, scored on a scale from 1 to 4 where 4 means the clinician always communicates in a patient-centered way, draws on validated survey instruments designed to quantify how well providers elicit patient concerns, explain things clearly, and involve patients in decisions. Health literacy was assessed with brief screening questions originally validated in large outpatient populations, which ask patients about confidence with written medical information and the difficulty of filling out forms. Distrust in the healthcare system was likewise scored on a 1-to-4 scale, with higher values indicating greater distrust. These instruments allowed the team to move beyond crude demographic comparisons and test whether the texture of the clinical relationship itself predicted screening behavior.

The results painted a sobering picture of where patients stand in the screening pipeline. Respondents fell into four self-reported categories: 13.7 percent said colorectal cancer screening had never been discussed with them; 36.3 percent said it had been recommended but never completed; 15.2 percent said they had been screened at some point but were no longer up to date; and 34.8 percent reported being up to date. In other words, nearly two-thirds of these patients were not current with a test that guidelines say they should have, and roughly one in seven had never even had the conversation. For a cancer that develops slowly over many years from removable precancerous lesions, that represents a large and theoretically preventable reservoir of risk.

Statistical analysis revealed which factors moved the needle. In bivariate comparisons using chi-square and trend tests, older age, higher health literacy, and better patient-centered communication were each associated with significantly greater odds of having a colorectal cancer screening history, with p-values of 0.01, 0.01, and 0.007 respectively. Screening history also differed sharply by race and by preferred language, both with p-values below 0.001. When the team built a multivariable logistic regression model to disentangle these effects, several predictors held firm: each additional year of age raised the odds of screening by 8 percent (odds ratio 1.08, p < 0.001); being non-Hispanic Black, compared with Hispanic, more than doubled the odds (odds ratio 2.27, p = 0.003); each point of higher health literacy increased odds by 30 percent (odds ratio 1.30, p = 0.04); and each point of better patient-centered communication raised odds by nearly half (odds ratio 1.48, p = 0.02).

That last number deserves attention. An odds ratio of 1.48 for patient-centered communication means that, holding age, race, health literacy, and other factors constant, patients who experienced more patient-centered care were substantially more likely to have completed screening. This aligns with a growing body of evidence cited in the paper: systematic reviews have found that provider-patient communication quality predicts cancer screening adherence, and studies of community health centers have linked sociodemographic disparities in colorectal screening to differences in communication. The mechanism is plausible on its face — a patient who understands why a test matters, feels heard when raising concerns, and leaves the visit with a clear plan is far more likely to follow through than one who receives a rushed recommendation or no recommendation at all.

The racial disparity in the multivariable model was striking in the opposite direction from what raw national statistics might suggest. Non-Hispanic Black respondents in this sample had more than twice the odds of screening history compared with Hispanic respondents, after adjustment. The authors point to differences by preferred language as a likely contributor, and the broader literature they cite documents how limited English proficiency creates barriers across the care experience, from scheduling to informed consent. Prior intervention studies offer a roadmap: Spanish-language patient navigation has been associated with improved adherence to stool-based testing, and culturally tailored navigation programs for Hispanic patients have reduced screening disparities in real-world settings. Patient navigation more broadly — trained guides who help patients overcome logistical, informational, and trust-related barriers — has accumulated systematic-review evidence of effectiveness across the cancer care continuum.

The study’s connection to mistrust is more nuanced. While distrust in the healthcare system was measured, it was the communication and literacy variables, not distrust itself, that emerged as significant in the final model. That does not mean mistrust is irrelevant; prior work has shown that medical mistrust and experiences of discrimination are associated with lower colorectal screening uptake among African Americans and among Hispanic and Asian American populations, and that discrimination experiences breed mistrust over time. Rather, the findings suggest that within a health system, the day-to-day quality of clinician-patient interaction may be a modifiable lever that operates alongside — and perhaps partially through — the deeper structural forces that generate mistrust in the first place.

The authors are careful about the study’s limits, and readers should be too. Self-reported screening history is known to overestimate actual completion compared with medical records, a discrepancy documented in multiple validation studies. The 30 percent response rate among contacted patients, while typical for modern telephone and outreach surveys, raises the possibility that respondents differ systematically from non-respondents. The cross-sectional design cannot establish whether good communication causes screening or whether patients who are already engaged with their care both perceive better communication and get screened. And with 204 completers, the analysis had limited statistical power for some subgroup comparisons. Still, the consistency of the communication and health literacy findings with prior prospective and experimental literature strengthens the case that these are real signals rather than statistical noise.

The practical implications are concrete. The authors conclude that tailoring outreach to younger, Hispanic, and lower-health-literacy populations, and improving patient-centered communication, may improve screening uptake and guideline adherence. For health systems, that could mean training clinicians in communication practices that elicit patient concerns and confirm understanding, offering screening discussions and materials in patients’ preferred language, and deploying patient navigators for groups facing the largest gaps. The study is part of a larger research program — the team’s Supporting ColoREctal Equitable Navigation, or SCREEN, protocol, a stepped-wedge cluster randomized trial of patient navigation in primary care funded by the Agency for Healthcare Research and Quality — which will test whether systematic navigation can close the gaps this survey documented. As the screening age drops to 45 and millions more adults become eligible, the question is no longer whether effective screening exists, but whether the healthcare system can communicate its way past the disparities that have stubbornly persisted for decades.

Subject of Research: Colorectal cancer screening communication and completion among Black and Hispanic primary care patients

Article Title: Colorectal Cancer Screening Communication and Completion Among Black and Hispanic Primary Care Patients: A Cross-Sectional Study

Article References: Rivera Rivera, J. N., AuBuchon, K. E., Schubel, L. C., Tran, J., Fong, A., Adams, K., Mete, M., Grady, M., Galarraga, J. E., & Arem, H. (2026). Colorectal Cancer Screening Communication and Completion Among Black and Hispanic Primary Care Patients: A Cross-Sectional Study. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10700-3

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10700-3

Keywords: colorectal cancer screening, patient-centered communication, health literacy, health disparities, Black patients, Hispanic patients, primary care, medical mistrust, patient navigation, cross-sectional study, cancer prevention, Journal of General Internal Medicine