Barriers to utilization of three colorectal cancer screening options – Data from a national survey

Zhu, Xuan; Parks, Philip D.; Weiser, Emily L.; Jacobson, Debra J.; Limburg, Paul J.; Rutten, Lila J. Finney

doi:10.1016/j.pmedr.2021.101508

Cited by 15 publications

(8 citation statements)

References 41 publications

(52 reference statements)

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“…Recent research found disparities by race/ethnicity and socioeconomic status indicators in awareness, knowledge, and utilization of newly-introduced CRC screening modalities including mt-sDNA and identified variations by sociodemographic factors in patient concerns and factors influencing CRC screening decision-making. [25][26][27]35 Further research is encouraged to identify potential sociodemographic differences in the relative importance of various attitudinal and experiential factors associated with mt-sDNA screening completion and adherence, with the goal to inform behavioral interventions and communication strategies that are better tailored to community needs and preferences.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12][13] Barriers to CRC screening include lack of awareness, lack of clinician recommendation, burdensome bowel preparation regimens, logistical barriers, medical mistrust, fears about cancer, and feelings of embarrassment. [14][15][16][17][18][19][20][21][22][23][24][25][26][27] The increase in the uptake of mt-sDNA as a screening option is promising and suggests growing interest among both patients and clinicians in noninvasive stool-based screening that can be performed at home. 28 Understanding the factors that influence completion of stool-based CRC screening is important to inform development of behavior change and communication interventions that will improve screening uptake and adherence.…”

Section: Introductionmentioning

confidence: 99%

“…8–13 Barriers to CRC screening include lack of awareness, lack of clinician recommendation, burdensome bowel preparation regimens, logistical barriers, medical mistrust, fears about cancer, and feelings of embarrassment. 14–27 The increase in the uptake of mt-sDNA as a screening option is promising and suggests growing interest among both patients and clinicians in non-invasive stool-based screening that can be performed at home. 28…”

Section: Introductionmentioning

confidence: 99%

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Attitudes and Experiential Factors Associated with Completion of mt-sDNA Test Kit for Colorectal Cancer Screening

Finney Rutten,

Zhu,

Treiman

et al. 2023

Journal of Patient Experience

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Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States. Despite the availability of multiple screening options, CRC screening is underutilized. We conducted a survey of patients (n = 2973) who were prescribed the multi-target stool DNA (mt-sDNA) screening test (commercialized as Cologuard® and manufactured by Exact Sciences Corporation) to understand attitudes and experiences that influence test completion and likelihood of future test completion. Using exploratory factor analyses, we developed three scales: Perceived Effectiveness, Perceived Ease of Use, and Perceived Comfort.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Attitudes and Experiential Factors Associated with Completion of mt-sDNA Test Kit for Colorectal Cancer Screening

Finney Rutten,

Zhu,

Treiman

et al. 2023

Journal of Patient Experience

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“…Multiple factors affect adherence to CRC screening. The top barriers to screening identified among respondents who had previously used stool-based screening options were lack of provider recommendations and lack of knowledge [25]. In order to address these barriers and increase adherence to screening, different outreach strategies have been proposed; these organized outreach programs have been shown to be effective to various degrees [26].…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of mt-sDNA versus Mailed FIT Outreach for Medicare Advantage Enrollees using the CRC-AIM Microsimulation Model

2022

J Community Med Public Health

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Background: Despite proven effectiveness in reducing Colorectal Cancer (CRC) cases, screening for CRC remains underutilized. As the use of an outreach program may increase uptake and adherence to screening, we examined the cost-effectiveness of provider-ordered multi-target stool DNA (mt-sDNA) versus an outreach program with a mailed Fecal Immunochemical Test (FIT), in a Medicare Advantage population. Methods: Annual FIT, mailed as part of an outreach program, and triennial mt-sDNA were compared using the validated CRC-AIM microsimulation model over a lifetime horizon. Costs and clinical outcomes of 2 million average-risk individuals, free of diagnosed CRC at age 40, who initiated CRC screening at age 65, were simulated. Test sensitivity and specificity inputs were based on the 2021 United States Preventive Services Task Force modeling study; adherence rates were based on published real-world data for stool-based tests and follow-up colonoscopies (COLs). The cost of the outreach program, screening tests, COLs, complications, and CRC care were included. Discount rates (3%) and the perspective of Medicare Advantage were employed. Outcomes are reported in Life-Years Gained (LYG), Quality-Adjusted Life Years (QALY), Incidence Reduction (IR), mortality reduction (MR) and the incremental cost-effectiveness ratio. Scenario analyses explored alternate adherence rates. Results: In the base case, using real-world adherence rates, mt-sDNA had higher IR, MR and LYG; mt-sDNA was cost-effective at a willingness-to-pay threshold of $50,000 per QALY compared to mailed FIT outreach. In scenario analyses, when assuming 100% adherence for both screening test and follow-up COL, mt-sDNA was dominated by mailed FIT outreach. mt-sDNA remained cost-effective versus outreach with mailed FIT in a scenario where FIT had 20% higher adherence than the base case. Conclusions: Adherence to CRC screening and follow-up COL greatly impacts clinical and cost-effectiveness outcomes. Future analyses should consider evidence-based, health plan-specific data to accurately reflect outcomes in order to aid payers in decision making.g.

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“…Individuals from areas with higher levels of social deprivation were less likely to participate in screening. 8 Zhu (2021) 9 reported that psychosocial barriers such as unpleasantness, embarrassment, pain and fear about a positive result were the most commonly reported barriers to colonoscopy screening among the Hispanic population.…”

Section: Introductionmentioning

confidence: 99%

Acceptability of alternative technologies compared with faecal immunochemical test and/or colonoscopy in colorectal cancer screening: A systematic review

et al. 2022

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Objective Colorectal cancer (CRC) is the third most common cancer and the second largest cause of cancer-related death worldwide. Current CRC screening in various countries involves stool-based faecal immunochemical testing (FIT) and/or colonoscopy, yet public uptake remains sub-optimal. This review assessed the literature regarding acceptability of alternative CRC screening modalities compared to standard care in average-risk adults. Method Systematic searches of MEDLINE, EMBASE, CINAHL, Cochrane and Web of Science were conducted up to February 3rd, 2022. The alternative interventions examined were computed tomography colonography, flexible sigmoidoscopy, colon capsule endoscopy and blood-based biomarkers. Outcomes for acceptability were uptake, discomfort associated with bowel preparation, discomfort associated with screening procedure, screening preferences and willingness to repeat screening method. A narrative data synthesis was conducted. Results Twenty-one studies met the inclusion criteria. Differences between intervention and comparison modalities in uptake did not reach statistical significance in most of the included studies. The findings do suggest FIT as being more acceptable as a screening modality than flexible sigmoidoscopy. There were no consistent significant differences in bowel preparation discomfort, screening procedure discomfort, screening preference and willingness to repeat screening between the standard care and alternative modalities. Conclusion Current evidence comparing standard colonoscopy and stool-based CRC screening with novel modalities does not demonstrate any clear difference in acceptability. Due to the small number of studies available and included in each screening comparison and lack of observed differences, further research is needed to explore factors influencing acceptability of alternative CRC modalities that might result in improvement in population uptake within different contexts.

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Barriers to utilization of three colorectal cancer screening options – Data from a national survey

Cited by 15 publications

References 41 publications

Attitudes and Experiential Factors Associated with Completion of mt-sDNA Test Kit for Colorectal Cancer Screening

Attitudes and Experiential Factors Associated with Completion of mt-sDNA Test Kit for Colorectal Cancer Screening

Cost-Effectiveness of mt-sDNA versus Mailed FIT Outreach for Medicare Advantage Enrollees using the CRC-AIM Microsimulation Model

Acceptability of alternative technologies compared with faecal immunochemical test and/or colonoscopy in colorectal cancer screening: A systematic review

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