Complicating “the good result”: narratives of colorectal cancer screening when cancer is not found

Abstract

In this paper, we analyze narratives from a Photovoice project on colorectal cancer screening that was carried out with people who had undergone screening and were found to not have cancer. Three groups, totaling eighteen participants, took part in the project, meeting multiple times over the course of approximately 10 weeks, and discussing photos they took about colorectal cancer screening. A common way in which the participants conveyed their screening experiences was through reflection on their own or other people's illnesses. Our findings highlight the multiple meanings of receiving a 'good' or noncancerous screening result after undergoing cancer screening. Such findings suggest that framing noncancerous results only in terms of relief or other positive emotions may ignore the realities people and their families face and their remaining concerns. This paper has broader implications for policies to reduce cancer disparities as well as public health and patient-provider communication about screening. [Colorectal < Cancer Type; Qualitative < Research Methods; Photovoice; Narrative research; Health care disparities] Colorectal cancer (CRC) screening, particularly through colonoscopy, is highly effective in reducing mortality. 1 A CRC diagnosis now has a promising 5-year survival rate of 90 percent when it is detected early, and polyps can be removed prior to becoming malignant. However, only 39 percent of people diagnosed with CRC are diagnosed at this early stage, when the cancer remains localized, 2 and there are substantial disparities in CRC incidence and mortality along lines of socioeconomic status, race and ethnicity, and in medically under-served geographic areas. 3 Because differences in CRC screening uptake contribute to CRC disparities, 4 barriers to CRC screening have been a prime area of study for health researchers. 5-9 To better understand screening uptake, we carried out a community-based participatory research project on CRC screening with people from medically-underserved areas to hear their screening narratives. We focus on narratives because narratives are integral to how people "make sense of" 10 and "work through their experiences." 11 Narratives of health or illness offer insight into "local moral worlds," in the neighborhoods, families, and communities in which people carry out

Distance and Transportation Barriers to Colorectal Cancer Screening in a Rural Community

“…Even a completed colonoscopy may lead to additional time-consuming and expensive procedures, diagnoses, and concerns. 16 …”

“…Even a completed colonoscopy may lead to additional time-consuming and expensive procedures, diagnoses, and concerns. 16 Third, interviewees described frustrations trying to link patients with colonoscopies. They attempted to address challenges of distance and transportation by combining multiple approaches.…”

Not FIT for Use: Fecal Immunochemical Testing in the Inpatient and Emergency Settings

“…A positive FIT may lead to patient anxiety and stress, as its only validated indication is for colon cancer screening. 24 Guidelines from the US Multi-Society Task Force recommend colonoscopy as the next step in this situation-a procedure that carries not insignificant risk. This potentially false-positive FIT also places physicians in a difficult position, as a subsequent negative FIT cannot be used to negate a positive test.…”

Qualitative Research Methods in Chronic Disease: Introduction and Opportunities to Promote Health Equity

“…This includes a contextualized understanding of the factors that place people at risk for disease, the conditions affecting access to screening and care, patient experiences during acute treatment, and challenges to chronic disease self-management ( 14 , 51 , 56 , 59 , 82 , 129 ). Qualitative research can include longitudinal and prospective explorations across multiple time points along the chronic disease continuum to highlight places for intervention or for improving the delivery of care for patients across the disease trajectory (e.g., 69 , 119 ). The majority of chronic disease research has limited the use of qualitative methods to informing formative research and to understanding factors that affect the risk of, or experiences with, specific aspects of chronic disease care or treatment.…”