Facilitators and barriers to colorectal cancer screening in an outpatient setting

Abstract

BACKGROUND Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related deaths in the United States. Still, 1 in 3 adults aged 50 years to 75 years have not been screened for CRC. Early detection and management of precancerous or malignant lesions has been shown to improve overall mortality. AIM To determine the most significant facilitators and barriers to CRC screening in an outpatient clinic in rural North Carolina. The results of this study can then be used for quality improvement to increase the rate of patients ages 50 to 75 who are up to date on CRC screening. METHODS This retrospective study examined 2428 patients aged 50 years to 75 years in an outpatient clinic. Patients were up to date on CRC screening if they had fecal occult blood test or fecal immunochemical test in the past one year, Cologuard in the past three years, flexible sigmoidoscopy/virtual colonoscopy in the past five years, or colonoscopy in the past ten years. Data on patient socioeconomic status, comorbid conditions, and other determinants of health compliance were included as covariates. RESULTS Age [odds ratio (OR) = 1.058; P = 0.017], no-show rate percent (OR= 0.962; P < 0.05), patient history of obstructive sleep apnea (OR = 1.875; P = 0.025), compliance with flu vaccinations (OR = 1.673; P < 0.05), compliance with screening mammograms (OR = 2.130; P < 0.05), and compliance with screening pap smears (OR = 2.708; P < 0.05) were important factors in determining whether a patient will receive CRC screening. Race, gender, insurance or employment status, use of blood thinners, family history of CRC, or other comorbid conditions including diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and end-stage renal disease were not found to have a statistically significant effect on patient adherence to CRC screening. CONCLUSION Patient age, history of sleep apnea, and compliance with other health maintenance tests were significant facilitators to CRC screening, while no-show rate percent was a significant barrier in our patient population. This study will be of benefit to physicians in addressing and improving the CRC screening rates in our community.

Identifying the main barriers for participation in a population-based colorectal cancer screening programme in East Azerbaijan, Iran

“…Cost of colonoscopy, medications, insurance coverage and travel costs are regarded as the most common barriers reported in many previous studies [ 11 , 18 , 19 ]. These problems are common, even in the developed societies as the USA and European countries [ 24 ].…”

“…(1) Personal and/or procedural related factors or the so-called Patient Related Factors: They are related to a lack of public awareness about the goals and benefits of CRC screening programme. Fear and discomfort related to colonoscopy, pain during the procedure, cancer, bowel preparation difficulties, complications ranked as the most important and common causes reported in a large number of studies [ 11 , 17 – 19 ].…”

“…(2) Practical and/or health system problems or the so-called System Related Factors: The most important problems of this category are the lack of awareness of primary healthcare (PHC) workers and physicians, misinformation about colonoscopy and its possible harms, crowded public and referral centres for screening and cost and length of colonoscopy. Lack of availability of screening tests in all treatment centres and scheduling appointment are regarded as other problems [ 18 , 19 ].…”

Prevalence of chronic obstructive pulmonary disease among 48,061 digestive tract cancer patients in Europe

“…Just recently, elevate arterial blood pressure, myocardial infarction, COPD and asthma were comorbidities with a high risk for increased mortality in patients with colorectal cancer receiving surgery (7). Finally, besides other factors, COPD was identified as a factor reducing patients' adherence to cancer screening programs, potentially preventing cancer diagnosis in early disease stages (8). Despite these strong data showing an association between COPD and digestive tract cancers incidence as well as cancer-related morbidity, no comparative analyses regarding frequencies of COPD in digestive tract cancer patients from different countries have been published so far.…”

Management of obstructed colorectal carcinoma in an emergency setting: An update

“…In 20%-30% of patients, mainly geriatrics, obstruction and ileus may be the first clinical manifestations of carcinoma that has advanced (stage II, III, or even IV)[ 2 , 9 - 12 ]. It is a potentially fatal condition that requires emergency intestinal decompression[ 3 , 13 ], and various models that predict the risk of mortality have been developed[ 14 ].…”