Patient Knowledge, Risk Perception, and Barriers to Barrett's Esophagus Screening

Abstract

INTRODUCTION: Most patients with esophageal adenocarcinoma (EAC) do not have a previous diagnosis of Barrett's esophagus (BE), demonstrating a failure of current screening practices. An understanding of patient attitudes and barriers is essential to develop and implement interventions to improve BE screening adherence. METHODS:We conducted a Web-based survey of patients aged >50 years with chronic gastroesophageal reflux disease at 3 academic medical centers and 1 affiliated safety net health systems. Survey domains included patient characteristics, endoscopy history, familiarity with screening practices, perceived BE/EAC risk, and barriers to screening. RESULTS:We obtained a response rate of 22.6% (472/2,084) (74% men, mean age 67.9 years). Self-identified race and ethnicity of participants was 66.5% non-Hispanic White, 20.0% non-Hispanic Black, 13.4% other race, and 7.1% Hispanic. Screening for BE was recommended in only 13.2%, and only 5.3% reported previous screening. Respondents had notable gaps in knowledge about screening indications; only two-thirds correctly identified BE risk factors and only 19.5% believed BE screening was needed for gastroesophageal reflux disease. More than 1 in 5 respondents believed they would get BE (31.9%) or EAC (20.2%) but reported barriers to screening. Compared with White respondents, more Black respondents were concerned about getting BE/EAC and interested in screening but report higher barriers to screening.DISCUSSION:Patients at risk for BE, particularly racial and ethnic minorities, are worried about developing EAC but rarely undergo screening and have poor understanding of screening recommendations.

Real World Experience and Clinical Utility of EsoGuard® - Interim Data from the Lucid Registry

“…About one fifth (20.4%) of patients admitted fear of discomfort as a barrier to undergoing screening UE, along with logistical considerations (e.g., scheduling, location, wait time, post-sedation/post-anesthesia needs etc.,); this concern was increased among patients who had never undergone a prior UE. [18] Interestingly, more Black respondents recognized the importance of screening and were more concerned about developing BE/EAC compared to White and other race groups, but more frequently reported difficulty with scheduling the procedure. This suggests that non-endoscopic approaches such as EsoCheck and EsoGuard (EC/EG) could reduce inequity and be instrumental in improving acceptability and accessibility of BE testing among individuals who might otherwise be unable or unwilling to comply with traditional diagnostic evaluation.…”

Dutch individuals’ views of screening for oesophageal cancer: a focus group study

“…The over-representation of individuals with GORD symptoms, higher education, upper endoscopy experience, or who knew someone with oesophageal cancer suggests that self-selection bias is likely to have occurred. These groups are all associated with having more favourable perceptions of BO/OAC screening,13 15–17 25 potentially limiting the generalisability of our findings to the general population. Furthermore, patients with BO were prone to a familiarity preference effect,31 with individuals tending to prefer tests (conventional endoscopy in this case) merely because they are familiar with it.…”

“…To guide the design of an effective screening strategy, it is important to gain a more comprehensive understanding of individuals’ general willingness to be screened for BO/OAC irrespective of the test used. Previous surveys and screening trials suggested that the presence of GORD symptoms and easily accessible test options may play an important role in screening motivation 13 15–17. However, the potential influence of socioeconomic factors, social stigma, and involvement of the general practitioner on willingness to be screened for BO/OAC remain largely untouched 18…”

Clinical Utility Study of EsoGuard® on Samples Collected with EsoCheck® as a Triage Test for Endoscopy to Identify Barrett’s Esophagus – Interim Data of the First 275 Subjects

“…[23, 24] This is likely multifactorial in nature, including the absence of specific symptoms associated with BE, poor patient understanding of their own disease risk, and fears around the discomfort or inconvenience of upper endoscopy. [25] Office-based, non-endoscopic testing with EC/EG can address these patient concerns by improving accessibility and minimizing invasiveness. Additionally, given the intended utility of EsoGuard as a high-sensitivity triage test, it is expected that the test positivity rate should be higher than true disease prevalence, so as not to risk missing any patients with disease.…”