Patients' self-reported barriers to colon cancer screening in federally qualified health center settings

Abstract

Colorectal cancer (CRC) is a leading cause of cancer-related death in the United States. Despite evidence that screening reduces CRC incidence and mortality, only about 60% of age-eligible adults are up-to-date on CRC screening. This analysis aims to identify self-reported barriers to CRC screening among patients in a safety-net healthcare setting. Participants were recruited from safety-net primary care sites that were participating in a trial to increase CRC screening. At baseline, patients (n = 483) completed self-report surveys that assessed demographics, healthcare and CRC screening. Barriers to CRC screening were assessed through an open-ended question. Using a basic text analysis, data were coded and organized into key topics. Overall, 65.2% ever had CRC screening; 46.4% were up-to-date. Of those who described barriers (n = 198), 22.9% said they were not due for screening or their provider had not recommended it. Other common barriers included fear or worry about the procedure or outcome, financial challenges such as lack of insurance or cost of testing, and logistic challenges such as transportation and time. Fewer said that screening was of low importance or mentioned discomfort with the procedure or colonoscopy preparation. In this safety-net setting, CRC screening rates were lower than national rates. These qualitative results are similar to quantitative findings reported in the literature but the qualitative data add to our understanding of patient-reported concerns and challenges faced by safety-net patients. These results may be applied to developing targeting communication or intervention strategies to improve CRC screening rates within safety-net health centers.

Vital Signs: Colorectal Cancer Screening Test Use — United States, 2018

“…Although lack of health insurance has been strongly associated with low CRC screening prevalence (7), the majority of persons in this study who had never been screened reported having health insurance. Other patient barriers to CRC screening include lack of a provider recommendation, being offered colonoscopy only instead of a choice of tests, lack of awareness of the need to be screened, fear, expense, competing priorities, inability to take time off work if referred for a colonoscopy, and the perceived undesirable nature of screening tests (e.g., sampling and storing fecal matter for stool tests or completing a bowel preparation for colonoscopy) (13)(14)(15)(16). Other factors positively associated with CRC screening include use of other preventive services such as cholesterol testing, receiving influenza vaccination, and mammography or cervical cancer screening.…”

Colorectal cancer statistics, 2020

“…Other characteristics associated with low screening prevalence include residence in the United States for fewer than 10 years (26%), being uninsured (30%) or insured by Medicaid (53%), and being of Asian descent (55%) (Table ). In addition, fewer than one‐half of individuals who receive care at federally qualified health centers are current for screening . Screening also varies widely by state; prevalence in 2018 ranged from 60% in Wyoming to 76% in Massachusetts in ages ≥50 overall (Fig.…”

Patient, Clinician, and Communication Factors Associated with Colorectal Cancer Screening

“…Another study in safety net practices found the top barrier for not receiving any screening was patients not knowing they were due for screening or their clinician not recommending screening. 17 The longer clinician-patient relationships and greater clinician involvement in decisions observed in this study may be addressing these barriers.…”