Perceptions of Colorectal Cancer Screening in Urban African American Clinic Patients: Differences by Gender and Screening Status

Abstract

African Americans have higher colorectal cancer (CRC) morbidity and mortality than whites, yet have low rates of CRC screening. Few studies have explored African Americans' own perceptions of barriers to CRC screening or elucidated gender differences in screening status. Focus groups were conducted with 23 African American patients between 50 and 70 years of age who were © Springer 2010 Correspondence to: Sarah Bauerle Bass, sbass@temple.edu. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript patients in a general internal medicine clinic in a large urban teaching hospital. Focus groups were delimited by gender and CRC screening status. Focus group transcripts were analyzed using an iterative coding process with consensus and triangulation to develop thematic categories. Results indicated key thematic differences in perceptions of screening by gender and CRC screening status. While both men and women who had never been screened had a general lack of knowledge about CRC and screening modalities, women had an overall sense that health screenings were needed and indicated a stronger need to have a positive relationship with their doctor. Women also reported that African American men do not get colonoscopy because of the perceived sexual connotation. Men who had never been screened, compared to those who had been screened, had less trust of their doctors and the health care system and indicated an overall fear of going to the doctor. They also reiterated the sexual connotation of having a colonoscopy and were apprehensive about being sedated during the procedure. Overall, men expressed more fear and were more reluctant to undergo CRC screening than women, but among those who had undergone CRC screening, particularly colonoscopy, men expressed advantages of having the screening. All groups were also found to have a negative attitude about the use of fecal occult blood testing and felt colonoscopy was the superior screening modality. Results suggest that messages and education about CRC screening, particularly colonoscopy, might place more emphasis on accuracy and might be more effective in increasing screening rates among African Americans if tailored to gender and screening status. NIH Public Access

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

“…Previous research supports the importance of provider recommendations for CRC screening, and patients who have never completed CRC screening may need provider counseling before completing a FIT. 30 , 33 , [37][38][39] Our study has several limitations. First, it was conducted in a single organization with a somewhat homogenous population and few clinical sites.…”

“…Finally, this study did not stratify patients by prior screening behaviors, despite the fact that never-screened patients may have lower knowledge about CRC screening, tend to rely on physician recommendations, and have negative attitudes toward FOBT. [28][29][30][31][32][33] To address gaps in the evidence base, we conducted this study to determine the marginal effect of outreach (mailed FIT, reminders, and personal calls), compared to high-quality point-of-care strategies, on CRC screening among CHC patients with no screening history. Understanding the benefits of outreach over point-of-care strategies is important because of the resources required for outreach.…”

Systematic Review and Meta-study Synthesis of Qualitative Studies Evaluating Facilitators and Barriers to Participation in Colorectal Cancer Screening

“…Numerous qualitative studies have investigated perceptions and experiences with colorectal cancer screening participation (17)(18)(19)(20). These studies have identified factors that affect screening decisions, as well as barriers and facilitators of colorectal cancer screening in a variety of settings.…”

Psychological barriers and facilitators of colorectal cancer screening: a French qualitative study

“…[14][15][16] This manifest lack of knowledge and its potential risks are clearly at least partly responsible for low screening rates. 8 Thus some people consider that CRC cannot be a serious disease, because if it were, they would be better informed.…”

“…17 Others seem to be unaware of the need for regular screening, or at least think that once is enough. 22 The Hemoccult-II ® test raises a large number of questions and strong reticence, 14 which very likely explains why it is the most infrequently used test. 20 It arouses considerable distrust due to its presumed lack of reliability, based on the feeling that only tests carried out by doctors guarantee a degree of credibility, 9 together with the fact that certain members of the medical profession question the test's sensitivity.…”