Patient-Reported Barriers to Colorectal Cancer Screening A Mixed-Methods Analysis

Department of Epidemiology and Community Health, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
American journal of preventive medicine (Impact Factor: 4.28). 05/2010; 38(5):508-16. DOI: 10.1016/j.amepre.2010.01.021
Source: PubMed

ABSTRACT Barriers experienced by patients influence the uptake of colorectal cancer (CRC) screening. Prior research has quantified how often patients encounter these challenges but has generally not revealed their complex perspective and experience with barriers.
This mixed-methods study was conducted to understand current perspectives on CRC screening.
A two-part, mixed-methods study was conducted of primary care patients recruited from Virginia Ambulatory Care Outcomes Research Network practices. First, in June-July 2005 a survey was mailed to 660 patients aged 50-75 years posing an open-ended question about "the most important barrier" to CRC screening. Second, beginning in October 2005, seven gender- and largely race-specific focus groups involving 40 patients aged 45-75 years were conducted. Beginning in October 2005, survey verbatim responses were coded and quantitatively analyzed and focus group transcripts were qualitatively analyzed.
Responses to the open-ended survey question, answered by 74% of respondents, identified fear and the bowel preparation as the most important barriers to screening. Only 1.6% of responses cited the absence of physician advice. Focus group participants cited similar issues and other previously reported barriers, but their remarks exposed the intricacies of complex barriers, such as fear, lack of information, time, the role of physicians, and access to care. Participants also cited barriers that have little documentation in the literature, such as low self-worth, "para-sexual" sensitivities, fatalism, negative past experiences with testing, and skepticism about the financial motivation behind screening recommendations.
Mixed-methods analysis helps to disaggregate the complex nuances that influence patient behavior. In the present study, patients explained the web of influences on knowledge, motivation, and ability to undergo CRC screening, which clinicians and policymakers should consider in designing interventions to increase the level of screening.

  • Source
    • "Screening decisions are inherently infused with cognitive affect. Fear or worry about cancer and the screening process has been linked to increased and decreased screening behaviors in different studies (Hay, McCaul, & Magnan, 2006; Jones, Devers, Kuzel, & Woolf, 2010; R. A. Smith, Cokkinides, Brooks, Saslow, & Brawley, 2010). Specific types of affect, such as culturally driven shame associated with cancer, are thought to contribute to disparities in screening rates (M. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cancer control research involves the conduct of basic and applied behavioral and social sciences to reduce cancer incidence, morbidity, and mortality and improve quality of life. Given the importance of behavior in cancer control, fundamental research is necessary to identify psychological mechanisms underlying cancer risk, prevention, and management behaviors. Cancer prevention, diagnosis, and treatment are often emotionally laden. As such, affective science research to elucidate questions related to the basic phenomenological nature of emotion, stress, and mood is necessary to understand how cancer control can be hindered or facilitated by emotional experiences. To date, the intersection of basic affective science research and cancer control remains largely unexplored. The goal of this article is to outline key questions in the cancer control research domain that provide an ecologically valid context for new affective science discoveries. We also provide examples of ways in which basic affective discoveries could inform future cancer prevention and control research. These examples are not meant to be exhaustive or prescriptive but instead are offered to generate creative thought about the promise of a cancer research context for answering basic affective science questions. Together, these examples provide a compelling argument for fostering collaborations between affective and cancer control scientists. © The Author(s) 2015.
    Perspectives on Psychological Science 05/2015; 10(3):328-45. DOI:10.1177/1745691615576755 · 4.89 Impact Factor
  • Source
    • "In this way, people remain confident that they are risk-free from CRC because they are symptom free, thus, to them, do not require screening. The absence of symptoms as a barrier to CRC screening has been reported in other studies (Jones et al. 2010, Katz et al. 2004), including studies with Indigenous Australians (Christou et al. 2010) and Iranians (Salimzadeh et al. 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Colorectal cancer (CRC) has the second highest cancer prevalence and mortality rates in Australia. The Australian National Bowel Cancer Screening Program (NBCSP) aims to increase early detection of CRC by offering free faecal occult blood testing. The NBCSP aims to offer choice to consumers about whether or not to participate in screening. This article presents data on trust, choice and perceived obligation to participate in the NBCSP by population groups with low uptake. A qualitative study was undertaken in South Australia. We interviewed 94 people from four culturally distinct groups: Greek, Iranian, Anglo-Australian and Indigenous peoples. This article demonstrates the complexity of factors shaping the choice, or lack thereof, to participate in the NBCSP. Informed choice is based on adequate knowledge, although this varied among our participants, highlighting the need for more health education in appropriate languages. An obligation to participate was found in the Iranian and Anglo-Australian groups and resulted from an established personal relationship with the doctor, a sense of duty, the acknowledgement of government investment and appreciation. Overall, this article makes a link between trust, choice and obligation, adding to literature on the sociology of trust and medical screening and highlighting important issues in the need of a policy and practice to improve CRC screening rates. © 2015 Foundation for the Sociology of Health & Illness.
    Sociology of Health & Illness 04/2015; DOI:10.1111/1467-9566.12280 · 1.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Chez les Français de plus de 50 ans, le cancer colorectal est une cause majeure de morbidité et de mortalité, et l’efficacité thérapeutique est d’autant améliorée que la maladie est traitée précocement. Pour une population asymptomatique présentant un risque moyen de développer un cancer intestinal, le test de dépistage a été systématisé. Le test habituellement utilisé est le test Hémoccult® II. Il permet de repérer d’infimes traces de sang dans les selles. Le recours à ce test reste encore de nos jours en deçà des normes recommandées (35/50 %), en dépit des campagnes de sensibilisation qui encouragent son usage. Ce dernier dépend de plusieurs facteurs: l’âge, le genre, le statut marital et le niveau d’étude, tout comme certains freins socioéconomiques et culturels et des raisons pratiques propres à la méthode employée. Quoi qu’il en soit, le dialogue et les recommandations du médecin envers le dépistage du cancer colorectal paraissent décisifs. Or, la peur, l’embarras, la gêne peuvent décourager certains patients à parler ouvertement avec leur médecin du cancer colorectal et de la technique bien particulière de son dépistage. Le rôle probable de ces émotions perturbatrices vis-à-vis de l’adoption d’un test de dépistage du cancer fait l’objet d’un nombre croissant d’études. Il est notamment encore difficile de savoir si l’anxiété décourage ou motive le dépistage du cancer colorectal. Nous pensons qu’il est important de mieux décrire les attitudes psychologiques affichées à son égard, en vue d’optimiser l’impact des campagnes qui recommandent son usage et de faciliter le dialogue singulier avec le médecin. In French people aged over 50 years, colorectal cancer is a major cause of morbidity and mortality. For an asymptomatic population at average risk of developing this somatic disease, the test usually used is the Hemoccult II® Test, which can detect the presence of occult blood in the stool. It is clear that using this test remains today below the recommended standards despite health campaigns that encourage efficient use. Several practical reasons and socio-economic obstacles can be invoked to explain these findings. Anyway, the doctor’s recommendations against screening for colorectal cancer seem to be decisive. But fear and embarrassment may deter some patients from talking openly with their doctors about colorectal cancer and its screening. The possible role of these disturbing emotions in the adoption of cancer screening has been the subject of a growing number of researches over the past thirty years. But, it still remains very unclear whether anxiety inhibits or motivates colorectal cancer screening. To promote equal access to it, we think it is important to better describe the psychological attitudes displayed toward it, to maximize the impact of campaigns that recommend the use of the Hemoccult II® test. Mots clésDépistage du cancer colorectal–Adhésion–Facteurs psychologiques–Anxiété envers la santé–Embarras KeywordsColorectal cancer screening–Adherence–Psychological factors–Health anxiety–Embarrassment
    Psycho-Oncologie 03/2011; 5(1):25-33. DOI:10.1007/s11839-011-0304-8 · 0.08 Impact Factor
Show more