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: 4.53). 05/2010; 38(5):508-16. DOI: 10.1016/j.amepre.2010.01.021
Source: PubMed


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.

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Available from: Resa M Jones, Oct 07, 2014
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    • "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). "
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    • "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. "
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    • "n a clinic or in a physician ' s office , and involves discomfort ( cf . Cahill & McGaugh 1998 , describing cognitive and neural mecha - nisms that modulate memory formation , storage and recall of emotionally arousing events ) . Another possible source of error in reporting FOBT is that respondents may confuse in - office with home - based FOBT ( Jones et al . 2010 ) . In 15 of the 19 studies with FOBT data , respondents were explicitly asked about home - based FOBT , whereas the other four studies do not mention what type of FOBT was analysed and whether the type of FOBT was clarified / defined in the survey . A possible cause of the low accuracy of self - reporting for DCBE is that , despite the"
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