Self-reported barriers to colorectal cancer screening in a racially diverse, low-income study population

Abstract

Colorectal cancer (CRC) screening is underutilized, especially in low income, high minority populations. We examined the effect test-specific barriers have on colonoscopy and fecal immunochemical test (FIT) completion, what rationales are given for non-completion, and what "switch" patterns exist when participants are allowed to switch from one test to another. Low income adults who were not up-to-date with CRC screening guidelines were recruited from safety-net clinics and offered colonoscopy or FIT (n = 418). Follow up telephone surveys assessed test-specific barriers. Test completion was determined from patient medical records. For subjects who desired colonoscopy at baseline, finding a time to come in and transportation applied more to non-completers than completers (p = 0.001 and p < 0.001, respectively). For participants who initially wanted FIT, keeping track of cards, never putting stool on cards, and not remembering to mail cards back applied more to non-completers than completers (p = 0.003, p = 0.006, and p < 0.001, respectively). The most common rationale given for not completing screening was a desire for the other screening modality: 7 % of patients who initially preferred screening by FIT completed colonoscopy, while 8 % of patients who initially preferred screening by colonoscopy completed FIT. We conclude that test-specific barriers apply more to subjects who did not complete CRC screening. As a common rationale for test non-completion is a desire to receive a different screening modality, our findings suggest screening rates could be increased by giving patients the opportunity to switch tests after an initial choice is made.

Figure 1. Study Diagram

Shaded area represents participants included in data analysis (N=418).

Figure 2. Comparison of Completers and Non-Completers Negative Responses to Colonoscopy Barrier Questions

91 of 96 completers (94.8%) and 75 of 155 non-completers (48.4%) gave responses. *Statistically significant difference (Bonferroni’s procedure for controlling 5% type I error rate). †A= Problems finding a time you can come in; B= Not liking the large amount of fluid and laxative you have to drink; C= Discomfort from going to the bathroom 10-15 times to clear out the colon; D= Fear of pain; E= Fear of embarrassment; F= Fear of injury to colon; G= Unwilling to have a tube inserted in rectum; H= Too much of an invasion of personal privacy; I= Fear that the test results would show something bad; J= Problems getting to and from appointment.

Figure 3. Comparison of Completers and Non-Completers Negative Responses to FIT Barrier Questions

80 of 85 completers (94.1%) and 34 of 82 non-completers (41.5%) gave responses. *Statistically significant difference (Bonferroni’s procedure for controlling 5% type I error rate). †K= Problems keeping track of the cards; L= Never getting around to putting the stool on the cards; M= Disgusted by the idea of putting stool and water on the cards; N= Worry about germs or contamination from stool; O= Not remembering to mail the cards back; P= Takes too long to get the test results; Q= Doubt that the test results would be correct or accurate; R= Fear that the test results would show something bad.