title: Patient and provider barriers to colorectal cancer screening in the primary care safety-net.
abstract: OBJECTIVE
  This study examines patient and provider barriers to screening for colorectal cancer among low-income uninsured African-Americans aged 50 years or older in an urban safety-net primary care clinic, with the goal of informing a future intervention.
  
  
  METHODS
  Four focus groups were conducted among 40 patients from, or living in the immediate neighborhood of, a primary care clinic for uninsured residents of Washington, DC. An additional focus group was conducted among primary care providers from the same clinic. Using semistructured open-ended questions, moderators elicited perceptions of barriers and promoters of colorectal cancer screening and suggestions to improve adherence to screening guidelines. The focus groups were audio-taped and transcribed verbatim. The transcripts were independently coded by two reviewers using established qualitative methodology.
  
  
  RESULTS
  Patient and provider comments from the five focus groups fell into one of eight content areas: primary care characteristics (36% of comments), procedural issues related to screening (16% of comments), knowledge (14% of comments), cost/insurance coverage (13%), ordering of priorities (12%), attitudes (5%), information sources (2%), and perceptions of discrimination (2%). Involving various members of the primary care team in colorectal cancer screening processes, and using reminders with feedback, were identified as promising avenues for future interventions in the safety-net setting. Patients and providers cited the lack of referral sources for colonoscopy for follow-up of abnormal fecal occult blood tests (FOBT), and lack of treatment sources as major barriers to the initiation of colorectal cancer screening in uninsured populations.
  
  
  CONCLUSIONS
  Organizational level interventions, such as a team approach to colorectal cancer screening, are important areas identified for future colorectal cancer screening interventions in the safety-net primary care setting. Larger policy efforts to provide coverage for screening, diagnosis, and treatment among the uninsured are critical to implementing adequate colorectal cancer screening for this population.
authors.affiliation: Georgetown University Medical Center, Lombardi Cancer Center, Washington, DC20007, USA. omalleya@georgetown.edu
authors.forename: A S
authors.initials: AS
authors.lastname: O'Malley
authors.forename: E
authors.initials: E
authors.lastname: Beaton
authors.forename: K R
authors.initials: KR
authors.lastname: Yabroff
authors.forename: R
authors.initials: R
authors.lastname: Abramson
authors.forename: J
authors.initials: J
authors.lastname: Mandelblatt
mesh_terms: D001294:Attitude to Health; D044383:Black People / Q000523:psychology; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D004219:District of Columbia; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000523:psychology; D017057:Medically Uninsured / Q000523:psychology*; D008875:Middle Aged; D011203:Poverty; D011320:Primary Health Care; D014505:Urban Population; D001741:Black or African American