title: Barriers to colorectal cancer screening: a comparison of reports from primary care physicians and average-risk adults.
abstract: BACKGROUND
  Barriers to colorectal cancer (CRC) screening are not well understood.
  
  
  OBJECTIVE
  We sought to compare barriers to CRC screening reported by primary care physicians (PCPs) and by average-risk adults, and to examine characteristics of average-risk adults who identified lack of provider recommendation as a major barrier to CRC screening.
  
  
  METHODS
  This was a comparative study using data from the 1999-2000 Survey of Colorectal Cancer Screening Practices and the 2000 National Health Interview Survey (NHIS).
  
  
  METHODS
  We recruited nationally representative samples of PCPs (n= 1235) from the SCCSP and average-risk adults (n = 6497) from the NHIS.
  
  
  METHODS
  We measured barriers to CRC screening identified by PCPs and average-risk adults who were not current with screening.
  
  
  RESULTS
  Both PCPs and average-risk adults identified lack of patient awareness and physician recommendation as key barriers to obtaining CRC screening. PCPs also frequently cited patient embarrassment/anxiety about testing and test cost/lack of insurance coverage, but few adults identified these as major barriers. Of adults not current with testing, those who had visited a doctor in the past year or had health insurance were more likely to report lack of physician recommendation as the main reason they were not up-to-date compared with their counterparts with no doctor visit or health insurance. Only 10% of adults not current with testing and who had a doctor visit in the past year reported receiving a screening recommendation.
  
  
  CONCLUSIONS
  A need exists for continued efforts to educate the public about CRC and the important role of screening in preventing this disease. Practice-based strategies to systematically prompt health care providers to discuss CRC screening with eligible patients also are required.
authors.affiliation: Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-7344, USA. ck97b@nih.gov
authors.forename: Carrie N
authors.initials: CN
authors.lastname: Klabunde
authors.forename: Sally W
authors.initials: SW
authors.lastname: Vernon
authors.forename: Marion R
authors.initials: MR
authors.lastname: Nadel
authors.forename: Nancy
authors.initials: N
authors.lastname: Breen
authors.forename: Laura C
authors.initials: LC
authors.lastname: Seeff
authors.forename: Martin L
authors.initials: ML
authors.lastname: Brown
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D003144:Communication Barriers; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006266:Health Education / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology