Physician and staff perceptions of barriers to colorectal cancer screening in Appalachian Kentucky.
BACKGROUND
Data indicate that in 1997 to 1999, only 44% of Appalachian Kentuckians underwent colorectal cancer screening consistent with guidelines. We investigated the reasons for, barriers to, and follow-up of colorectal cancer (CRC) screening recommendations in primary care practices seeing patients from Appalachian Kentucky.


METHODS
A mixed-methods [qualitative (focus group) and quantitative (survey)] approach was used to gather and analyze data in five primary care practices. A total of 34 participated in the focus groups.


RESULTS
In focus groups, physicians and office staff reported a number of indicators for CRC screening; physician, patient, and procedural barriers to CRC screening; and strategies to overcome these barriers to screening. Most physicians used personal experience to guide screening, but it was unclear what was meant by personal experience. Commonly cited patient barriers to screening were fear and embarrassment. Physicians reported several approaches to overcome these barriers, including establishing trust and educating patients. Survey data identified a number of resources to assist practices in promoting screening, most commonly, patient educational materials. Finally, fecal occult blood test was most commonly recommended because it is inexpensive and easy to administer.


CONCLUSIONS
Our mixed methods approach not only helped to understand the physicians' perceptions of the problems and barriers to CRC screening in Appalachian Kentucky, but also elucidated how practices endeavor to overcome these barriers and identified the additional resources practices would like in order to promote CRC screening.
Kelly
Kimberly M
KM
Human Cancer Genetics Program, The Ohio State University, Columbus, OH 43210, USA. Kimberly.Kelly@osumc.edu
Phillips
Clarenda M
CM
Jenkins
Crystal
C
Norling
Gretchen
G
White
Carol
C
Jenkins
Todd
T
Armstrong
Debra
D
Petrik
Joe
J
Steinkuhl
Amy
A
Washington
Regina
R
Dignan
Mark
M
D001061:Appalachian Region; D001291:Attitude of Health Personnel; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D005239:Fear; D017144:Focus Groups; D019538:Health Care Surveys / Q000379:methods*; D006293:Health Promotion; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007629:Kentucky; D008403:Mass Screening / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods / Q000592:standards*