Barriers to colorectal cancer screening in community health centers: a qualitative study.
BACKGROUND
Colorectal cancer screening rates are low among disadvantaged patients; few studies have explored barriers to screening in community health centers. The purpose of this study was to describe barriers to/facilitators of colorectal cancer screening among diverse patients served by community health centers.


METHODS
We identified twenty-three outpatients who were eligible for colorectal cancer screening and their 10 primary care physicians. Using in-depth semi-structured interviews, we asked patients to describe factors influencing their screening decisions. For each unscreened patient, we asked his or her physician to describe barriers to screening. We conducted patient interviews in English (n = 8), Spanish (n = 2), Portuguese (n = 5), Portuguese Creole (n = 1), and Haitian Creole (n = 7). We audiotaped and transcribed the interviews, and then identified major themes in the interviews.


RESULTS
Four themes emerged: 1) Unscreened patients cited lack of trust in doctors as a barrier to screening whereas few physicians identified this barrier; 2) Unscreened patients identified lack of symptoms as the reason they had not been screened; 3) A doctor's recommendation, or lack thereof, significantly influenced patients' decisions to be screened; 4) Patients, but not their physicians, cited fatalistic views about cancer as a barrier. Conversely, physicians identified competing priorities, such as psychosocial stressors or comorbid medical illness, as barriers to screening. In this culturally diverse group of patients seen at community health centers, similar barriers to screening were reported by patients of different backgrounds, but physicians perceived other factors as more important.


CONCLUSIONS
Further study of these barriers is warranted.
Lasser
Karen E
KE
Department of Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA, USA. klasser@challiance.org
Ayanian
John Z
JZ
Fletcher
Robert H
RH
Good
Mary-Jo DelVecchio
MJ
D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D003144:Communication Barriers; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005069:Evaluation Studies as Topic; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008404:Massachusetts; D008875:Middle Aged; D010817:Physician-Patient Relations