title: 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.
authors.affiliation: Research Division, Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA.
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Quick
authors.forename: Christina M
authors.initials: CM
authors.lastname: Hester
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Young
authors.forename: K Allen
authors.initials: KA
authors.lastname: Greiner
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007615:Kansas; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D057240:Patient Preference; D011204:Poverty Areas; D044469:Racial Groups; D057566:Self Report