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Persistent Barriers to Colorectal Cancer Screening Completion Amid Centralized Outreach: A Mixed Methods Study
Jocelyn V Wainwright1, Shivan J Mehta2,3, Alicia Clifton3
1Department of Family Medicine and Community Health, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA.
American Journal of Health Promotion : AJHP
|December 31, 2021
Summary
Mailed fecal immunochemical test (FIT) outreach improved colorectal cancer (CRC) screening, but fears about results and treatment remain barriers. Tailored communication and navigation are key for timely CRC screening completion.
Area of Science:
- Public Health
- Preventive Medicine
- Health Services Research
Background:
- Colorectal cancer (CRC) screening is crucial for early detection and improved outcomes.
- Centralized outreach programs aim to increase screening rates in urban settings.
- Understanding patient experiences and barriers is vital for optimizing CRC screening strategies.
Purpose of the Study:
- To investigate patient experiences and persistent barriers to colorectal cancer (CRC) screening.
- To assess the effectiveness of mailed fecal immunochemical test (FIT) outreach in urban family medicine practices.
- To identify factors influencing CRC screening decisions and FIT uptake.
Main Methods:
- A pragmatic trial assessed mailed FIT outreach.
- Semi-structured qualitative interviews and structured questionnaires were administered to a subset of participants.
- Andersen's Behavioral Model guided the development of the interview guide.
- Qualitative data were analyzed using the constant comparative method; quantitative data using descriptive statistics.
Main Results:
- 82% of participants had previously undergone some form of CRC screening.
- 43% completed the mailed FIT during the trial.
- 60% preferred FIT over colonoscopy due to convenience and privacy.
- Fears regarding test results and cancer treatment persisted as barriers for some patients.
Conclusions:
- Mailed FIT can effectively overcome structural barriers to CRC screening.
- Clear communication and consistent follow-up are essential components of centralized outreach.
- Tailored interventions or navigation may be necessary to address patient-specific fears and beliefs to ensure timely CRC screening.
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