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Provider- and System-Level Barriers and Facilitators to Colonoscopy and Multi-Target Stool DNA for Colorectal Cancer

Diana Redwood¹, Melissa Toffolon², Christie Flanagan¹

¹Alaska Native Tribal Health Consortium, 3900 Ambassador Dr., Anchorage, AK 99508, USA.

International Journal of Environmental Research and Public Health

|November 24, 2023

Summary

Colorectal cancer (CRC) screening for Alaska Native people faces provider and system barriers. Multi-target stool DNA (mt-sDNA) tests may overcome some colonoscopy challenges, but further research is needed.

Keywords:

Alaska Native cancer screening colorectal cancer colorectal neoplasms/prevention and control early detection of cancer health care health personnel provider screening barriers surveys and questionnaires

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Area of Science:

Public Health
Cancer Prevention
Health Disparities

Background:

Alaska Native people have the world's highest colorectal cancer (CRC) rates.
The Alaska Tribal Health System aims to improve CRC screening in this population.
Understanding provider and system barriers is crucial for effective screening strategies.

Purpose of the Study:

To examine provider- and system-level barriers and facilitators to CRC screening.
To explore these factors from the perspective of healthcare providers serving Alaska Native people in rural/remote areas.
To assess the potential of multi-target stool DNA (mt-sDNA) testing as an alternative or supplement to colonoscopy.

Main Methods:

Conducted 28 in-depth interviews with healthcare providers (physicians, advanced practice providers, Community Health Aides/Practitioners).
Interviews took place between February 1 and November 30, 2021.
Qualitative analysis of provider perspectives on colonoscopy and mt-sDNA screening.

Main Results:

Colonoscopy barriers included provider time, competing priorities, staffing, travel costs, weather, and COVID-19.
mt-sDNA barriers involved test viability, provider unfamiliarity, and prior stool test experiences.
Limited medical record reminders were a barrier for both methods.
Facilitators included community outreach, cultural competency, patient navigation, and system improvements.

Conclusions:

mt-sDNA testing may address colonoscopy barriers like waitlists and travel costs.
System-level barriers to colonoscopy remain significant.
Further research on patient barriers/facilitators and mt-sDNA integration is needed to reduce cancer disparities and promote equity in CRC prevention for Alaska Native people.