Rural barriers to colonoscopy screening identified through patient navigation

Rural residence is associated with disparities in colorectal cancer (CRC) screening and mortality. There is limited data about barriers to screening experienced after referral for colonoscopy among rural populations. Patient navigation (PN) is an evidence-based approach to supporting cancer screening, and addressing screening barriers is an important aspect of PN programs. We examine the barriers identified by the Colonoscopy Outreach for Rural Communities (CORC) study patient navigator.

Descriptive analysis of barrier frequencies reported by the CORC patient navigator and qualitative descriptive analysis of the patient navigator's field notes using the Framework Method to investigate barriers experienced across 157 rural CORC PN patients.

The navigator identified barriers among 64.3% (n = 101) of the patients. Scheduling (31.2%) and knowledge (28.0%) were the most common types of barriers observed among nine barrier types identified and described. Prevalence was higher among people who did not complete colonoscopy for system-level scheduling, time, cost, comorbid conditions, psychosocial, and language barriers.

Our study design of using patient navigation documentation to characterize barriers to screening colonoscopy as patients encountered them in real time is an innovative analytic approach. Literature on rural colonoscopy barriers has generally relied on patient perceptions of anticipated or prior barriers to colonoscopy and clinician reports of what they have observed among patients, which limits the findings to static or hypothetical concerns. This innovative approach allowed us to capture a view of barriers as experienced by patients: dynamic, evolving, and embedded within health system interactions and the real-time personal contexts in which screening decisions were being made.

Our findings add to the literature by offering detailed descriptions of barriers as experienced by rural patients as they receive navigation to complete their screening colonoscopy.