Provider Preferences, Perceptions, and Barriers to Colorectal Cancer Screening in Federally Qualified Health Centers:...

Colorectal cancer (CRC) screening reduces mortality, yet uptake varies by screening modality, provider type, and clinical setting. Federally Qualified Health Centers (FQHCs) care for underserved populations and face unique challenges, including limited resources, diverse care needs, and competing clinical priorities. Despite the importance of screening, provider preferences for CRC screening modalities are not well understood.

We conducted a cross-sectional survey of primary care providers (physicians, nurse practitioners, physician assistants) at four FQHCs in Wisconsin. Providers were asked to estimate the percentage of average-risk patients to whom they recommended colonoscopy, stool DNA, and FIT/FOBT (fecal immunochemical test/fecal occult blood test) for two age groups (45-49 and 50-75 years), and to identify factors, barriers, and facilitators influencing their screening decisions. Associations between provider characteristics and recommendations were analyzed using chi-square tests.

33 providers completed the survey (MD/DO = 18, NP = 10, PA = 5). FIT/FOBT recommendations for ages 50-75 differed by provider type. MD/DOs recommended FIT/FOBT to fewer than 25% of patients, while advanced practice providers had a more even distribution across modalities (p = 0.025). When NPs and PAs were analyzed separately, differences remained significant (p = 0.032). Colonoscopy recommendations for ages 45-49 were associated with whether the provider had a family member who completed stool DNA (p = 0.0061). Colonoscopy was the most frequently recommended screening modality, followed by stool DNA and FIT/FOBT. Patient preferences and circumstances were ranked highest among factors influencing screening recommendations. Clinic policy, workflow, and length of patient appointments were the least influential factors. Barriers to prescribing stool DNA included prioritizing other acute health issues, inconvenience, and lack of on-site kit distribution. Provider-ranked patient barriers to completion included complicated instructions, lack of understanding, and fear of results. Top facilitators for increasing stool DNA use included patient reminders, point-of-care kit distribution, and streamlined electronic health record ordering.

In FQHCs, provider type influences CRC screening recommendations, but providers often use multiple modalities suggesting they value tailored recommendations. Targeted efforts to reduce electronic health record workflow challenges, improve kit access and distribution, and enhance patient education may increase screening uptake.