Persistent Barriers to Colorectal Cancer Screening Completion Amid Centralized Outreach: A Mixed Methods Study

• Published in: American journal of health promotion 2022-05, Vol.36 (4), p.697-705
• Main Authors: Wainwright, Jocelyn V., Mehta, Shivan J., Clifton, Alicia, Bocage, Claire, Ogden, Shannon N., Cohen, Sarah, Rendle, Katharine A.
• Format: Article
• Language: English
• Subjects: Barriers; Centralization; Colonoscopy; Colonoscopy - methods; Colorectal cancer; Colorectal Neoplasms - diagnosis; Early Detection of Cancer; Fear & phobias; Health care; Health promotion; Humans; Interviews; Mass Screening; Medical screening; Mixed methods research; Navigation; Non-invasive; Occult Blood; Outreach programs; Pragmatic Clinical Trials as Topic; Qualitative Research; Surveys and Questionnaires; Uptake
• ISSN: 0890-1171; 2168-6602
• DOI: 10.1177/08901171211064492

Purpose To understand patient experiences and persistent barriers to colorectal cancer (CRC) screening amid centralized outreach at urban family medicine practices. Approach Following a pragmatic trial assessing mailed fecal immunochemical test (FIT) outreach, we invited a subset of participants to complete a semi-structured qualitative interview and structured questionnaire. Setting Single urban academic healthcare system. Participants Sixty patients who were eligible and overdue for CRC screening at the time of trial enrollment. Method Using Andersen’s Behavioral Model, we developed an interview guide to systematically assess factors shaping screening decisions and FIT uptake. Close-ended responses were analyzed using descriptive statistics. Qualitative data were analyzed using the constant comparative method. Results Most participants (82%) self-reported that they had ever completed any modality of CRC screening, and nearly half (43%) completed the mailed FIT during the trial. Most patients (60%) preferred FIT to colonoscopy due to its private, convenient, and non-invasive nature; however, persistent barriers related to screening beliefs including fear of test results and cancer treatment still prevented some patients from completing any form of CRC screening. Conclusions Mailed FIT can overcome many structural barriers to CRC screening, yet clear communication and follow-up amid centralized outreach are essential. For some patients, tailored outreach or navigation to address screening-related fears or other screening beliefs may be needed to ensure timely completion of CRC screening.