Identifying barriers to colorectal cancer screening

Introduction: Colorectal Cancer (CRC) is the second most common cause of cancer death in the U.S. Novel methods may be needed to help patients plan for the specifics of screening tests that are currently underutilized.

Methods: Participants were over 50 years old, not up-to-date with colorectal cancer screening, and planning to complete a CRC screening test. The participants were asked to choose between a colonoscopy and a fecal occult blood test (FOBT). Open-ended interviews were conducted to explore patients' plans for FOBT completion, colonoscopy scheduling and bowel prep. A consensus-based qualitative analysis of interview transcripts was conducted.

Results: Participants (N=36) chose FOBT and colonoscopy in equal numbers. Virtually all participants felt they would have little difficulty completing their chosen test. FOBT participants stated specifically that they would keep card kits on the toilet as a reminder. Colonoscopy participants described keeping bowel prep materials in the kitchen or bathroom. Most stated a family member would drive them to and from the test site. The interview process helped participants identify personal barriers and solutions to overcome them by guiding them through the screening process. We anticipated fear of embarrassment, pain, bowel prep and complexity as barriers in completing FOBT or colonoscopy; however these were not identified as barriers.

Conclusion: Primary Care patients can develop specific “Implementation Intentions” for CRC screening. Findings from this pilot should help future education and public health campaigns around CRC prevention.