Perceived colonoscopy barriers and facilitators among urban African American patients and their medical residents

African Americans suffer from higher colorectal cancer (CRC) morbidity and mortality than whites, yet have the lowest screening rates. To understand barriers and facilitators to CRC screening, we used perceptual mapping (multidimensional scaling) methods to compare patients' perceptions of colonoscopy and general preventive health practices to those of their doctors in a general internal medicine clinic in a large urban hospital in Philadelphia. African American patients (n=102) were surveyed about their own CRC screening beliefs; third-year resident physicians (n=29) were asked what they perceived their patients believed. The perceptual maps showed significant differences between the patients' and physicians' perceptions of barriers, facilitators, and beliefs about CRC screening. Physicians believed logistical lifestyle issues were the greatest screening barriers for their patients whereas fears of complications, pain, and a possible cancer diagnosis were the most important barriers perceived by patients. Physicians also underestimated patients' understanding of the benefits and importance of screening, doctors' recommendations, and beliefs that faith in God could facilitate CRC screening. Both physicians and patients perceived a doctor's recommendation for screening was an important facilitator. Better understanding of patient perceptions can be used to improve doctor-patient communication about CRC screening, and to improve medical resident training by incorporating specific messages tailored for use with African American patients.