Confusion about colorectal cancer screening options decreases screening adherence

Background: While colorectal cancer (CRC) is the second leading cause of cancer death, colorectal cancer screening (CRCS) can reduce the mortality. However, age-eligible adults (i.e., ≥50 years) experience barriers to CRCS and screening adherence is less than ideal. There is evidence that confusion about the different CRCS modalities acts as a barrier and decreases CRCS uptake. Methods: In September 2011 a cross-sectional, self-administered questionnaire was distributed to age-eligible employees at a worksite in southeastern Virginia (N=89). Questions ascertained CRCS history, CRCS-related confusion, and demographics. Descriptive statistics were calculated and multivariate logistic regression was performed to examine the association between confusion (5 individual items; summation of items, range 0-5) and CRCS adherence status adjusting for model specific confounders (e.g., age, race, education, and gender). Results: Roughly 74% of the sample was female, 44% were white, and mean age was 56.5 years (response rate=50%). Overall, 77% reported having CRCS per national guidelines. Not feeling adequately informed about CRCS tests, having difficulty comparing the various CRCS features, and thinking there are too many tests to choose from were each significantly associated with non-adherence. Further, with each increase in the number of reported barriers there was a 46% reduction in the odds of being adherent to national CRCS screening guidelines (OR=0.54, 95% CI: 0.35–0.85). Conclusions: Among a largely adherent employee population, confused respondents are significantly less likely to be adherent to CRCS recommendations. Interventions and educational programs should help age-eligible adults make sense of CRCS and the various options to ultimately increase CRCS.