Factors associated with self-reported barriers to colonoscopy among low-income/under-served patients in a family medicine setting

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer death in the U.S with an estimated 142,820 new cases and 50,830 deaths in 2013. Five counties in the Brazos Valley region of Texas have invasive CRC incidence rates higher than state average. Screening rates fall short of the Healthy People 2020 Objectives. Studies have demonstrated demographic variations in screening rates. Learning objectives: Identify the influence of race/ethnicity, education, gender and marital status on the extent to which patients identified certain factors as barriers to CRC screening. Methods: Patients receiving colonoscopy at the Texas A&M Physician Family Medicine Center through a CPRIT-funded screening and prevention program for Brazos Valley residents reported the extent to which certain factors were barriers to having a screening colonoscopy using a Likert scale 1 (strongly disagree) to 5 (strongly agree). Descriptive statistics were conducted; ordinal logistic regression was used to analyze the effect of the independent variables on the outcome variables. P-value of 0.05 or lower was considered significant. Results: 32.8% of respondents were whites, 24.3% blacks, and 32.4% Hispanics. 95.1% of respondents reported cost (strongly agreed and agreed) as a barrier to colonoscopy utilization, followed by fear (60.2%) and lack of knowledge (50%). Hispanics were more likely to report embarrassment (P-value 0.05), lack of knowledge (P-value 0.02) and fear of finding cancer as barriers (P-value 0.0001). Males were more likely than females to report embarrassment as a barrier (P-value 0.03). Conclusion: Lack of knowledge, embarrassment and fear may contribute to CRC screening disparities.