Barriers and Facilitators of Colorectal Cancer Screening in a Federally Qualified Health Center (FQHC)

Abstract

Introduction:Colorectal cancer is a leading cause of cancer-related mortality in the United States. Current screening recommendations for individuals aged 50 to 75 years include colonoscopy every 10 years, flexible sigmoidoscopy every 5 years, or annual stool-based testing. Stool-based testing, including fecal immunochemical tests (FITs), are cost effective, easy to perform at home, and noninvasive, yet many patients fail to return testing kits and go unscreened. The purpose of the study was to identify patient characteristics and perceived barriers and facilitators of FIT return.Methods: Patients in a large, federally qualified health center who received a FIT kit order between January 1 and July 1, 2017 were identified. We compared sociodemographic and health characteristics between patients who returned and did not return FITs. We used telephone surveys to nonreturners to identify potential barriers (cost, knowledge, psychosocial factors) and facilitators (prepaid postage, outreach) of FIT kit return. An online survey of clinicians assessed perceived patient barriers and facilitators of colorectal cancer screening.Results: Of the 875 patients who received a FIT order, 435 (49.7%) did not return the kit and 121 of the nonreturners completed a telephone survey. Current smokers had an increased risk of FIT nonreturn compared with never smokers (RR ‫؍‬ 1.32; 95% CI, 1.13-1.54). Forgetfulness and lack of motivation were the most common FIT return barriers perceived by both patients and clinicians. Prepaid postage with return address on FIT return envelopes and live call reminders were the most commonly reported facilitators. Barriers and facilitators varied greatest between English-and Spanish-speaking patients.Conclusion: In this study, the most common perceived barriers to return of screening fecal test kits were forgetfulness and lack of motivation. The most common perceived facilitators were live call reminders and postage-paid return envelopes. Understanding barriers and facilitators to FITs may be necessary to enhance cancer screening rates in underserved patient populations. (J Am Board Fam Med 2019;32:180 -190.)Colorectal cancer is the second most common type of cancer-related death in men and the third most common in women; over 50,000 deaths a year in the United States are attributable to colorectal cancer. 1 Although substantial progress was made over the past 2 decades and colorectal cancer death rates This article was externally peer reviewed.

Colorectal cancer screening in Uruguay: current assessment and roadmap for the future

“…With regard to obtaining a colonoscopy, in one study of Latinx with moderate CRC risk, those who exhibited greater worry and lower optimism were more likely to obtain the test than individuals with lower worry and higher optimism (Efuni et al, 2018). With regard to stool-based tests, researchers have found that the most common perceived facilitators were live call reminders and postage-paid return envelopes (Ylitalo et al, 2019). Moreover, a social support-based intervention was successful in increasing screening rates.…”

Impacting Underserved Communities as a GI Trainee

“…The most commonly used screening test for average risk individuals is annual fecal immunochemical testing (FIT) in patients 50-75 years old. A number of inefficiencies that arise when initiating screening via FIT and performing colonoscopy often occur; issues can include, but are not limited to, inappropriate use of FIT screening, institutional challenges of distributing and collecting FIT kits, patients' difficulty with returning FIT kits, institutional challenges with timely scheduling of colonoscopies for positive FIT tests, poor bowel prep, and patient misconceptions about colonoscopy [3]. Over the course of a 3-year fellowship, GI trainees can initiate a QI project to identify and address the specific inefficiencies of colorectal cancer screening within a community and hospital system that will identify opportunities to systematically improve care.…”

Physician‐office vs home uptake of colorectal cancer screening using FOBT/FIT among screening‐eligible US adults

“…A study found that 81% of clinicians believed that patients who received a FIT order may not have the motivation to return home-test kits, 61% believed that patients may forget to return home-test kits, and 55% believed that poor understanding of test instructions was a barrier to returning hometest kits. 21 While physicians may conduct in-office FOBT/ FIT in a bid to address these perceived barriers and ensure their patient is screened, this practice is guideline incongruent 4,11 and deemed inadequate for CRC screening by medical bodies such as the American College of Obstetricians and Gynecologists. 22 Other drivers of in-office screening may include factors such as financial incentives, as well as screening in an effort to satisfy quality measures such as the Healthcare Effectiveness Data and Information Set.…”

“…In addition to obtaining results almost immediately, in‐office testing boosts compliance. A study found that 81% of clinicians believed that patients who received a FIT order may not have the motivation to return home‐test kits, 61% believed that patients may forget to return home‐test kits, and 55% believed that poor understanding of test instructions was a barrier to returning home‐test kits . While physicians may conduct in‐office FOBT/FIT in a bid to address these perceived barriers and ensure their patient is screened, this practice is guideline incongruent and deemed inadequate for CRC screening by medical bodies such as the American College of Obstetricians and Gynecologists .…”