Barriers to Screening Colonoscopy for Low-income Latino and White Patients in an Urban Community Health Center

Abstract

Understanding of the range of barriers to colorectal cancer screening can help develop multimodal interventions to increase colonoscopy rates for all patients including low-income Latinos. Interventions including systems improvements and navigator programs could address barriers by assisting patients with scheduling, insurance issues, and transportation and providing interpretation, education, emotional support, and motivational interviewing.

A Culturally Tailored Navigator Program for Colorectal Cancer Screening in a Community Health Center: A Randomized, Controlled Trial

“…We believe, after discussion with the navigators, that the higher rate in our controls may have been due to "intervention contamination" among non English-speaking control patients, many of whom had interaction with navigators (study-trained HC outreach workers) or became interested in CRC screening through family or friends who interacted with navigators. Many barriers previously identified 6,[15][16][17][18][19][20]22,23 were also reported by patients in our study, particularly knowledge gaps, lack of motivation, and concerns about the colonoscopy procedure. Many patients needed help with scheduling their procedure.…”

“…6,[15][16][17][18][19][20][21] Factors particularly relevant for low income and limited English proficiency patients may include: insufficient time to effectively discuss CRC screening during clinic visits, difficulty contacting patients, financial strains associated with taking time off from work, lack of health insurance, difficulty obtaining transportation, and/or lack of interpreters at procedure sites. 22,23 These unique barriers may contribute to observed disparities in care. [24][25][26][27][28][29][30][31] Strategies shown to modestly increase preventive cancer screening rates in low income and limited English proficiency populations have included both mailed reminders with educational information for patients and physician-directed efforts to increase recommendation rates.…”

Predicting Non-Adherence with Outpatient Colonoscopy Using a Novel Electronic Tool that Measures Prior Non-Adherence

“…We did not investigate certain variables that may be associated with non-attendance, including socio-economic status, ethnicity, indication for colonoscopy, colonoscopy referral source, or patient-specific barriers to attendance. 10,14,16,25,32 Furthermore, because few patients in this study were uninsured, on Medicaid, or lacked college education, our findings may not extend to these populations. Likewise, because the NAR relies on data from prior interactions with a health system, it may have limited utility for predicting adherence for patients who are new to a health system, or rarely see a physician.…”

“…A number of studies have identified predictors of non-adherence with colonoscopy scheduling and completion. [9][10][11][13][14][15][16][17] However, no study has described a validated multivariable model for predicting non-adherence with scheduled colonoscopy. Furthermore, no automated method to assess a patient's prior record of nonadherence has been developed, an essential step for any implementation strategy involving large patient populations.…”

Patient‐reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis

“…Effective intervention strategies can be adapted from breast and colon cancer screening programs, where similar barriers have been reported. (27)(28)(29)(30) Simple reassurance about insurance coverage may be sufficient to allay fears of surveillance costs, and having clinic staff schedule ultrasounds the same day as clinic visits can likely mitigate patient issues with ultrasound scheduling, transportation, and uncertainty regarding potential surveillance sites.Comparative effectiveness trials evaluating intervention strategies to address patient-reported barriers are needed. It is important to note that our study had limitations.…”