Perceived Colonoscopy Barriers and Facilitators Among Urban African American Patients and Their Medical Residents

Abstract

African Americans suffer from higher colorectal cancer morbidity and mortality than do Whites, yet have the lowest screening rates. To understand barriers and facilitators to colorectal cancer screening, this study 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. African American patients (n = 102) were surveyed about their own 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 screening. Physicians believed logistical lifestyle issues were the greatest screening barriers for their patients whereas fears of complications, pain, and cancer 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 screening. 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 and to improve medical resident training by incorporating specific messages tailored for use with African American patients.

Explaining persistent under-use of colonoscopic cancer screening in African Americans: A systematic review

“…Studies reported several types of patient fear: 1) fear of pain during colonoscopy; 2) fear of invasion during colonoscopy; 3) fear of bowel preparation; 4) fear of sedation or of hospital setting; and 5) fear of receiving a cancer diagnosis. 18–22, 24–25, 27–28,30–32 Fear of perceived “invasion” during colonoscopy was a common theme among African American males in particular. 18–21,24,27–28,30 Male respondents in focus groups and cognitive interviews described colonoscopy as “offensiveness,” “violating,” and “treading on my masculinity.” 18,24,27 Cancer-related fear stemmed from concerns about being diagnosed with cancer 19, 21, 25, 28,30 and of cancer treatment.…”

“…The existing literature demonstrates that competing factors such as personal or financial obligations, 30 life stressors, 30 an inability to find transportation, 21, 25, 30, 34 and concern about other more pressing illness or comorbidity 35 also present barriers to colonoscopic screening.…”

“…We identified provider-level barriers to screening including lack of provider recommendation for colonoscopy, 21, 26, 28,30–31 insufficient patient counseling about screening, 19, 22, 28 poor knowledge of updated CRC screening guidelines in African Americans, 36 lack of provider recognition of barriers, 10, 25 and long wait times at the primary medical doctor’s office. 19 …”

“…In two survey studies of internal medicine resident physicians at an urban, academic medical center, physicians were unaware of previously identified barriers to colonoscopy screening among African Americans (access to care, cost, and medical mistrust), and barriers deemed important by their African American patients (multiple types of fear, embarrassment, and cancer fatalism). 10, 25 Moreover, residents did not attribute importance to several facilitating factors that motivated their African American patients, including receiving a physician’s recommendation for colonoscopy, removing pre-cancerous growths, and believing that the benefit of colonoscopy was “worth the effort”. 25 …”

Pain Management for Older African Americans in the Perianesthesia Setting: The “Eight I's”

“…9 The Eight I's represent: (1) Intensity, (2) Importance, (3) Impact/interference, (4) Instances, (5) Imani-intercession, (6) Interventions, (7) Irritating effects, and (8) Inquiry of pain relief ( Figure 1 and Table 1). …”