Screening for colorectal cancer in people ages 45–49: research gaps, challenges and future directions for research and practice

Hyams, Travis; Mueller, Nora; Curbow, Barbara; King‐Marshall, Evelyn; Sultan, Shahnaz

doi:10.1093/tbm/ibab079

Cited by 9 publications

(7 citation statements)

References 39 publications

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“…Aversion to colonoscopy has been well documented and recommendations for other screening or detection methods may be better received 24,25 . We recommend a shared‐decision making approach to ensure complete understanding of the range of CRC screening options and the corresponding risks and burden 26‐29 . Providers should be prepared to tailor discussions of screening options to patients' presentation, personal preferences, and concerns.…”

Section: Discussionmentioning

confidence: 99%

“…24,25 We recommend a shared-decision making approach to ensure complete understanding of the range of CRC screening options and the corresponding risks and burden. [26][27][28][29] Providers should be prepared to tailor discussions of screening options to patients' presentation, personal preferences, and concerns. Perceptions of screening among our participants were generally favorable; however, women rated the importance of screening significantly lower compared with men and the importance of screening should be highlighted for women.…”

Section: Discussionmentioning

confidence: 99%

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Colorectal cancer knowledge and perceptions among individuals below the age of 50

et al. 2021

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Background Colorectal cancer (CRC) rates are increasing in individuals below the age of 50 and this trend has been projected to continue for the foreseeable future. Health officials are calling for increased awareness of rising rates in affected populations to promote discussion and early detection. Methods In May 2018, we surveyed an online purposive sample of adults below the age of 50 (N = 624). We conducted an exploratory analysis examining knowledge of current CRC screening guidelines, knowledge of available CRC screening methods, perceived risk of CRC, and perceived importance of screening for CRC by gender, race, and previous CRC screening activity. Results The sample was 56% female, averaged 36 years of age, largely identified as Caucasian (84%), married (48%), and well educated (70% with some college or a college degree). 36% correctly identified the current age of recommended CRC screening initiation. Few (8%) correctly identified all CRC screening options presented. Genetics was thought to be the most relevant determinant of CRC. African American or black participants perceived themselves to be at lower risk of CRC, while women rated the importance of screening significantly lower than men. Conclusion We identified a lack of CRC knowledge in individuals below the age of 50. Interventions should correct perceptions of risk of CRC and highlight the importance of screening. Complete knowledge of the range of screening options may reduce barriers to screening while a greater knowledge of modifiable risk factors of CRC can promote healthy behaviors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Colorectal cancer knowledge and perceptions among individuals below the age of 50

et al. 2021

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“…Collecting patient input from this newly eligible age group will be critical to identifying potentially different barriers to screening compared with those for patients aged ≥50 years [25].…”

Section: Discussionmentioning

confidence: 99%

Tailoring a Text Messaging and Fotonovela Program to Increase Patient Engagement in Colorectal Cancer Screening in a Large Urban Community Clinic Population: Quality Improvement Project

Guo¹,

Prayaga²,

Levitz³

et al. 2023

JMIR Cancer

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Background Appropriate annual screenings for colorectal cancer (CRC) are an essential preventive measure for the second-leading cause of cancer-related death in the United States. Studies have shown that CRC screening rates are influenced by various social determinants of health (SDOH) factors, including race, ethnicity, and geography. According to 2018 national data, participation in screening is lowest among Hispanic or Latinx individuals (56.1%). At an urban Federally Qualified Health Center, a quality improvement project was conducted to evaluate a texting program with a motivational fotonovela—a short narrative comic. Fotonovelas have previously been used in programs to improve knowledge of cervical cancer and human papillomavirus, vaccinations, and treatments for depression. Objective This study aimed to encourage compliance with fecal immunochemical test (FIT) screening. Patient engagement involved a texting program with fotonovelas informed by behavior change techniques. This study sought to understand the qualitative characteristics of patient motivation, intention, and barriers to completing their screening. Methods A total of 5241 English-speaking or Spanish-speaking Federally Qualified Health Center patients aged 50 to 75 years were randomized to either intervention (a 4-week tailored 2-way texting program with a fotonovela comic) or usual care (an SMS text message reminder and patient navigator phone call). The texting vendor used a proprietary algorithm to categorize patients in the intervention group into SDOH bands based on their home addresses (high impact=high social needs and low impact=low social needs). Over 4 weeks, patients were texted questions about receiving and returning their FIT, what barriers they may be experiencing, and their thoughts about the fotonovela. Results The SDOH index analysis showed that most of the patient population was in the SDOH band categories of high impact (555/2597, 21.37%) and very high impact (1416/2597, 54.52%). Patients sent 1969 total responses to the texting system. Thematic analysis identified 3 major themes in these responses: messages as a reminder, where patients reported that they were motivated to return the FIT and had already done so or would do so as soon as possible; increasing patients’ understanding of screening importance, where patients expressed an increased knowledge about the purpose and importance of the FIT; and expressing barriers, where patients shared reasons for not completing the FIT. Conclusions The texting program and fotonovela engaged a subset of patients in each SDOH band, including the high and very high impact bands. Creating culturally tailored messages can encourage patient engagement for accepting the content of the messaging, confirming intentions to complete their FIT, and sharing insights about barriers to behavior change. To better support all patients across the continuum of care with CRC screening, it is important to continue to develop and assess strategies that engage patients who did not return their home-mailed FIT.

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“…Understanding these operational details and how they might vary could prove crucial to improving CRC screening rates and ensuring colonoscopy resources are not shifted away from higher risk or higher need populations, which might contribute to worse access for vulnerable populations and even greater disparities. [39][40][41][42][43][44][45] Therefore, we conducted this qualitative research study with rural providers in primary care and endoscopy centers to examine the breadth of providers performing colonoscopy and to explore their views on access and challenges related to colonoscopy in rural settings.…”

Section: Introductionmentioning

confidence: 99%

“…In addition to understanding who is delivering colonoscopy, we know little about workflow processes after a patient is identified through to colonoscopy completion in rural settings. Understanding these operational details and how they might vary could prove crucial to improving CRC screening rates and ensuring colonoscopy resources are not shifted away from higher risk or higher need populations, which might contribute to worse access for vulnerable populations and even greater disparities 39–45 …”

Section: Introductionmentioning

confidence: 99%

Provision of colonoscopy in rural settings: A qualitative assessment of provider context, barriers, facilitators, and capacity

Ramalingam,

Coury,

Barnes

et al. 2023

The Journal of Rural Health

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PurposeColonoscopy can prevent morbidity and mortality from colorectal cancer (CRC) and is the most commonly used screening method in the United States. Barriers to colonoscopy at multiple levels can contribute to disparities. Yet, in rural settings, little is known about who delivers colonoscopy and facilitators and barriers to colonoscopy access through screening completion.MethodsWe conducted a qualitative study with providers in rural Oregon who worked in endoscopy centers or primary care clinics. Semistructured interviews, conducted in July and August, 2021, focused on clinician experiences providing colonoscopy to rural Medicaid patients, including workflows, barriers, and access. We used thematic analysis, through immersion crystallization, to analyze interview transcripts and develop emergent themes.FindingsWe interviewed 19 providers. We found two categories of colonoscopy providers: primary care providers (PCPs) doing colonoscopy on their own patients (n = 9; 47%) and general surgeons providing colonoscopy to patients referred to their services (n = 10; 53%). Providers described barriers to colonoscopy at the provider, community, and patient levels and suggested patient supports could help overcome them. Providers found current colonoscopy capacity sufficient, but noted PCPs trained to perform colonoscopy would be key to continued accessibility. Finally, providers shared concerns about the shrinking number of PCP endoscopists, especially with anticipated increased screening demand related to the CRC screening guideline shift.ConclusionsThese themes reflect opportunities to address multilevel barriers to improve access, colonoscopy capacity, and patient education approaches. Our results highlight that PCPs are an essential part of the workforce that provides colonoscopy in rural areas.

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Screening for colorectal cancer in people ages 45–49: research gaps, challenges and future directions for research and practice

Cited by 9 publications

References 39 publications

Colorectal cancer knowledge and perceptions among individuals below the age of 50

Colorectal cancer knowledge and perceptions among individuals below the age of 50

Tailoring a Text Messaging and Fotonovela Program to Increase Patient Engagement in Colorectal Cancer Screening in a Large Urban Community Clinic Population: Quality Improvement Project

Provision of colonoscopy in rural settings: A qualitative assessment of provider context, barriers, facilitators, and capacity

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