What are common barriers and helpful solutions to colorectal cancer screening? A cross-sectional survey to develop intervention content for a planning support tool

Abstract

ObjectiveColorectal screening using faecal immunochemical tests (FITs) can save lives if the people invited participate. In Scotland, most people intend to complete a FIT but this is not reflected in uptake rates. Planning interventions can bridge this intention-behaviour gap. To develop a tool supporting people willing to do colorectal screening with planning to complete a FIT, this study aimed to identify frequently experienced barriers and solutions to these barriers.DesignThis is a cross-sectional study.SettingParticipants were recruited through the Scottish Bowel Screening Programme to complete a mailed questionnaire.ParticipantsThe study included 2387 participants who had completed a FIT (mean age 65 years, 40% female) and 359 participants who had not completed a FIT but were inclined to do so (mean age 63 years, 39% female).Outcome measuresThe questionnaire assessed frequency of endorsement of colorectal screening barriers and solutions.ResultsParticipants who had not completed a FIT endorsed significantly more barriers than those who had completed a FIT, when demographic, health and behavioural covariates were held constant (F(1,2053)=13.40, p<0.001, partial η2=0.01). Participants who completed a FIT endorsed significantly more solutions than those who did not (U=301 585.50, z=−3.21, p<0.001, r=0.06). This difference became insignificant when covariates were controlled. Participants agreed on the most common barriers and solutions regardless of screening history. Barriers included procrastination, forgetting, fear of the test result, screening anxiety, disgust and low self-efficacy. Solutions included hand-washing, doing the FIT in private, reading the FIT instructions, benefit of early detection, feelings of responsibility, high self-efficacy and seeing oneself as a person who looks after one’s health.ConclusionThis survey identified six barriers and seven solutions as key content to include in the development of a planning tool for colorectal screening using the FIT. Participatory research is required to codesign an engaging and accessible planning tool.

Utilising pancreatic exocrine insufficiency in the detection of resectable pancreatic ductal adenocarcinoma

“…The biggest limitation with FE-1 testing is that samples may not be returned. In bowel cancer screening programs, failure to return samples was often attributed to forgetting about the kit or hygiene concerns [31,32]. More than 80% of the stool samples were returned in those with PDAC and HVs in this study, but most of these samples were made available during the 240 min in which test was conducted, and this was clearly explained on the participant information sheet.…”

Increasing uptake of FIT colorectal screening: protocol for the TEMPO randomised controlled trial testing a suggested deadline and a planning tool

“…While the planning tool instructions encourage people to use the planning tool, they do not suggest that participants must do so in order to take part in CRC screening. The specific listed concerns and tips are based on extensive development work involving consideration of existing theoretical and empirical literature, in-depth qualitative interviews, a survey of people who had been invited to complete a FIT and codesign workshops to create a user-friendly planning tool with members of the public who have completed the FIT and others who have not completed the FIT 31–33. The final planning tool was reviewed and approved by the Research Team, Patient and Public Involvement representatives (PPRs), and a patient and public group of the Scottish Primary Care Network.…”

“…The aim is to obtain responses from approximately 1000 cases and 1000 controls across the eight groups. Based on previous work, we anticipate achieving a higher response rate from those returning the FIT and a lower response from those not returning the FIT, therefore approximately 11 872 questionnaires will be mailed, as shown in figure 1 32. A reminder questionnaire will be sent to those who have not returned the questionnaire after 3 weeks.…”

“…A brief questionnaire will include items to assess cognitive and behavioural mechanisms, for example, action and coping planning,17 that were previously adapted for the CRC screening context 19 32. It will also include a theory-informed acceptability measure that has been subject to a prevalidation method but does not yet have fully established psychometric properties,35 as well as demographic characteristics.…”

Discovering The Barriers to Colon Cancer Screening in Jordan

“…In Scotland, 2387 participants identified procrastination and anxiety about possible cancer as limiting factors for undergoing FIT. 35 colonoscopies were associated with a significant reduction in CRC incidence by 69% and mortality by 68%. 22 This shows the successful story of how the United States decreased CRC by implementing this screening protocol.…”