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

Journal of the American Board of Family Medicine: JABFM

M. Renée Umstattd Meyer^1¹  Brendan G. Camp^1²  Kelly R. Ylitalo^1³ 

[1] Family Health Center, Waco (BH, RL, JOG)^1;Medical Humanities Program, College of Arts and Sciences, Baylor University, Waco (LAB);From the Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX (KRY, BGC, MRUM, GB)

关键词: Colonoscopy;    Colorectal Cancer;    Early Detection of Cancer;    Motivation;    Occult Blood;    Primary Health Care;    Sigmoidoscopy;    Vulnerable Populations;   

DOI  :  10.3122/jabfm.2019.02.180205

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

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.

【 授权许可】

CC BY