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Self-Reported Barriers to Colorectal Cancer Screening in a Racially Diverse, Low-Income Study Population

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Abstract

Colorectal cancer (CRC) screening is underutilized, especially in low income, high minority populations. We examined the effect test-specific barriers have on colonoscopy and fecal immunochemical test (FIT) completion, what rationales are given for non-completion, and what “switch” patterns exist when participants are allowed to switch from one test to another. Low income adults who were not up-to-date with CRC screening guidelines were recruited from safety-net clinics and offered colonoscopy or FIT (n = 418). Follow up telephone surveys assessed test-specific barriers. Test completion was determined from patient medical records. For subjects who desired colonoscopy at baseline, finding a time to come in and transportation applied more to non-completers than completers (p = 0.001 and p < 0.001, respectively). For participants who initially wanted FIT, keeping track of cards, never putting stool on cards, and not remembering to mail cards back applied more to non-completers than completers (p = 0.003, p = 0.006, and p < 0.001, respectively). The most common rationale given for not completing screening was a desire for the other screening modality: 7 % of patients who initially preferred screening by FIT completed colonoscopy, while 8 % of patients who initially preferred screening by colonoscopy completed FIT. We conclude that test-specific barriers apply more to subjects who did not complete CRC screening. As a common rationale for test non-completion is a desire to receive a different screening modality, our findings suggest screening rates could be increased by giving patients the opportunity to switch tests after an initial choice is made.

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Acknowledgments

This study was made possible by a partnership with the Wyandotte County Kansas City Kansas Safety Net Clinic Coalition. The study was supported by laboratory services from Enterix, Inc., a Division of Quest Diagnostics, Inc., Lenexa, Kansas. We would also like to thank study staff in the KUMC Family Medicine Research Division, particularly Angela Watson, Aaron Epp, Marina Carizosa-Ramos, Megan Eckles, Heraclio Perez, and Andrew Witt. We are grateful to Hung-Wen Yeh, Ph.D., of the KUMC Department of Biostatistics, for providing assistance with the statistical analysis. This project was supported by research funding from the National Cancer Institute, R01 CA123245-02.

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The authors declare that they have no conflicts of interest to report.

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Correspondence to Christina M. Hester.

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Quick, B.W., Hester, C.M., Young, K.L. et al. Self-Reported Barriers to Colorectal Cancer Screening in a Racially Diverse, Low-Income Study Population. J Community Health 38, 285–292 (2013). https://doi.org/10.1007/s10900-012-9612-6

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