Skip to main content
SpringerLink
Log in

Barriers to Colorectal Cancer Screening in a Racially Diverse Population Served by a Safety-Net Clinic

  • Original Paper
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the US, yet screening rates remain low among minority populations. The purpose of the current study was to identify differences in the endorsement of barriers to CRC screening and to evaluate the association between provider recommendation and CRC screening adherence among Hispanic, Pacific Islander and White patients. This study utilized a cross sectional survey design to identify patient-reported barriers to CRC screening. Logistic regression was utilized to evaluate the association between patient demographic characteristics (race/ethnicity, gender, age), having received provider recommendation, and patient awareness of CRC screening. The study sample was comprised of a diverse population (N = 197); 48% Hispanic, 25% White, 10% Pacific Islander, 4% Black and 13% other races/ethnicity. The median age of participants was 58, yet fewer than 30% were up-to-date for CRC screening. The most commonly cited barriers included fear of test results (27.6%), inability to leave work for a CRC screening appointment (26.9%), being unaware of the need for colonoscopy (25.4%), and lack of provider recommendation for CRC screening (24.9%). Only 16.2% of participants reported that a provider had discussed CRC screening options with them. After adjusting for age and gender, Hispanic patients were less likely to report having had a provider discuss CRC screening options compared to White patients (OR = 0.24, 95% CI: 0.09–0.68, p < 0.05). The findings from this study indicate that patient’s perceived screening barriers, lack of awareness and a lack of provider communication about CRC screening options may contribute to low screening rates among minority populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. SEER Cancer Statistics Factsheets: Colon and rectum cancer (2016). http://seer.cancer.gov/statfacts/html/colorect.html.

  2. US Preventive Services Task Force (2016). Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA, 315(23), 2564–2575. doi:10.1001/jama.2016.5989.

    Article  Google Scholar 

  3. Winawer, S., et al. (2003). Colorectal cancer screening and surveillance: Clinical guidelines and rationale-update based on new evidence. Gastroenterology, 124(2), 544–560. doi:10.1053/gast.2003.50044.

    Article  PubMed  Google Scholar 

  4. Cancer Trends Progress Report: Colorectal cancer screening (2015). http://progressreport.cancer.gov/detection/colorectal_cancer.

  5. Geiger, T. M., et al. (2008). Improving rates for screening colonoscopy: Analysis of the health information national trends survey (HINTS I) data. Surgical Endoscopy and Other Interventional Techniques, 22(2), 527–533. doi:10.1055/s-0029-1242460.

    Article  PubMed  Google Scholar 

  6. Cameron, K. A., et al. (2007). Investigating Hispanic/Latino perceptions about colorectal cancer screening: A community-based approach to effective message design. Patient Education and Counseling, 68(2), 145–152. doi:10.1016/j.pec.2007.04.004.

    Article  PubMed  Google Scholar 

  7. Green, A. R., et al. (2008). Barriers to screening colonoscopy for low-income Latino and white patients in an urban community health center. Journal of General Internal Medicine, 23(6), 834–840. doi:10.1007/s11606-008-0572-6.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Honein-AbouHaidar, G. N., et al. (2016). Systematic review and meta-study synthesis of qualitative studies evaluating facilitators and barriers to participation in colorectal cancer screening. Cancer Epidemiology Biomarkers and Prevention, 25(6), 907–917. doi:10.1158/1055-9965.epi-15-0990.

    Article  Google Scholar 

  9. Jones, R. M., et al. (2010). The relative importance of patient-reported barriers to colorectal cancer screening. American Journal of Preventive Medicine, 38(5), 499–507. doi:10.1016/j.amepre.2010.01.020.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Klabunde, C. N., Schenck, A. P., & Davis, W. W. (2006). Barriers to colorectal cancer screening among Medicare consumers. American Journal of Preventive Medicine, 30(4), 313–319. doi:10.1016/j.amepre.2005.11.006.

    Article  PubMed  Google Scholar 

  11. McLachlan, S. A., Clements, A., & Austoker, J. (2012). Patients’ experiences and reported barriers to colonoscopy in the screening context—A systematic review of the literature. Patient Education and Counseling, 86(2), 137–146. doi:10.1016/j.pec.2011.04.010.

    Article  PubMed  Google Scholar 

  12. Taylor, V., et al. (2003). Colorectal cancer screening among African Americans: The importance of physician recommendation. Journal of the National Medical Association, 95(9), 806–812. https://www.scopus.com/inward/record.uri?eid=2-s2.00141818420&partnerID=40&md5=63a426d8372d31ae99bf3167629a9f38.

  13. Tessaro, I., et al. (2006). Knowledge, barriers, and predictors of colorectal cancer screening in an Appalachian church population. Preventing Chronic Disease, 3(4). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1779287/.

  14. Berkowitz, Z., et al. (2008). Beliefs, risk perceptions, and gaps in knowledge as barriers to colorectal cancer screening in older adults. Journal of the American Geriatrics Society, 56(2), 307–314. doi:10.1111/j.1532-5415.2007.01547.x.

    Article  PubMed  Google Scholar 

  15. O’Malley, A. S., et al. (2004). Patient and provider barriers to colorectal cancer screening in the primary care safety-net. Preventive Medicine, 39(1), 56–63. doi:10.1016/j.ypmed.2004.02.022.

    Article  PubMed  Google Scholar 

  16. Shokar, N. K., Carlson, C. A., & Weller, S. C. (2008). Factors associated with racial/ethnic differences in colorectal cancer screening. The Journal of the American Board of Family Medicine, 21(5), 414–426. doi:10.3122/jabfm.2008.05.070266.

    Article  PubMed  Google Scholar 

  17. Walsh, J. M. E., et al. (2004). Barriers to colorectal cancer screening in Latino and Vietnamese Americans. Journal of General Internal Medicine, 19(2), 156–166. doi:10.1111/j.1525-1497.2004.30263.x.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Brawarsky, P., et al. (2004). Effect of physician recommendation and patient adherence on rates of colorectal cancer testing. Cancer Detection and Prevention, 28(4), 260–268. doi:10.1016/j.cdp.2004.04.006.

    Article  CAS  PubMed  Google Scholar 

  19. Wee, C. C., McCarthy, E. P., & Phillips, R. S. (2005). Factors associated with colon cancer screening: The role of patient factors and physician counseling. Preventive Medicine, 41(1), 23–29. doi:10.1016/j.ypmed.2004.11.004.

    Article  PubMed  Google Scholar 

  20. Tessaro, I., et al. (2006). Knowledge, barriers, and predictors of colorectal cancer screening in an Appalachian church population. Preventing Chronic Disease, 3(4), 123–134. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1779287/.

  21. Davis, T. C., et al. (2001). The role of inadequate health literacy skills in colorectal cancer screening. Cancer Investigation, 19(2), 193–200. doi:10.1081/CNV-100000154.

    Article  CAS  PubMed  Google Scholar 

  22. Arora, N. K. (2003). Interacting with cancer patients: The significance of physicians’ communication behavior. Social Science and Medicine, 57(5), 791–806. doi:10.1016/S0277-9536(02)00449-5.

    Article  PubMed  Google Scholar 

  23. Bredart, A., Bouleuc, C., & Dolbeault, S. (2005). Doctor-patient communication and satisfaction with care in oncology. Current Opinion in Oncology, 17(4), 351–354.

    Article  PubMed  Google Scholar 

  24. Fallowfield, L., & Jenkins, V. (1999). Jenkins, effective communication skills are the key to good cancer care. European Journal of Cancer, 35(11), 1592–1597. doi:10.1016/S0959-8049(99)00212-9.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We greatly appreciate feedback from Dr. Natalie Stillman-Webb from the University of Utah, in addition to Dr. John Contreras and Dr. Kristine Lynch from Westminster College on earlier versions of this manuscript.

Funding

This work was supported, in part, by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) K07CA196985 (to YW), American College of Gastroenterology Junior Faculty Development award (to NJS) and the Huntsman Cancer Institute and Huntsman Cancer Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Author information

Authors and Affiliations

  1. Division of Public Health, Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA

    Elizabeth Nagelhout & Yelena P. Wu

  2. Westminster College, 1840 S. 1300 E., Salt Lake City, UT, 84105, USA

    Kristen Comarell

  3. Division of Gastroenterology, Department of Medicine, University of Utah, 30 N 1900 E, RM 4R118, Salt Lake City, UT, 84132, USA

    N. Jewel Samadder

  4. Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA

    N. Jewel Samadder & Yelena P. Wu

Authors
  1. Elizabeth Nagelhout
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristen Comarell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Jewel Samadder
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yelena P. Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elizabeth Nagelhout.

Ethics declarations

Conflict of interest

Dr. Samadder has received a speaker honorarium from Cook Medical Inc. All other co-authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nagelhout, E., Comarell, K., Samadder, N.J. et al. Barriers to Colorectal Cancer Screening in a Racially Diverse Population Served by a Safety-Net Clinic. J Community Health 42, 791–796 (2017). https://doi.org/10.1007/s10900-017-0319-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-017-0319-6

Keywords

Search

Navigation