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

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.

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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.

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Correspondence to Elizabeth Nagelhout.

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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.

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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

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

Keywords

  • Colorectal cancer
  • Cancer screening
  • Patient barriers
  • Racial disparities
  • Patient awareness