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Barriers and Facilitators to Stool-Based Screening for Colorectal Cancer Among Black Louisville Residents

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Abstract

Knowledge of colorectal cancer (CRC) screening options remains suboptimal in Black populations, contributing to screening disparities. Guided by community-based participatory research (CBPR) principles, we partnered with five Black churches in Louisville, a region of Kentucky with high Black-white CRC screening disparities, to explore screening barriers and facilitators for CRC education and outreach. Project champions (n = 5) served as primary points of contact, developed project support within their churches, and were trained to recruit church and community members (n = 39) to participate in five semi-structured focus groups. Interview questions probed actual and perceived barriers to CRC screening, focusing on knowledge and perceptions of stool-based tests. Subsequent questions explored perceptions of different screening tests, CRC knowledge and beliefs, and trusted community locations for screening outreach. Transcripts were analyzed iteratively, and codes were derived inductively and refined to develop overarching themes. Participants experienced multilevel barriers to completing CRC screening. Primary themes about CRC screening included acknowledgment of importance, positive and negative personal experiences, need for increased outreach, and desire for greater cultural representation in educational materials. Participants frequently discussed perceptions of inadequate medical care, with most having only ever been offered colonoscopy; subsequently, knowledge of stool-based tests was low. To address this knowledge gap, participants stressed interpersonal communication from trusted individuals, such as local Black medical providers and CRC survivors. Given the low knowledge of stool-based testing among participants and identified inequities in receipt of clinical care, community-based CRC screening interventions are warranted to reduce Black-white CRC screening disparities.

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References 

  1. Kentucky Cancer Registry. Based on data released July 2021. Accessed October 6, 2022. https://www.cancer-rates.info/ky/

  2. Rutter CM, Knudsen AB, Lin JS, Bouskill KE (2021) Black and White differences in colorectal cancer screening and screening outcomes: a narrative review. Cancer Epidemiol Biomarkers Prev 30(1):3–12. https://doi.org/10.1158/1055-9965.EPI-19-1537

    Article  PubMed  Google Scholar 

  3. Greiner KA, Born W, Nollen N, Ahluwalia JS (2005) Knowledge and perceptions of colorectal cancer screening among urban African Americans. J Gen Intern Med 20(11):977–983

    Article  PubMed  PubMed Central  Google Scholar 

  4. May FP, Whitman CB, Varlyguina K, Bronley EG, Spiegel BMR (2016) Addressing low colorectal cancer screening in African Americans: using focus groups to inform the development of effective interventions. J Cancer Educ 31(3):561–574

    Article  Google Scholar 

  5. Buehler JW, Castro JC, Cohen S, Zhao Y, Melly S, Moore K (2019) Personal and neighborhood attributed associated with cervical and colorectal cancer screening in an urban African American population. Prev Chronic Dis 16:190030

    Article  Google Scholar 

  6. U.S. Census Bureau. American Community Survey 2021 1-year estimates. Census Reporter Profile page for Jefferson County, KY. Accessed October 6, 2022. http://censusreporter.org/profiles/05000US21111-jefferson-county-ky/

  7. US Preventive Services Task Force, Davidson KW, Barry MJ et al (2021) Screening for colorectal cancer: US Preventive Services Task Force recommendation statement [published correction appears in JAMA. 2021 Aug 24;326(8):773]. JAMA. 2021;325(19):1965–1977. https://doi.org/10.1001/jama.2021.6238

  8. Zhu X, Parks PD, Weiser E, Fischer K, Griffin JM, Limburg PJ, Finney Rutten LJ (2021) National survey of patient factors associated with colorectal cancer screening preferences. Cancer Prev Res 14(5):OF1-11

    Article  Google Scholar 

  9. Ward SH, Parameswaran L, Bass SB, Paranjape A, Gordon TF, Ruzek SB (2010) Resident physicians’ perceptions of barriers and facilitators to colorectal cancer screening for African Americans. J Natl Med Assoc 102(4):303–311

    PubMed  Google Scholar 

  10. Inadomi JM, Vijan S, Janz NK et al (2012) Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. Arch Intern Med 172(7):575–582. https://doi.org/10.1001/archinternmed.2012.332

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gupta S, Halm EA, Rockey DC et al (2013) Comparative effectiveness of fecal immunochemical test outreach, colonoscopy outreach, and usual care for boosting colorectal cancer screening among the underserved: a randomized clinical trial. JAMA Intern Med 173(18):1725–1732. https://doi.org/10.1001/jamainternmed.2013.9294

    PubMed  PubMed Central  Google Scholar 

  12. Arnett MJ, Thorpe RJ Jr, Gaskin DJ, Bowie JV, LaVeist TA (2016) Race, medical mistrust, and segregation in primary care as usual source of care: findings from the Exploring Health Disparities in Integrated Communities study. J Urban Health 93(3):456–467. https://doi.org/10.1007/s11524-016-0054-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Blumenthal DS, Smith SA, Majett CD, Alema-Mensah E (2010) A trial of 3 interventions to promote colorectal cancer screening in African Americans. Cancer 116(4):922–929

    Article  PubMed  Google Scholar 

  14. Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101

    Article  Google Scholar 

  15. Vilaro MJ, Wilson-Howard DS, Neil JM et al (2021) A subjective culture approach to cancer prevention: rural black and white adults’ perceptions of using virtual health assistants to promote colorectal cancer screening. Health Commun 37(9):1123–1134. https://doi.org/10.1080/10410236.2021.1910166

    Article  PubMed  Google Scholar 

  16. Hovick SR, Yamasaki JS, Burton-Chase AM, Peterson SK (2015) Patterns of family health history communication among older African American adults. J Health Commun 20(1):80–87. https://doi.org/10.1080/10810730.2014.908984

    Article  PubMed  Google Scholar 

  17. Scaglioni G, Guidetti M, Cavazza N (2021) The role of disgust as an emotional barrier to colorectal cancer screening participation: a systematic review and meta-analysis [published online ahead of print, 2021 Aug 25]. Psychol Health 1–20. https://doi.org/10.1080/08870446.2021.1967351

  18. Zhu X, Parks PD, Weiser E, Jacobson DJ, Limburg PJ, Finney Rutten LJ (2021) Barriers to utilization of three colorectal cancer screening options - data from a national survey. Prev Med Rep 24:101508. https://doi.org/10.1016/j.pmedr.2021.101508

    Article  PubMed  PubMed Central  Google Scholar 

  19. Adams LB, Richmond J, Corbie-Smith G, Powell W (2017) Medical mistrust and colorectal cancer screening among African Americans. J Community Health 42(5):1044–1061. https://doi.org/10.1007/s10900-017-0339-2

    Article  PubMed  PubMed Central  Google Scholar 

  20. US Preventive Services Task Force, Davidson KW, Mangione CM et al (2022) Collaboration and shared decision-making between patients and clinicians in preventive health care decisions and US Preventive Services Task Force recommendations. JAMA. 327(12):1171–1176. https://doi.org/10.1001/jama.2022.3267

    Article  Google Scholar 

  21. Association of American Medical Colleges. Diversity in medicine: facts and figures 2019. Accessed June 18, 2022. https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018

  22. Roy S, Dickey S, Wang HL et al (2021) Systematic review of interventions to increase stool blood colorectal cancer screening in African Americans. J Community Health 46(1):232–244. https://doi.org/10.1007/s10900-020-00867-z

    Article  PubMed  Google Scholar 

  23. National Colorectal Cancer Roundtable and American Cancer Society. 2022 messaging guidelines for Black and African American people. Accessed July 28, 2022. https://nccrt.org/resource/2022-messaging-guidebook-black-african-american-people/

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Acknowledgements

The authors wish to acknowledge our community and church partners, without whom this project would not have been possible. We thank them for their continued support, advocacy, and leadership in working to eliminate cancer disparities in Kentucky and beyond.

Funding

This research was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR001998 and by the National Cancer Institute through the Cancer Center Support Grant P30CA177558.

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Correspondence to Aaron J. Kruse-Diehr.

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Kruse-Diehr, A.J., Cegelka, D., Holtsclaw, E. et al. Barriers and Facilitators to Stool-Based Screening for Colorectal Cancer Among Black Louisville Residents. J Canc Educ 38, 1050–1058 (2023). https://doi.org/10.1007/s13187-022-02231-2

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