Abstract
The rates of colorectal cancer (CRC) screening in the U.S. remain below national targets, so many people at risk are not being screened. The objective of this qualitative research project was to assess patient and provider knowledge and preferences about CRC screening modalities and specifically the use of the fecal immunochemical test (FIT) as a first line screening choice. Nine focus groups were conducted with a medically underserved patient population and qualitative interviews were administered to their medical providers. Thematic analysis was used to synthesize key findings. Both providers and patients thought that the FIT would be a good option for CRC screening both as an individual choice and for an overall program approach. The test is less expensive and therefore more readily available for patients compared to colonoscopy. Overall, there was consensus that the FIT offers a reasonably priced, simple approach to CRC screening which has broad appeal to both providers and patients. Concerns identified by patients and providers included the possibility of false positives with the FIT which could be caused by test contamination or failing to perform the test properly. Patients also described feelings of disgust toward performing the FIT and difficulties in following the instructions. Study findings indicate provider and patient support for using the FIT for CRC screening at both the individual and system-wide levels of implementation. While barriers to the use of the FIT were listed, benefits of using the FIT were perceived as positive motivators to engage previously unscreened and uninsured or under-insured individuals in CRC screening.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Change history
07 June 2018
The original version of this article unfortunately contained a mistake. There is a typo in the coauthor name, it should be Franklin G. Berger.
References
Siegel, R. L., Miller, K. D., & Jemal, A. (2018). Cancer statistics, 2018. CA: A Cancer Journal for Clinicians, 68(1), 7–30.
Preventive Services Task, U. S., Force, Bibbins-Domingo, K., Grossman, D. C., Curry, S. J., Davidson, K. W., Epling, J. W. Jr., … Siu, A. L. (2016). Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA, 315(23), 2564–2575.
Rex, D. K., Boland, C. R., Dominitz, J. A., Giardiello, F. M., Johnson, D. A., Kaltenbach, T., … Robertson, D. J. (2017). Colorectal cancer screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. The American Journal of Gastroenterology, 112(7), 1016–1030.
Singal, A. G., Gupta, S., Skinner, C. S., Ahn, C., Santini, N. O., Agrawal, D., … Halm, E. A. (2017). Effect of colonoscopy outreach vs. fecal immunochemical test outreach on colorectal cancer screening completion: A randomized clinical trial. JAMA, 318(9), 806–815.
Inadomi, J. M., Vijan, S., Janz, N. K., Fagerlin, A., Thomas, J. P., Lin, Y. V., … Hayward, R. A. (2012). Adherence to colorectal cancer screening: A randomized clinical trial of competing strategies. Archives of Internal Medicine, 172(7), 575–582.
Gupta, S., Halm, E. A., Rockey, D. C., Hammons, M., Koch, M., Carter, E., … Skinner, C. S. (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 Internal Medicine, 173(18), 1725–1732.
Kaiser Family Foundation. (2017). Health insurance coverage of the total population. Retrieved October 30, 2017, from http://www.kff.org.
Brown, T., Lee, J. Y., Park, J., Nelson, C. A., McBurnie, M. A., Liss, D. T., … Baker, D. W. (2015). Colorectal cancer screening at community health centers: A survey of clinicians’ attitudes, practices, and perceived barriers. Preventive Medicine Reports, 2, 886–891.
Task Force on Community Preventive Services. (2008). Recommendations for client- and provider-directed interventions to increase breast, cervical, and colorectal cancer screening. American Journal of Preventive Medicine, 35(1 Suppl), S21–S25.
Carethers, J. M. (2015). Screening for colorectal cancer in African Americans: Determinants and rationale for an earlier age to commence screening. Digestive Diseases and Sciences, 60(3), 711–721.
Bernard, H. R., & Ryan, G. W. (2010). Analyzing qualitative data: Systematic approaches. Thousand Oaks, CA: Sage Publications.
Krueger, R. A., & Casey, M. A. (2000). Focus groups: A practical guide for applied research (3rd ed.). Thousand Oaks, CA: Sage Publications.
Crabtree, B. F., & Miller, W. L. (1999). Doing qualitative research in primary care: Multiple strategies (2nd ed.). Newbury Park, CA: Sage Publications.
Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis (2nd edn.). Thousand Oaks, CA: Sage Publications.
Pham, R., Cross, S., Fernandez, B., Corson, K., Dillon, K., Yackley, C., & Davis, M. M. (2017). “Finding the Right FIT”: Rural patient preferences for fecal immunochemical test (FIT) characteristics. The Journal of the American Board of Family Medicine, 30(5), 632–644.
Davis, S. N., Christy, S. M., Chavarria, E. A., Abdulla, R., Sutton, S. K., Schmidt, A. R., … Gwede, C. K. (2017). A randomized controlled trial of a multicomponent, targeted, low-literacy educational intervention compared with a nontargeted intervention to boost colorectal cancer screening with fecal immunochemical testing in community clinics. Cancer, 123(8), 1390–1400.
Martin, J., Halm, E. A., Tiro, J. A., Merchant, Z., Balasubramanian, B. A., McCallister, K., … Singal, A. G. (2017). Reasons for lack of diagnostic colonoscopy after positive result on fecal immunochemical test in a safety-net health system. The American Journal of Medicine, 130(1), 93 e91–93 e97.
Wallace, K., Brandt, H. M., Bearden, J. D., Blankenship, B. F., Caldwell, R., Dunn, J., … Alberg, A. J. (2015). Race and prevalence of large bowel polyps among the low-income and uninsured in South Carolina. Digestive Diseases and Sciences, 61, 265–272.
Acknowledgements
This project was supported by the South Carolina Cancer Alliance and the National Cancer Institute K07CA151864. We greatly appreciate the research participation of St. Luke’s Free Medical Clinic, the Dream Center Clinic, the Shifa Free Clinic, Polymedco, Inc., and Lowcountry Gastroenterology Associates. We acknowledge the leadership of Dr. Heather Brandt, Associate Dean of Professional Development and Associate Professor in the Arnold School of Public Health at the University of South Carolina, who chaired the committee at the South Carolina Cancer Alliance that made the pilot funding possible for this project.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
This study was reviewed, approved, and continuously overseen by the Institutional Review Board at the Medical University of South Carolina. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Additional information
The original version of this article was revised: The typo in the co-author name Franklin G. Berger was corrected.
Rights and permissions
About this article
Cite this article
Luque, J.S., Wallace, K., Blankenship, B.F. et al. Formative Research on Knowledge and Preferences for Stool-based Tests compared to Colonoscopy: What Patients and Providers Think. J Community Health 43, 1085–1092 (2018). https://doi.org/10.1007/s10900-018-0525-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-018-0525-x