Facilitators and barriers to colorectal cancer screening in an outpatient setting

ARTICLE HIGHLIGHTS

Research background

Colorectal cancer (CRC) remains the third most common cancer in the United States. With appropriate screening, early lesions can be identified before they have developed into malignancy. Unfortunately, only about 2 of 3 Americans between the ages of 50 and 75 are up to date on CRC screening. We developed this study to determine the barriers and facilitators to CRC screening.

Research motivation

By completing this study, we aimed to determine which factors lead to increased or decreased adherence to CRC screening in our patients. By learning these facilitators or barriers to screening, we can implement practices to increase screening rates and hopefully decrease rates of CRC.

Research objectives

The main objective was determining facilitators and barriers to CRC screening. As we established these factors, we are opening our minds to changes that can be generalized to all cancer screening tests, to make a difference in our communities.

Research methods

We performed a retrospective analysis, reviewing the electronic medical records for every patient between the ages of 50 and 75 who visited our internal medicine clinic in a 1-year period. We recorded data pertaining to demographics, comorbid conditions, and adherence with other medical screening tests to look for correlations with screening adherence or nonadherence. Multivariate analysis was performed using STATA v. 15.

Research results

Advanced age was associated with increased adherence to CRC screening. A diagnosis of obstructive sleep apnea was also associated with increased adherence to CRC screening, but no other comorbid condition shared this finding. Higher no-show rates to the clinic was consistent with lower CRC screening adherence. Finally, adherence with other health maintenance screenings was associated with increased adherence with CRC screening.

Research conclusions

We concluded that patients with obstructive sleep apnea likely had multiple providers who encouraged screening for CRC, and were compliant with other outpatient studies (sleep studies for example) which may be why these patients had higher rates of CRC screening. With advanced age likely comes more frequent visits to the physician and hence more opportunities for counseling on cancer screening tests. Conversely, if a patient has a high no-show rate to routine clinic appointments, then they likely will also have poor adherence to screening tests and have less counseling on the importance of these tests. Finally, if a patient is adherent with other health maintenance exams like mammograms or pap smears, then they likely will also be adherent to screening for CRC.

Research perspectives

We now know some of the factors that influence adherence to CRC screening. Future research should focus on those patients who are not up-to-date on screening, and determine what personal, religious, or physician-related factors have kept them from completing CRC screening.