Jocelyn V Wainwright1, Shivan J Mehta2,3, Alicia Clifton3, Claire Bocage1, Shannon N Ogden4, Sarah Cohen1, Katharine A Rendle1,3. 1. Department of Family Medicine and Community Health, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA. 2. Department of Medicine, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA. 3. Penn Center for Cancer Care Innovation, Abramson Cancer Center, 14640University of Pennsylvania, Philadelphia, PA, USA. 4. Department of Health Law, Policy and Management, 27118Boston University School of Public Health, Boston, MA, USA.
Abstract
PURPOSE: To understand patient experiences and persistent barriers to colorectal cancer (CRC) screening amid centralized outreach at urban family medicine practices. APPROACH: Following a pragmatic trial assessing mailed fecal immunochemical test (FIT) outreach, we invited a subset of participants to complete a semi-structured qualitative interview and structured questionnaire. SETTING: Single urban academic healthcare system. PARTICIPANTS: Sixty patients who were eligible and overdue for CRC screening at the time of trial enrollment. METHOD: Using Andersen's Behavioral Model, we developed an interview guide to systematically assess factors shaping screening decisions and FIT uptake. Close-ended responses were analyzed using descriptive statistics. Qualitative data were analyzed using the constant comparative method. RESULTS: Most participants (82%) self-reported that they had ever completed any modality of CRC screening, and nearly half (43%) completed the mailed FIT during the trial. Most patients (60%) preferred FIT to colonoscopy due to its private, convenient, and non-invasive nature; however, persistent barriers related to screening beliefs including fear of test results and cancer treatment still prevented some patients from completing any form of CRC screening. CONCLUSIONS: Mailed FIT can overcome many structural barriers to CRC screening, yet clear communication and follow-up amid centralized outreach are essential. For some patients, tailored outreach or navigation to address screening-related fears or other screening beliefs may be needed to ensure timely completion of CRC screening.
PURPOSE: To understand patient experiences and persistent barriers to colorectal cancer (CRC) screening amid centralized outreach at urban family medicine practices. APPROACH: Following a pragmatic trial assessing mailed fecal immunochemical test (FIT) outreach, we invited a subset of participants to complete a semi-structured qualitative interview and structured questionnaire. SETTING: Single urban academic healthcare system. PARTICIPANTS: Sixty patients who were eligible and overdue for CRC screening at the time of trial enrollment. METHOD: Using Andersen's Behavioral Model, we developed an interview guide to systematically assess factors shaping screening decisions and FIT uptake. Close-ended responses were analyzed using descriptive statistics. Qualitative data were analyzed using the constant comparative method. RESULTS: Most participants (82%) self-reported that they had ever completed any modality of CRC screening, and nearly half (43%) completed the mailed FIT during the trial. Most patients (60%) preferred FIT to colonoscopy due to its private, convenient, and non-invasive nature; however, persistent barriers related to screening beliefs including fear of test results and cancer treatment still prevented some patients from completing any form of CRC screening. CONCLUSIONS: Mailed FIT can overcome many structural barriers to CRC screening, yet clear communication and follow-up amid centralized outreach are essential. For some patients, tailored outreach or navigation to address screening-related fears or other screening beliefs may be needed to ensure timely completion of CRC screening.
Entities:
Keywords:
cancer prevention; colorectal cancer screening; early detection; population health; qualitative research
Authors: Gloria D Coronado; Jennifer L Schneider; Jennifer J Sanchez; Amanda F Petrik; Beverly Green Journal: Transl Behav Med Date: 2015-03 Impact factor: 3.046
Authors: Rebecca L Siegel; Kimberly D Miller; Ann Goding Sauer; Stacey A Fedewa; Lynn F Butterly; Joseph C Anderson; Andrea Cercek; Robert A Smith; Ahmedin Jemal Journal: CA Cancer J Clin Date: 2020-03-05 Impact factor: 508.702
Authors: Kirsten Bibbins-Domingo; David C Grossman; Susan J Curry; Karina W Davidson; John W Epling; Francisco A R García; Matthew W Gillman; Diane M Harper; Alex R Kemper; Alex H Krist; Ann E Kurth; C Seth Landefeld; Carol M Mangione; Douglas K Owens; William R Phillips; Maureen G Phipps; Michael P Pignone; Albert L Siu Journal: JAMA Date: 2016-06-21 Impact factor: 56.272
Authors: Stacy N Davis; Shannon M Christy; Enmanuel A Chavarria; Rania Abdulla; Steven K Sutton; Alyssa R Schmidt; Susan T Vadaparampil; Gwendolyn P Quinn; Vani N Simmons; Chukwudi B Ufondu; Chitra Ravindra; Ida Schultz; Richard G Roetzheim; David Shibata; Cathy D Meade; Clement K Gwede Journal: Cancer Date: 2016-12-01 Impact factor: 6.860
Authors: Beverly B Green; Imara I West; Laura Mae Baldwin; Malaika R Schwartz; Jennifer Coury; Gloria D Coronado Journal: J Community Health Date: 2020-10
Authors: Chyke A Doubeni; Stacey A Fedewa; Theodore R Levin; Christopher D Jensen; Chelsea Saia; Alexis M Zebrowski; Virginia P Quinn; Katharine A Rendle; Ann G Zauber; Tracy A Becerra-Culqui; Shivan J Mehta; Robert H Fletcher; Joanne Schottinger; Douglas A Corley Journal: Gastroenterology Date: 2018-09-27 Impact factor: 22.682
Authors: Djenaba A Joseph; Jessica B King; Nicole F Dowling; Cheryll C Thomas; Lisa C Richardson Journal: MMWR Morb Mortal Wkly Rep Date: 2020-03-13 Impact factor: 17.586