Fr059 INSIGHTS INTO PATIENTS’ KNOWLEDGE, ATTITUDES, BELIEFS, AND MAIN DRIVERS OF DECISION MAKING WHEN SELECTING AMONG DIFFERENT COLORECTAL CANCER (CRC) SCREENING OPTIONS: THEMATIC ANALYSIS OF PATIENT FOCUS GROUPS

Abstract Background Colorectal cancer (CRC) is a common malignancy worldwide. Despite being the most common cancer in Singapore, CRC screening rate remains low due to knowledge deficits, social reasons such as inconvenience and a lack of reminder or recommendation. A decision aid (DA) may facilitate an individual’s decision-making to undertake CRC screening by addressing misconceptions and barriers. We postulate that a more person-centred and culturally adapted DA will better serve the local population. The views of the target users are thus needed to develop such a DA. A CRC screening DA prototype has been adapted from an American DA to cater to the Asian users. This study aimed to explore user perspectives on an adapted CRC screening DA-prototype in terms of the design, content and perceived utility. Methods The study used in-depth interviews (IDIs) and focus group discussions (FGDs) to gather qualitative data from English-literate multi-ethnic Asian adults aged 50 years old and above. They had yet to screen for CRC before they were recruited from a public primary care clinic in Singapore. The interviews were audio-recorded, transcribed and analysed to identify emergent themes via thematic analysis. Results This study included 27 participants involved in 5 IDI and 5 FGDs. Participants found the DA easily comprehensible and of appropriate length. They appreciated information about the options and proposed having multi-lingual DAs. The design, in terms of the layout, size and font, was well-accepted but there were suggestions to digitalize the DA. Participants felt that the visuals were useful but there were concerns about modesty due to the realism of the illustration. They would use the DA for information-sharing with their family and for discussion with their doctor for decision making. They preferred the doctor’s recommendation for CRC screening and initiating the use of the DA. Conclusions Participants generally had favourable perceptions of the DA-prototype. A revised DA will be developed based on their feedback. Further input from doctors on the revised DA will be obtained before assessing its effectiveness to increase CRC screening rate in a randomized controlled trial.

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Barriers and Facilitators to Colorectal Cancer Screening Within a Hispanic Population

Hispanic Health Care International ◽

10.1177/1540415318818982 ◽

2018 ◽

Vol 17 (1) ◽

pp. 23-29 ◽

Cited By ~ 9

Author(s):

Theresa L. Byrd ◽

Jessica Calderón-Mora ◽

Rebekah Salaiz ◽

Navkiran K. Shokar

Keyword(s):

Colorectal Cancer ◽

Focus Groups ◽

Screening Program ◽

El Paso ◽

Barriers And Facilitators ◽

Hispanic Population ◽

Community Based ◽

Crc Screening ◽

Predominantly Hispanic ◽

9Th Grade

Introduction: Colorectal cancer (CRC) is the third leading cancer cause of death among US Hispanics. CRC screening among the Hispanic population is lower compared with non-Hispanic Whites. Method: The purpose of this qualitative, exploratory study was to better understand the barriers and facilitators of CRC screening and preference for stool-based testing collection methods among the predominantly Hispanic population of El Paso, Texas. Nine focus groups were conducted by a trained bilingual facilitator with a moderator guide informed by the literature. Transcripts of the focus groups were entered into qualitative analysis software and a thematic network was developed. Results: Fifty-six participants were recruited: average age was 68.5 years, 58.9% were female, 98.2% were Hispanic, 87.5% had an annual income of less than $20,000, 58.9% had 9th grade education or less, 12.5% had a discount program, and 5.4% had no insurance. Barriers to CRC screening included cost, fear, and embarrassment. Facilitators to screening included in-person health education and physician recommendation. Participants preferred the hygienic nature of a stool test collected with a brush and bottle. Conclusion: Overall, there was a lack of knowledge regarding CRC and significant barriers to CRC screening. A community-based CRC screening program was subsequently developed from our findings.

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Shared Decision-Making (SDM) for Colorectal Cancer (CRC)Screening Increases Adherence

Gastroenterology ◽

10.1016/s0016-5085(11)61662-4 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-404

Author(s):

Paul C. Schroy ◽

Karen Emmons ◽

Ellen Peters ◽

Michael Pignone ◽

Julie Glick ◽

...

Keyword(s):

Colorectal Cancer ◽

Decision Making ◽

Shared Decision Making ◽

Shared Decision ◽

Crc Screening

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Knowledge and Informed Decision-Making about Population-Based Colorectal Cancer Screening Participation in Groups with Low and Adequate Health Literacy

Gastroenterology Research and Practice ◽

10.1155/2016/7292369 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

M. L. Essink-Bot ◽

E. Dekker ◽

D. R. M. Timmermans ◽

E. Uiters ◽

M. P. Fransen

Keyword(s):

Colorectal Cancer ◽

Decision Making ◽

Health Literacy ◽

Decisional Conflict ◽

Informed Decision ◽

Informed Decision Making ◽

Crc Screening ◽

Adequate Health Literacy ◽

Screening Participation ◽

Intention To Participate

Objective. To analyze and compare decision-relevant knowledge, decisional conflict, and informed decision-making about colorectal cancer (CRC) screening participation between potential screening participants with low and adequate health literacy (HL), defined as the skills to access, understand, and apply information to make informed decisions about health.Methods. Survey including 71 individuals with low HL and 70 with adequate HL, all eligible for the Dutch organized CRC screening program. Knowledge, attitude, intention to participate, and decisional conflict were assessed after reading the standard information materials. HL was assessed using the Short Assessment of Health Literacy in Dutch. Informed decision-making was analyzed by the multidimensional measure of informed choice.Results. 64% of the study population had adequate knowledge of CRC and CRC screening (low HL 43/71 (61%), adequate HL 47/70 (67%),p>0.05). 57% were informed decision-makers (low HL 34/71 (55%), adequate HL 39/70 (58%),p>0.05). Intention to participate was 89% (low HL 63/71 (89%), adequate HL 63/70 (90%)). Respondents with low HL experienced significantly more decisional conflict (25.8 versus 16.1;p=0.00).Conclusion. Informed decision-making about CRC screening participation was suboptimal among both individuals with low HL and individuals with adequate HL. Further research is required to develop and implement effective strategies to convey decision-relevant knowledge about CRC screening to all screening invitees.

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Colorectal cancer screening behaviors among South Asian immigrants in Canada: a qualitative study

International Journal of Migration Health and Social Care ◽

10.1108/ijmhsc-09-2014-0037 ◽

2015 ◽

Vol 11 (2) ◽

pp. 130-146 ◽

Cited By ~ 3

Author(s):

Joanne Crawford ◽

Farah Ahmad ◽

Dorcas E. Beaton ◽

Arlene S. Bierman

Keyword(s):

Colorectal Cancer ◽

Focus Groups ◽

South Asian ◽

Cultural Context ◽

Future Research ◽

Average Risk ◽

Collaborative Partnerships ◽

Structural Barriers ◽

Content Type ◽

Crc Screening

Purpose – The purpose of this paper is to gain an in-depth understanding of beliefs, attitudes, and reasons for decision making about colorectal cancer (CRC) screening among South Asian (SA) immigrants. Design/methodology/approach – Six focus groups conducted in English, Punjabi, and Urdu were held with 42 SA immigrants, 50-74 years old and at average risk for CRC, from November 2012 to May 2013. All focus group discussions were audio-taped and transcribed verbatim. Data analysis used an inductive and systematic approach employing constant comparison techniques. Findings – Three dominant themes emerged. Beliefs and attitudes towards cancer and screening represented SA immigrant’s perceptions that early detection was beneficial; screening was not necessary in the absence of symptoms; cancer was scary; and the loss of previously established bowel practices upon immigration as potential risks for CRC. Knowledge and awareness focused on unscreened participants’ cancer stories; screened participants’ knowledge of CRC, risk factors, and screening; experiential learning from focus groups; and screened participants’ strategies to promote screening. Support and accessibility concentrated on physician support and responsibility to provide information, explanation, and recommend screening to facilitate access. Originality/value – Findings provide novel insights on socio-cultural context, beliefs, and barriers to CRC screening among SA immigrants. Culturally appropriate community-based strategies included story-telling, the use of social networks, and greater physician engagement. Enhancing collaborative partnerships with physicians and public health may minimize structural barriers and reduce health disparities. Future research could explore effectiveness of outreach strategies including these collaborations.

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Barriers to and Facilitators of Colorectal Cancer Screening in Egypt: Examining the Perceptions of Physicians and Residents in Alexandria

JCO Global Oncology ◽

10.1200/go.20.35000 ◽

2020 ◽

Vol 6 (Supplement_1) ◽

pp. 40-40

Author(s):

Lori Brand Bateman ◽

Somaia Khamess ◽

Ahmed Nawar ◽

Salah-Eldin Abdelmoneim ◽

Waleed Arafat ◽

...

Keyword(s):

Colorectal Cancer ◽

Focus Group ◽

Early Detection ◽

Focus Groups ◽

Primary Care Physicians ◽

Screening Program ◽

Low Cost ◽

Screening Tests ◽

Structural Level ◽

Crc Screening

PURPOSE Colorectal cancer (CRC) screening is not routinely performed in Egypt, and more than one third of CRC cases occur in individuals age 40 and younger, with overall survival estimated at only 2 years, presumably because of late diagnoses. To lay the foundation for the development of a CRC multilevel screening program in Egypt to promote CRC prevention and early detection, this qualitative study aimed to explore the potential barriers to and facilitators of screening from the perspectives of physicians and residents in Alexandria. METHODS We conducted one-on-one, 1-hour, semistructured interviews with primary health care physicians and specialists—oncologists and gastroenterologists—practicing in Alexandria, Egypt. Focus groups of residents, stratified by social class and gender, were also held. Interviews and focus groups were conducted in Arabic by trained interviewers/moderator, and were audio recorded, transcribed, translated into English, and analyzed using thematic analysis. RESULTS Seventeen physicians participated—8 specialists and 9 primary care physicians—and 7 focus groups—7 to 8 participants each—were held. According to both interview and focus group participants, individual-level barriers to CRC screening included socioeconomic status, a lack of emphasis on prevention in the culture, fear, and cost. Provider-level barriers as mentioned by physicians included a belief that only high-risk patients should be screened and a lack of confidence in providers to perform and interpret screening tests appropriately. Structural-level barriers, discussed by physicians and focus group participants, included cost and a lack of testing availability. Potential facilitators of screening mentioned by physicians included implementing a media campaign emphasizing early detection and curability. Focus group participants focused on making screening tests free or low cost, obligatory, and convenient. CONCLUSION On the basis of the perceptions of physicians and residents of Alexandria, Egypt, multiple barriers to and facilitators of CRC screening exist. Addressing these would be important in designing a successful screening program.

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Shared Decision-Making and Colorectal Cancer Screening Behaviors Among Older Adults With Low Health Literacy

Innovation in Aging ◽

10.1093/geroni/igab046.1154 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 299-299

Author(s):

Rebekah Halmo ◽

Siobhan McDonold ◽

Mara Schonberg ◽

Tamara Cadet

Keyword(s):

Colorectal Cancer ◽

Decision Making ◽

Health Literacy ◽

Shared Decision Making ◽

Shared Decision ◽

Structured Interviews ◽

National Guidelines ◽

Crc Screening ◽

High School Degree ◽

Low Health Literacy

Abstract National guidelines recommend adults >75 engage in shared decision making (SDM) around colorectal cancer (CRC) screening because of the uncertain benefit to risk ratio. There are no decision tools to support CRC decision making for adults >75 years with low health literacy (LHL). The purpose of this mixed-methods study was to better understand the perspectives of adults >75 with LHL on SDM around CRC screening and to obtain their feedback on an existing higher literacy CRC decision aid. Utilizing the Brief Health Literacy Screening Tool to identify participants with LHL, semi-structured interviews were conducted with 30 adults. Findings indicate that 80% of participants were non-Hispanic Black and 42% had < high school degree. 76% felt they would benefit from CRC screening despite their age. Themes related to CRC screening included lack of knowledge of options and harms, but a desire to understand more to better take care of their health.

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Decision-Making Preferences Among Older Hispanics Participating in a Colorectal Cancer (CRC) Screening Program

Journal of Community Health ◽

10.1007/s10900-017-0352-5 ◽

2017 ◽

Vol 42 (5) ◽

pp. 1027-1034 ◽

Cited By ~ 4

Author(s):

Jennifer C. Molokwu ◽

Eribeth Penaranda ◽

Navkiran Shokar

Keyword(s):

Colorectal Cancer ◽

Decision Making ◽

Screening Program ◽

Crc Screening

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The Role of Health Literacy in Explaining the Relation between Educational Level and Decision Making about Colorectal Cancer Screening

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16234644 ◽

2019 ◽

Vol 16 (23) ◽

pp. 4644

Author(s):

Anke J. Woudstra ◽

Ellen M. A. Smets ◽

Mathilde G. E. Verdam ◽

Mirjam P. Fransen

Keyword(s):

Colorectal Cancer ◽

Decision Making ◽

Health Literacy ◽

Structural Equation ◽

Decisional Conflict ◽

Informed Decision ◽

Informed Decision Making ◽

Descriptive Norm ◽

Injunctive Norm ◽

Crc Screening

Little is known about why educational inequalities exist in informed decision making in colorectal cancer (CRC) screening. Insight into the role and impact of health literacy is essential for intervention development. This study investigates associations between health literacy and informed decision making in CRC screening and explores to what extent health literacy mediates the association between education and informed decision making in CRC screening. In total, 696 individuals eligible for CRC screening (55–75 years of age) were recruited from online panels and filled in an online questionnaire at T0 (n = 696), T1 (n = 407) and T2 (n = 327). A hypothetical mediation model was tested using structural equation modelling. Outcomes included CRC knowledge, CRC screening knowledge, attitude, injunctive norm, descriptive norm, risk perception, self-efficacy, decisional conflict and decisional certainty. Health literacy domains included Comprehension, Application, Numeracy and Communication. Comprehension, Application and Numeracy, were found to mediate the association between education and knowledge about CRC and CRC screening, injunctive norm, descriptive norm, decisional conflict and decisional certainty. In light of these findings, targeting multiple health literacy domains in decision-support interventions is essential for facilitating informed decision making in CRC screening.

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Understanding barriers and facilitators to participation in colorectal cancer screening: A French qualitative study

Journal of Health Psychology ◽

10.1177/1359105320909883 ◽

2020 ◽

pp. 135910532090988

Author(s):

Alice Le Bonniec ◽

Sébastien Mas ◽

Marie Préau ◽

Florence Cousson-Gélie

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

General Population ◽

Qualitative Study ◽

Focus Groups ◽

Colorectal Cancer Screening ◽

Thematic Analysis ◽

Social Representations ◽

Negative Image ◽

Main Determinants

Based on the theory of social representations, this study aims to identify the main determinants to participation in colorectal cancer screening. Six focus groups (N = 29 participants belonging to the general population) were conducted, followed by a theoretical thematic analysis. Screening obstacles are a lack of test’s accessibility, a low preoccupation for prevention and the negative image of colorectal cancer. Conversely, screening facilitators are the ease of the new test, being encouraged to get screened and appointment reminder. This study advances understanding of adherence to screening by addressing the beliefs and knowledge surrounding it.

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