Barriers and Facilitators to Colorectal Cancer Screening Within a Hispanic Population

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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Tailored message interventions versus typical messages for increasing participation in colorectal cancer screening among a non-adherent population: A randomized controlled trial

BMC Public Health ◽

10.1186/s12889-016-3069-y ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 10

Author(s):

Kei Hirai ◽

Yoshiki Ishikawa ◽

Jun Fukuyoshi ◽

Akio Yonekura ◽

Kazuhiro Harada ◽

...

Keyword(s):

Colorectal Cancer ◽

Randomized Controlled Trial ◽

Screening Program ◽

Controlled Trial ◽

Baseline Survey ◽

Attendance Rates ◽

Community Based ◽

Crc Screening ◽

Randomized Controlled ◽

Significant Difference

Abstract Background The purpose of this study was to examine the effectiveness and cost-efficiency of a tailored message intervention compared with a non-tailored message intervention for increasing colorectal cancer (CRC) screening rates among a non-adherent population, in a community-based client reminder program. Methods After a baseline survey for psychological segmentation, 2140 eligible individuals were randomly assigned either to a group with a tailored matched-message condition (N = 356), a group with a non-tailored unmatched-message condition (N = 355), or to two control groups, one using a typical message with a professional design (N = 717) and one without a professional design (N = 712). The main outcome measure was attendance rates in a community-organized CRC screening program within five months of receiving a print reminder. Results There was a significant difference in fecal occult blood test (FOBT) attendance rates at follow-up assessments between the tailored matched-message condition (14.0 %) and the control (9.9 %; OR = 1.48, p = 0.026), while there was no significant difference between the unmatched-message condition (11.0 %) and the control (OR = 1.12, p = 0.558), and between the matched-message condition and the unmatched-message condition (OR = 1.32, p = 0.219). The cost of a one-person increase in FOBT screening was 3,740 JPY for the tailored matched-message condition, while it was 2,747 JPY for the control. Conclusions A tailored-message intervention for segmented individuals designed to increase CRC screening rates in a community-based client reminder program was significantly effective compared to a usual reminder, but not more effective than an unmatched message in a randomized controlled trial, and was not sufficiently effective to highlight its value from a cost perspective. Therefore, the tailored intervention including target segmentation needs to be improved for future implementation in a CRC screening program for a non-adherent population. Trial registration UMIN Clinical Trials Registry UMIN000004384. Date of Registration: March 2011.

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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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Barriers and facilitators for colorectal cancer screening in a low-income urban community in Mexico City

10.21203/rs.3.rs-17322/v1 ◽

2020 ◽

Author(s):

Karla Unger-Saldaña ◽

Minerva Saldaña-Tellez ◽

Michael B. Potter ◽

Katherine Van Loon ◽

Betania Allen-Leigh ◽

...

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Cancer Screening ◽

Screening Program ◽

Barriers And Facilitators ◽

Health Care Personnel ◽

Crc Screening ◽

Lay Beliefs ◽

Incidence And Mortality ◽

The Social

Abstract Background Colorectal cancer (CRC) incidence and mortality are increasing in many middle- and lower-income countries, possibly due to a combination of changing lifestyles and improved healthcare infrastructure that facilitates diagnosis. Unfortunately, a large proportion of cases may be diagnosed at advanced stages, resulting in poor outcomes. Decreasing trends in higher income countries are likely due to improved early detection combined with best practices in CRC treatment and management. More data on implementation of better quality CRC screening programs are needed for contexts where incidence is increasing. Therefore, we sought to identify potential barriers and facilitators for future implementation of fecal immunochemical test (FIT)-based CRC screening in a public healthcare system in a middle-income country with increasing CRC incidence and mortality. Methods. Qualitative study including semi-structured individual and focus group interviews with different stakeholders of colorectal cancer screening: 30 average-risk lay people, 13 health care personnel from a local public clinic, and 7 endoscopy unit personnel from a cancer referral hospital. All interviews were transcribed verbatim for analysis. Data was analyzed using the constant comparison method, under the theoretical perspectives of the Social Ecological Model (SEM), the PRECEDE-PROCEED Model, and the Health Belief Model. Results. We found multiple barriers and facilitators for implementation of a FIT-based CRC screening program at different levels of the SEM. The main barriers in each of the SEM levels, were: 1) at the social context level: poverty, health literacy and lay beliefs related to gender, cancer, allopathic medicine, and religion; 2) at the health services organization level: the lack of CRC knowledge among health care personnel and the community perception of poor quality of health care; 3) at the individual level: a lack of CRC awareness and therefore lack of risk perception, together with fear of participating in screening activities and finding out about a serious disease. The main facilitators perceived by the participants were CRC screening information and the free provision of screening tests.Conclusions. This study’s findings suggest the need for a multi-level CRC screening program that includes complementary strategies aimed at reducing perceived barriers and enhancing facilitators, starting with: 1) free provision of screening tests, 2) education of primary health care personnel, and 3) promotion of non fear-based CRC screening awareness among the target population, taking into account their lay beliefs.

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Development of a Group-Based Community Health Worker Intervention to Increase Colorectal Cancer Screening Among Latinos

Hispanic Health Care International ◽

10.1177/1540415320923564 ◽

2020 ◽

pp. 154041532092356

Author(s):

C. L. De La Torre ◽

J. N. Dumbauld ◽

J. Haughton ◽

S. Gupta ◽

J. Nodora ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Focus Groups ◽

Community Health ◽

Health Worker ◽

Community Health Worker ◽

Community Advisory Board ◽

Community Based ◽

Latino Men ◽

Crc Screening

Introduction: Latinos are at higher risk of colorectal cancer (CRC) mortality than non-Hispanic Whites due, in part, to disparities in cancer screening. There is a need to evaluate community-based CRC interventions as they may reach underinsured communities and those at highest risk for CRC. This article describes the development of a group-based CRC intervention ( Juntos contra el Cancer). Method: Purposive sampling was used to recruit Latino men and women aged 50 to 75 years not-up-to-date with CRC screening. The development of the intervention was guided by the socioecologic framework, a community needs assessment, literature reviews, five focus groups ( n = 39) from the target community and feedback from a Community Advisory Board. Results: Findings from focus groups suggested that a group-based, promotor or community health worker (CHW) led, cancer prevention education with linkages to care would address barriers to CRC screening. Conclusion: Development of community-based CRC screening interventions should be informed by early and sustained community engagement. Interventions led by CHWs with linkages to care are feasible and can reach populations not connected to health care settings.

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Differences in Colorectal Cancer (CRC) patients who did and did not undergo screening

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1343 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

J Thompson ◽

J Ng ◽

B Armstrong ◽

E Feletto ◽

T Ha

Keyword(s):

Physical Activity ◽

Colorectal Cancer ◽

Cohort Study ◽

Screening Program ◽

Barriers And Facilitators ◽

Average Risk ◽

Physical Activity Guidelines ◽

Crc Screening ◽

Female Patients ◽

Screening Participation

Abstract Background The Australian National Bowel Cancer Screening Program (NBSCP) is a free population-based screening program which aims to identify precancerous lesions and early colorectal cancer (CRC) using an immunochemical faecal occult blood test in average risk Australians. Formally commencing in 2006, NBCSP participation rate in eligible 50-74-year-old people was 42% in 2018. The barriers and facilitators of participation in the NBCSP have been explored for the general, at-risk population but not in a population of CRC patients. This is the first study to assess a population of CRC patients, post diagnosis, who would have been eligible for CRC screening to determine the barriers and facilitators to screening. Methods A cross sectional study nested within a cohort study. Data from CRC patients who participated in the 45 and Up Study; the largest cohort study in Australia and southern hemisphere, were analysed to compare those who had and had not participated in CRC screening. Logistic regression analyses were conducted using RStudio (version 3.5.2, Boston, Massachusetts, USA.). Multiple Imputation (MI), was used to handle missing values assumed to be missing at random. Results A total of 339 CRC patients were included. Patients who were female, overweight (≥25kg/m2), consumed less than the recommended five servings of vegetables per day, consumed less than or equal to fourteen standard drinks per week (compared to non-drinkers) or did not meet physical activity guidelines were significantly less likely to have participated in screening. Conclusions Our study has taken a unique approach to identifying a high-risk group by exploring factors to screening participation in CRC patients. CRC patients with less healthy lifestyles were less likely to participate in screening. In contrast to previous studies, female patients were less likely to participate in screening than males were. This was an unexpected finding and should be replicated. Key messages Not surprising that those with less healthy lifestyle practices also reflected less than ideal screening practices. Surprising that female patients participated less in screening than males. Future interventions to improve CRC screening participation rates should consider specialised messaging for average-risk females who are overweight not meeting dietary or physical activity guidelines.

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Barriers and facilitators for colorectal cancer screening in a low-income urban community in Mexico City

10.21203/rs.2.24822/v1 ◽

2020 ◽

Author(s):

Karla Unger-Saldaña ◽

Minerva Saldaña-Tellez ◽

Michael B. Potter ◽

Katherine Van Loon ◽

Betania Allen-Leigh ◽

...

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Screening Program ◽

Barriers And Facilitators ◽

Health Care Personnel ◽

Crc Screening ◽

Lay Beliefs ◽

The Social

Abstract Background. Colorectal cancer (CRC) incidence and mortality are increasing in many middle- and lower-income countries, possibly due to a combination of changing lifestyles and improved healthcare infrastructure that facilitates diagnosis. Unfortunately, a large proportion of cases may be diagnosed at advanced stages, resulting in poor outcomes. Decreasing trends in higher income countries are likely due to improved early detection combined with best practices in CRC treatment and management. More data on implementation of better quality CRC screening programs are needed for contexts where incidence is increasing. Therefore, we sought to identify potential barriers and facilitators for future implementation of fecal immunochemical test (FIT)-based CRC screening in a public healthcare system in a middle-income country with increasing CRC incidence and mortality.Methods. Qualitative study including semi-structured individual and focus group interviews with different stakeholders of colorectal cancer screening: 30 average-risk lay people, 13 health care personnel from a local public clinic, and 7 endoscopy unit personnel from a cancer referral hospital. All interviews were transcribed verbatim for analysis. Data was analyzed using the constant comparison method, under the theoretical perspectives of the Social Ecological Model (SEM), the PRECEDE-PROCEED Model, and the Health Belief Model. Results. We found multiple barriers and facilitators for implementation of a FIT-based CRC screening program at different levels of the SEM. The main barriers in each of the SEM levels, were: 1) at the social context level: poverty, health literacy and lay beliefs related to gender, cancer, allopathic medicine, and religion; 2) at the health services organization level: the lack of CRC knowledge among health care personnel and the community perception of poor quality of health care; 3) at the individual level: a lack of CRC awareness and therefore lack of risk perception, together with fear of participating in screening activities and finding out about a serious disease. The main facilitators perceived by the participants were CRC screening information and the free provision of screening tests.Conclusions. This study’s findings suggest the need for a multi-level CRC screening program that includes complementary strategies aimed at reducing perceived barriers and enhancing facilitators, starting with: 1) free provision of screening tests, 2) education of primary health care personnel, and 3) promotion of non fear-based CRC screening awareness among the target population, taking into account their lay beliefs.

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National Colorectal Cancer Screening Program in Lithuania: Description of the 5-Year Performance on Population Level

Cancers ◽

10.3390/cancers13051129 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1129

Author(s):

Audrius Dulskas ◽

Tomas Poskus ◽

Inga Kildusiene ◽

Ausvydas Patasius ◽

Rokas Stulpinas ◽

...

Keyword(s):

Colorectal Cancer ◽

Quality Assurance ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Screening Program ◽

Histopathological Examination ◽

Insurance Fund ◽

Crc Screening ◽

Cancer Screening Program ◽

The Impact

We aimed to report the results of the implementation of the National Colorectal Cancer (CRC) Screening Program covering all the country. The National Health Insurance Fund (NHIF) reimburses the institutions for performing each service; each procedure within the program has its own administrative code. Information about services provided within the program was retrieved from the database of NHIF starting from the 1 January 2014 to the 31 December 2018. Exact date and type of all provided services, test results, date and results of biopsy and histopathological examination were extracted together with the vital status at the end of follow-up, date of death and date of emigration when applicable for all men and women born between 1935 and 1968. Results were compared with the guidelines of the European Union for quality assurance in CRC screening and diagnosis. The screening uptake was 49.5% (754,061 patients) during study period. Participation rate varied from 16% to 18.1% per year and was higher among women than among men. Proportion of test-positive and test-negative results was similar during all the study period—8.7% and 91.3% annually. Between 9.2% and 13.5% of test-positive patients received a biopsy of which 52.3–61.8% were positive for colorectal adenoma and 4.6–7.3% for colorectal carcinoma. CRC detection rate among test-positive individuals varied between 0.93% and 1.28%. The colorectal cancer screening program in Lithuania coverage must be improved. A screening database is needed to systematically evaluate the impact and performance of the national CRC screening program and quality assurance within the program.

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To do or not to do – a survey study on factors associated with participating in the Danish screening program for colorectal cancer

BMC Health Services Research ◽

10.1186/s12913-020-06023-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jesper Bo Nielsen ◽

Gabriele Berg-Beckhoff ◽

Anja Leppin

Keyword(s):

Colorectal Cancer ◽

Screening Program ◽

Demographic Data ◽

Survey Study ◽

Stepwise Logistic Regression ◽

Willingness To Participate ◽

Cross Sectional Survey ◽

Screening Programs ◽

Crc Screening ◽

Screening Participation

Abstract Background Screening programs for colorectal cancer (CRC) exist in many countries, and with varying participation rates. The present study aimed at identifying socio-demographic factors for accepting a cost-free screening offer for CRC in Denmark, and to study if more people would accept the screening offer if the present fecal test was replaced by a blood test. Methods We used a cross-sectional survey design based on a representative group of 6807 Danish citizens aged 50–80 years returning a fully answered web-based questionnaire with socio-demographic data added from national registries. Data were analyzed in STATA and based on bivariate analyses followed by regression models. Results Danes in general have a high level of lifetime participation (+ 80%) in the national CRC screening program. The results of the stepwise logistic regression model to predict CRC screening participation demonstrated that female gender, higher age, higher income, and moderate alcohol intake were positively associated with screening participation, whereas a negative association was observed for higher educational attainment, obesity, being a smoker, and higher willingness to take health risks. Of the 1026 respondents not accepting the screening offer, 61% were willing to reconsider their initial negative response if the fecal sampling procedure were replaced by blood sampling. Conclusion The CRC screening program intends to include the entire population within a certain at-risk age group. However, individual factors (e.g. sex, age obesity, smoking, risk aversity) appear to significantly affect willingness to participate in the screening program. From a preventive perspective, our findings indicate the need for a more targeted approach trying to reach these groups.

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Outcomes of colonoscopy with non-anesthesiologist-administered propofol (NAAP): an equivalence trial

Endoscopy International Open ◽

10.1055/a-1452-9242 ◽

2021 ◽

Vol 09 (07) ◽

pp. E1070-E1076

Author(s):

Marco Alburquerque ◽

Antonella Smarrelli ◽

Julio Chevarria Montesinos ◽

Sergi Ortega Carreño ◽

Ana Zaragoza Fernandez ◽

...

Keyword(s):

Colorectal Cancer ◽

Screening Program ◽

Complication Rates ◽

Withdrawal Time ◽

Equivalence Trial ◽

Crc Screening ◽

Intention To Treat ◽

Adenoma Detection ◽

Group A ◽

Cecal Intubation Rate

Abstract Background and study aims Efficacy and safety of NAAP for gastrointestinal endoscopy have been widely documented, although there is no information about the outcomes of colonoscopy when the endoscopist supervises the sedation. In this context, the aim of this trial was to determine the equivalence of adenoma detection rate (ADR) in colorectal cancer (CRC) screening colonoscopies performed with non-anesthesiologist-administered propofol (NAAP) and performed with monitored anesthesia care (MAC). Patients and methods This was a single-blind, non-randomized controlled equivalence trial that enrolled adults from a national CRC screening program (CRCSP). Patients were blindly assigned to undergo either colonoscopy with NAAP or MAC. The main outcome measure was the ADR in CRCSP colonoscopies performed with NAAP. Results We included 315 patients per group. The median age was 59.76 ± 5.81 years; 40.5 % of patients were women. The cecal intubation rate was 97 %, 81.8 % of patients had adequate bowel preparation, withdrawal time was > 6 minutes in 98.7 %, and the median global exploration time was 24.25 ± 8.86 minutes (range, 8–70 minutes). The ADR was 62.9 % and the complication rate (CR) was 0.6 %. Analysis by intention-to-treat showed an ADR in the NAAP group of 64.13 % compared with 61.59 % in the MAC group, a difference (δADR) of 2.54 %, 95 %CI: −0.10 to 0.05. Analysis by per-protocol showed an ADR in the NAAP group of 62.98 %, compared with 61.94 % in the MAC group, δADR: 1.04 %, 95 %CI: −0.09 to 0.07. There was no difference in CR (NAAP: 0,63 vs. MAC: 0.63); P = 1.0. Conclusions ADR in colorectal cancer screening colonoscopies performed with NAAP was equivalent to that in those performed with MAC. Similarly, there was no difference in complication rates.

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