Assessment of Patient Barriers to and Facilitators of Screening Colonoscopy: Utilizing Patient Perspectives to Formulate Recommendations to Improve Colorectal Cancer Screening Rates

A pilot study was conducted that utilized focused patient interviews to determine patient barriers to and facilitators of screening colonoscopy. The interviews were transcribed and systematically analyzed to detect recurring patterns and themes related to screening colonoscopy completion or lack thereof. Descriptive statistics were used to summarize additional sample characteristics such as gender, education level, and income level. Among those who had received a screening colonoscopy (44%, 11 of 25), provider recommendation was the most influential factor for procedure completion, followed by the combination of provider plus family member recommendation. Additional findings revealed that due to medical necessity, several patients (32%, 8 of 25) had obtained a colonoscopy for non-screening purposes and were past due for screening at the time of completion (75%, 6 of 8). Of the six patients who received an initial colonoscopy out of medical necessity and were past due, half had never received a prior recommendation, while the other half reported Lack of Insurance/Financial Concern(s) and Refusal/Fear as reasons for not completing colonoscopy at the time of initial recommendation. Among those that had never had a colonoscopy for any reason (24%, 6 of 25) barriers that were identified include 1) Lack of Recommendation/Knowledge (50%, 3 of 6), 2) Lack of Insurance/Financial Concern(s) (16.7%, 1 of 6), 3) Scheduling conflict (16.7%, 1 of 6), and 4) Refusal/Fear (16.7%, 1 of 6). Overall study findings reveal that CRC screening rates in primary care may be improved with the implementation of an evidence-based multi-strategy practice program that ensures its interventions are 1) based upon utilizing the patient-identified facilitators and 2) address the patient-identified barriers to CRC screening exams. Implications for future research and policy were also revealed.