Patients' self-reported barriers to colon cancer screening in federally qualified health center settings
Patients' self-reported barriers to colon cancer screening in federally qualified health center settings
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DOI：
10.1016/j.pmedr.2019.100896
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发表时间：
2019-09-01
影响因子：
2.8
通讯作者：
James, Aimee S.
中科院分区：
文献类型：
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作者：
Muthukrishnan, Meera;Arnold, Lauren D.;James, Aimee S.
结直肠癌(CRC)是美国癌症相关死亡的主要原因。尽管有证据表明筛查可以降低结直肠癌的发病率和死亡率，但只有大约60%的符合年龄的成年人了解最新的结直肠癌筛查情况。这项分析旨在确定在安全网医疗保健环境中的患者中自我报告的结直肠癌筛查障碍。参与者从参加一项增加结直肠癌筛查的试验的安全网初级保健地点招募。在基线时，患者(n=483)完成了自我报告调查，评估了人口统计学、医疗保健和结直肠癌筛查。通过一个开放式问题评估了结直肠癌筛查的障碍。使用基本的文本分析，数据被编码并组织成关键主题。总体而言，65.2%的人曾经进行过CRC筛查；46.4%的人是最新的。在描述障碍的人(n=198)中，22.9%的人说他们不应该进行筛查或他们的提供者没有建议这样做。其他常见障碍包括对程序或结果的恐惧或担忧，缺乏保险或检测成本等财务挑战，以及运输和时间等后勤挑战。更少的人说筛查不重要，或提到对检查程序或结肠镜检查感到不适。在这种安全网环境下，结直肠癌筛查率低于全国筛查率。这些定性结果与文献中报道的定量结果相似，但定性数据增加了我们对患者报告的担忧和安全网患者面临的挑战的理解。这些结果可应用于制定针对性的沟通或干预策略，以提高安全网卫生中心内的结直肠癌筛查率。
Colorectal cancer (CRC) is a leading cause of cancer-related death in the United States. Despite evidence that screening reduces CRC incidence and mortality, only about 60% of age-eligible adults are up-to-date on CRC screening. This analysis aims to identify self-reported barriers to CRC screening among patients in a safety-net healthcare setting.Participants were recruited from safety-net primary care sites that were participating in a trial to increase CRC screening. At baseline, patients (n = 483) completed self-report surveys that assessed demographics, healthcare and CRC screening. Barriers to CRC screening were assessed through an open-ended question. Using a basic text analysis, data were coded and organized into key topics.Overall, 65.2% ever had CRC screening; 46.4% were up-to-date. Of those who described barriers (n = 198), 22.9% said they were not due for screening or their provider had not recommended it. Other common barriers included fear or worry about the procedure or outcome, financial challenges such as lack of insurance or cost of testing, and logistic challenges such as transportation and time. Fewer said that screening was of low importance or mentioned discomfort with the procedure or colonoscopy preparation.In this safety-net setting, CRC screening rates were lower than national rates. These qualitative results are similar to quantitative findings reported in the literature but the qualitative data add to our understanding of patient-reported concerns and challenges faced by safety-net patients. These results may be applied to developing targeting communication or intervention strategies to improve CRC screening rates within safety-net health centers.