Reasons for Never and Intermittent Completion of Colorectal Cancer Screening After Receiving Multiple Rounds of Mailed Fecal Tests

Authors:

Beverly Green (Presenter)
Kaiser Permanente Washington

Leah Tuzzio, Kaiser Permanente Washington
June BlueSpruce, Kaiser Permanente Washington
Sally Vernon, University of Texas Health Science Center Houston,
L Hay, University of Texas Health Science Center Houston,
Sheryl Catz, University of California Davis

Public Health Statement: Background: Long-term adherence to colorectal cancer (CRC) screening is particularly important for fecal testing. Some U.S. studies report that only 25% of individuals repeat fecal testing annually.

Purpose: The purpose of this qualitative study was to identify barriers and facilitators reported by patients with suboptimal screening adherence. We also explored whether individuals, particularly never screeners, would be willing to do a CRC screening blood test.

Methods/Approach: Forty-one patients who previously enrolled in the Systems of Support to Increase CRC Screening (SOS) trial were interviewed 4-5 years later. Participants were selected to include men and women with diverse race/ethnicities who had either been inconsistent screeners or had never screened during despite receiving at least two rounds of mailed fecal tests. Two interviewers conducted 30-minute telephone interviews using a semi-structured interview guide. An iterative thematic analysis approach was used.

Results: Screening barriers themes were more pervasive among never screeners including—

1. Avoidance (inattention, procrastination).
2. Concerns about handling stool.
3. Health concerns.
4. Fear of a cancer diagnosis.

Screening facilitators themes were more often mentioned by participants who screened at least once including—

1. Use of a simpler 1-sample fecal test;
2. Convenience of mailings and doing the test at home;
3. Salience of prevention, especially as one got older; and
4. Influence of recommendations from providers and family.

Participants had diverse preferences for the number (3 on average) and types (phone, mail, text) of screening reminders. Some participants did not prefer e-mail links to the patient shared electronic health record because of difficulties remembering their password. It was acceptable for a nurse or medical assistant not from their clinic to call them as long as that person was knowledgeable about their records and could communicate with their physician. Participants, especially never screeners, were generally very enthusiastic about the potential option of a CRC screening blood test.

Conclusions/Implications: Future CRC screening programs should be designed to minimize these barriers and maximize facilitators to improve long-term screening adherence.