Department of Epidemiology and Community Health, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
Am J Prev Med. 2010 May;38(5):508-16. doi: 10.1016/j.amepre.2010.01.021.
Barriers experienced by patients influence the uptake of colorectal cancer (CRC) screening. Prior research has quantified how often patients encounter these challenges but has generally not revealed their complex perspective and experience with barriers.
This mixed-methods study was conducted to understand current perspectives on CRC screening.
A two-part, mixed-methods study was conducted of primary care patients recruited from Virginia Ambulatory Care Outcomes Research Network practices. First, in June-July 2005 a survey was mailed to 660 patients aged 50-75 years posing an open-ended question about "the most important barrier" to CRC screening. Second, beginning in October 2005, seven gender- and largely race-specific focus groups involving 40 patients aged 45-75 years were conducted. Beginning in October 2005, survey verbatim responses were coded and quantitatively analyzed and focus group transcripts were qualitatively analyzed.
Responses to the open-ended survey question, answered by 74% of respondents, identified fear and the bowel preparation as the most important barriers to screening. Only 1.6% of responses cited the absence of physician advice. Focus group participants cited similar issues and other previously reported barriers, but their remarks exposed the intricacies of complex barriers, such as fear, lack of information, time, the role of physicians, and access to care. Participants also cited barriers that have little documentation in the literature, such as low self-worth, "para-sexual" sensitivities, fatalism, negative past experiences with testing, and skepticism about the financial motivation behind screening recommendations.
Mixed-methods analysis helps to disaggregate the complex nuances that influence patient behavior. In the present study, patients explained the web of influences on knowledge, motivation, and ability to undergo CRC screening, which clinicians and policymakers should consider in designing interventions to increase the level of screening.
患者所经历的障碍会影响结直肠癌（CRC）筛查的参与度。先前的研究已经量化了患者遇到这些挑战的频率，但通常未能揭示他们对障碍的复杂看法和体验。
本混合方法研究旨在了解当前对 CRC 筛查的看法。
对弗吉尼亚门诊保健结果研究网络实践中招募的初级保健患者进行了两部分混合方法研究。首先，在 2005 年 6 月至 7 月，向 660 名年龄在 50-75 岁的患者邮寄了一份调查问卷，提出了一个关于“CRC 筛查的最重要障碍”的开放式问题。其次，从 2005 年 10 月开始，进行了七个性别和主要种族特异性的焦点小组，涉及 40 名年龄在 45-75 岁的患者。从 2005 年 10 月开始，对调查的逐字回复进行了编码和定量分析，并对焦点小组的记录进行了定性分析。
对开放式调查问题的回答，74%的受访者回答了这个问题，他们确定恐惧和肠道准备是筛查的最重要障碍。只有 1.6%的回答提到缺乏医生的建议。焦点小组参与者提到了类似的问题和其他先前报告的障碍，但他们的言论揭示了复杂障碍的复杂性，例如恐惧、缺乏信息、时间、医生的角色和获得医疗保健的机会。参与者还提到了文献中记录较少的障碍，例如低自我价值感、“类性”敏感、宿命论、对测试的负面过往经历以及对筛查建议背后的经济动机的怀疑。
混合方法分析有助于分解影响患者行为的复杂细微差别。在本研究中，患者解释了影响 CRC 筛查知识、动机和能力的因素网络，临床医生和政策制定者在设计干预措施以提高筛查水平时应考虑这些因素。
