Tarasenko Yelena N, Schoenberg Nancy E
Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky, USA.
Rural Remote Health. 2011;11(1):1553. Epub 2011 Jan 21.
Colorectal cancer is the second leading cause of cancer deaths in the USA. Although early detection through screening has been shown to be effective in preventing colorectal cancer mortality, adherence to screening guidelines remains low. Among certain populations--namely those with lower socioeconomic status, a greater number of chronic conditions or multiple morbidity, and those living in rural locations-- colorectal cancer screening is particularly underused. This study explored the prevalence of such screening and explanations for how multiple chronic conditions might affect colorectal cancer screening among an especially vulnerable group of middle-aged and older adults.
In total, 41 participants were recruited aged 50-76 years with two or more chronic conditions, from three rural health clinics in Appalachian Kentucky, USA. Using semi-structured and structured questions and instruments, participants engaged in two interviews.
Study results demonstrate colorectal cancer screening rates lower than state and national averages. In addition to commonly expressed barriers including unpleasant screening modality, lack of health insurance, and shortage of gastroenterologists to perform colonoscopy, participants described the ways in which multiple morbidities undermine screening. Barriers specific to multiple morbidity include competing demands from other conditions, such as financial pressures, physical limitations, and worries over regimen interference.
The window of opportunity left open by more frequent visits to health care professionals should be used to patients' advantage, especially as people with multiple morbidity are living longer with their chronic conditions. Efforts must accelerate to establish clinical guidelines and practices incorporating both management of existing conditions and the prevention of additional future morbidity.
结直肠癌是美国癌症死亡的第二大主要原因。尽管通过筛查进行早期检测已被证明可有效预防结直肠癌死亡，但对筛查指南的依从性仍然很低。在某些人群中，即社会经济地位较低、患有更多慢性病或多种疾病并存的人群以及居住在农村地区的人群中，结直肠癌筛查的使用率尤其低。本研究探讨了此类筛查的患病率，以及多种慢性病可能如何影响一个特别脆弱的中老年人群体的结直肠癌筛查情况。
总共从美国肯塔基州阿巴拉契亚地区的三家农村健康诊所招募了41名年龄在50 - 76岁之间、患有两种或更多慢性病的参与者。通过半结构化和结构化问题及工具，对参与者进行了两次访谈。
研究结果表明，结直肠癌筛查率低于该州和全国平均水平。除了常见的障碍，包括不愉快的筛查方式、缺乏医疗保险以及进行结肠镜检查的胃肠病医生短缺外，参与者还描述了多种疾病如何破坏筛查。多种疾病特有的障碍包括来自其他疾病的相互竞争的需求，如经济压力、身体限制以及对治疗方案干扰的担忧。
应利用因更频繁就医而带来的机会窗口，使其对患者有利，尤其是因为患有多种疾病的人在慢性病状态下存活时间更长。必须加快努力，制定临床指南和实践，将现有疾病的管理与预防未来更多疾病结合起来。
