Research Division, Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA.
J Community Health. 2013 Apr;38(2):285-92. doi: 10.1007/s10900-012-9612-6.
Colorectal cancer (CRC) screening is underutilized, especially in low income, high minority populations. We examined the effect test-specific barriers have on colonoscopy and fecal immunochemical test (FIT) completion, what rationales are given for non-completion, and what "switch" patterns exist when participants are allowed to switch from one test to another. Low income adults who were not up-to-date with CRC screening guidelines were recruited from safety-net clinics and offered colonoscopy or FIT (n = 418). Follow up telephone surveys assessed test-specific barriers. Test completion was determined from patient medical records. For subjects who desired colonoscopy at baseline, finding a time to come in and transportation applied more to non-completers than completers (p = 0.001 and p < 0.001, respectively). For participants who initially wanted FIT, keeping track of cards, never putting stool on cards, and not remembering to mail cards back applied more to non-completers than completers (p = 0.003, p = 0.006, and p < 0.001, respectively). The most common rationale given for not completing screening was a desire for the other screening modality: 7 % of patients who initially preferred screening by FIT completed colonoscopy, while 8 % of patients who initially preferred screening by colonoscopy completed FIT. We conclude that test-specific barriers apply more to subjects who did not complete CRC screening. As a common rationale for test non-completion is a desire to receive a different screening modality, our findings suggest screening rates could be increased by giving patients the opportunity to switch tests after an initial choice is made.
结直肠癌(CRC)筛查的利用率较低,尤其是在低收入、少数民族占比较高的人群中。我们研究了特定测试障碍对结肠镜检查和粪便免疫化学测试(FIT)完成的影响,以及未完成测试的原因,以及当允许参与者从一种测试切换到另一种测试时存在哪些“转换”模式。我们从医疗保健网诊所招募了不符合 CRC 筛查指南的低收入成年人,并为他们提供结肠镜检查或 FIT(n=418)。后续的电话调查评估了特定测试的障碍。根据患者的医疗记录确定了测试完成情况。对于基线时希望进行结肠镜检查的受试者,找到合适的时间来进行检查和交通对未完成者的影响大于完成者(p=0.001 和 p<0.001)。对于最初希望进行 FIT 的参与者,跟踪卡片、从未将粪便放在卡片上、不记得将卡片寄回的情况对未完成者的影响大于完成者(p=0.003、p=0.006 和 p<0.001)。未完成筛查的最常见原因是对另一种筛查方式的渴望:7%最初希望通过 FIT 进行筛查的患者完成了结肠镜检查,而 8%最初希望通过结肠镜检查进行筛查的患者完成了 FIT。我们得出结论,特定测试的障碍对未完成 CRC 筛查的受试者的影响更大。由于未完成测试的常见原因是希望接受不同的筛查方式,我们的研究结果表明,通过在初始选择后为患者提供转换测试的机会,可以提高筛查率。