Perkins Allen, Nicholls Keith, Shaw Thomas, Liu Gerald, Molokhia Ehab
Department of Family Medicine, USA Polling Group, University of South Alabama, Mobile, AL 36604, USA.
South Med J. 2013 Aug;106(8):462-7. doi: 10.1097/SMJ.0b013e3182a0e7be.
To ascertain barriers to colorectal cancer screening in an environment of changing recommendations, payment structures, and information access, and to develop strategies for overcoming these barriers by undertaking a population survey of colorectal cancer (CRC) screening knowledge and attitudes in Alabama.
An 80-item questionnaire focused on cancer screening, specifically CRC screening, was developed and pretested. A random sample of Alabama residents was generated using random-digit dial methods and interviews of 615 participants aged 50 and older were conducted in March 2012 and April 2012. Screened and unscreened groups were compared using χ statistics.
Sixty-one percent of Alabamians who participated in this survey reported being screened for CRC, the majority (95%) of these by colonoscopy. Both screened and unscreened participants reported using the Internet for health information more often if they were younger than 65 years. Those screened often reported feeling well informed regarding the guidelines, often to have discussed CRC screening with their family physician, and often to have had other cancer screenings. All of the respondents, screened and unscreened, reported financial considerations to be the most significant barriers to screening.
Although educating the general population could be helpful, a physician championing screening is key. Home stool testing is underused in Alabama in part because physicians are not fully aware of its utility. As financial barriers diminish, it is important to offer multiple effective modalities when available, and insurance reform, which includes payment for preventive care, may improve screening rates.
在推荐意见、支付结构和信息获取不断变化的环境中，确定结直肠癌筛查的障碍，并通过对阿拉巴马州结直肠癌（CRC）筛查知识和态度进行人群调查，制定克服这些障碍的策略。
设计并预先测试了一份包含80个条目的问卷，重点关注癌症筛查，特别是CRC筛查。采用随机数字拨号方法生成阿拉巴马州居民的随机样本，并于2012年3月和2012年4月对615名50岁及以上的参与者进行了访谈。使用χ统计量对筛查组和未筛查组进行比较。
参与本次调查的阿拉巴马州人中，61%报告接受过CRC筛查，其中大多数（95%）通过结肠镜检查。筛查组和未筛查组的参与者均表示，如果年龄小于65岁，他们更常使用互联网获取健康信息。接受筛查的人经常报告对指南了解充分，经常与家庭医生讨论CRC筛查，并且经常接受其他癌症筛查。所有受访者，无论是否接受过筛查，均报告经济因素是筛查的最重要障碍。
虽然对普通人群进行教育可能会有所帮助，但医生支持筛查是关键。阿拉巴马州家庭粪便检测的使用率较低，部分原因是医生尚未充分认识到其效用。随着经济障碍的减少，重要的是在有多种有效方式时提供这些方式，包括支付预防保健费用的保险改革可能会提高筛查率。
