Green Beverly B, BlueSpruce June, Tuzzio Leah, Vernon Sally W, Aubree Shay L, Catz Sheryl L
Kaiser Permanente Washington Health Research Institute, Metropolitan Park East, 1730 Minor Avenue Suite 1600, Seattle, WA, 98101, USA.
University of Texas Health Science Center Houston, School of Public Health, 1200 Pressler Street, Houston, TX, 77030, USA.
BMC Public Health. 2017 May 30;17(1):531. doi: 10.1186/s12889-017-4458-6.
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. The purpose of this qualitative study was to identify barriers and facilitators reported by patients with suboptimal screening adherence to refine interventions for starting ongoing adherence to CRC screening. We also explored whether participants, particularly never screeners, would be willing to do a CRC screening blood test.
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 purposively selected to include men and women with diverse race/ethnicities who had either been inconsistent screeners or had never screened during the first three years of SOS despite receiving at least two rounds of mailed fecal tests. Two interviewers conducted 30-min telephone interviews using a semi-structured interview guide. An iterative thematic analysis approach was used.
Themes related to screening barriers 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 or positive test results. Themes related to screening facilitators 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, family and friends. 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.
Future CRC screening programs should be designed to minimize these barriers and maximize facilitators to improve long-term screening adherence.
Primary Funding Agency: The National Cancer Institute of the National Institutes of Health (R01CA121125). Registered at clinicaltrials.gov NCT00697047 .
长期坚持结直肠癌（CRC）筛查对于粪便检测尤为重要。一些美国研究报告称，每年仅有25%的人重复进行粪便检测。这项定性研究的目的是确定筛查依从性欠佳的患者所报告的障碍和促进因素，以完善干预措施，促使患者持续坚持CRC筛查。我们还探讨了参与者，尤其是从未接受过筛查的人，是否愿意进行CRC筛查血液检测。
对41名先前参与“支持增加CRC筛查系统（SOS）”试验的患者在4至5年后进行了访谈。目的是挑选出不同种族/族裔的男性和女性参与者，他们要么筛查不规律，要么在SOS试验的前三年中尽管收到了至少两轮邮寄的粪便检测，但从未进行过筛查。两名访谈员使用半结构化访谈指南进行了30分钟的电话访谈。采用了迭代主题分析方法。
与筛查障碍相关的主题在从未接受过筛查的人群中更为普遍，包括：（1）回避（注意力不集中、拖延）；（2）对处理粪便的担忧；（3）健康方面的担忧；（4）对癌症诊断或检测结果呈阳性的恐惧。与筛查促进因素相关的主题更多地被至少进行过一次筛查的参与者提及，包括：（1）使用更简单的单样本粪便检测；（2）邮寄的便利性以及在家中进行检测；（3）预防的重要性，尤其是随着年龄增长；（4）来自医疗服务提供者、家人和朋友建议的影响。参与者对筛查提醒的数量（平均3次）和类型（电话、邮件、短信）有不同的偏好。一些参与者不喜欢通过电子邮件链接访问患者共享的电子健康记录，因为难以记住密码。只要不是他们诊所的护士或医疗助理了解他们的记录并能与他们的医生沟通，打电话给他们是可以接受的。参与者，尤其是从未接受过筛查的人，总体上对CRC筛查血液检测这一潜在选择非常感兴趣。
未来的CRC筛查项目应设计为尽量减少这些障碍，并最大限度地发挥促进因素的作用，以提高长期筛查依从性。
主要资助机构：美国国立卫生研究院国家癌症研究所（R01CA121125）。在clinicaltrials.gov上注册，注册号为NCT00697047 。
