Tan Ker-Kan, Lopez Violeta, Wong Mee-Lian, Koh Gerald Choon-Huat
Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore.
Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
J Gastrointest Oncol. 2018 Jun;9(3):579-588. doi: 10.21037/jgo.2018.03.02.
First degree relatives (FDRs) of colorectal cancer (CRC) patients are at higher risks of developing the disease, but screening rates amongst this group remains dismal. We undertook a systematic review of qualitative studies to identify the barriers surrounding CRC screening among FDRs from both the FDRs' and the healthcare professionals' perspectives. A comprehensive search of major bibliographic databases from January 2000 till February 2017 was performed to answer the above research questions. Pre-determined inclusion and exclusion criteria were applied. Thematic analysis was used to derive the commonalities across the studies. COREQ checklist was used to evaluate the quality of the included studies. Eight qualitative studies were included. Some of the barriers reported by FDRs included the fear of diagnosis of cancer and socio-cultural barriers. The most important barrier was the FDRs' negative perceptions towards screening test such as discomfort, embarrassment, cost of procedure and accessibility to healthcare resources. Likewise, the lack of awareness amongst FDRs that they are at increased risk of developing CRC was also found to be a barrier. On the other hand, healthcare providers are keen for patients themselves to be advocates for CRC screening of their family members as constraints posed by their daily workload impede their time to advocate screening. Lack of knowledge of the physicians on CRC screening guidelines is another notable barrier. A lack of awareness of being at higher risk of developing CRC coupled with negative attitude towards colonoscopy are the main barriers faced by the FDRs of CRC patients. Healthcare providers are more comfortable with patients being the advocates of screening among their family members.
结直肠癌（CRC）患者的一级亲属（FDRs）患该疾病的风险更高，但这一群体的筛查率仍然很低。我们对定性研究进行了系统综述，以从FDRs和医疗保健专业人员的角度确定围绕FDRs进行CRC筛查的障碍。为回答上述研究问题，我们对2000年1月至2017年2月的主要书目数据库进行了全面搜索。应用了预先确定的纳入和排除标准。采用主题分析来找出各项研究的共性。使用COREQ清单来评估纳入研究的质量。纳入了八项定性研究。FDRs报告的一些障碍包括对癌症诊断的恐惧和社会文化障碍。最重要的障碍是FDRs对筛查测试的负面看法，如不适、尴尬、检查费用和获得医疗资源的难易程度。同样，还发现FDRs对自己患CRC风险增加缺乏认识也是一个障碍。另一方面，医疗保健提供者渴望患者自己成为其家庭成员进行CRC筛查的倡导者，因为他们日常工作量带来的限制妨碍了他们有时间去倡导筛查。医生对CRC筛查指南缺乏了解是另一个显著障碍。对患CRC风险增加缺乏认识以及对结肠镜检查持消极态度是CRC患者的FDRs面临的主要障碍。医疗保健提供者更倾向于让患者成为其家庭成员筛查的倡导者。
