Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, 1481 W. 10th Street 11H, Indianapolis, IN, 46202, USA.
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
BMC Fam Pract. 2020 Feb 26;21(1):43. doi: 10.1186/s12875-020-01113-0.
Despite proven effectiveness of colorectal cancer (CRC) screening, at least 35% of screen-eligible adults are not current with screening. Decision aids and risk prediction tools may help increase uptake, adherence, and efficiency of CRC screening by presenting lower-risk patients with options less invasive than colonoscopy. The purpose of this qualitative study was to determine patient and provider perceptions of facilitators and barriers to use of a risk prediction tool for advanced colorectal neoplasia (CRC and advanced, precancerous polyps), to maximize its chances of successful clinical implementation.
We conducted qualitative, semi-structured interviews with patients aged 50-75 years who were not current with CRC screening, and primary care providers (PCPs) at an academic and a U.S. Department of Veterans Affairs Medical Center in the Midwest from October 2016 through March 2017. Participants were asked about their current experiences discussing CRC screening, then were shown the risk tool and asked about its acceptability, barriers, facilitators, and whether they would use it to guide their choice of a screening test. The constant comparative method guided analysis.
Thirty patients and PCPs participated. Among facilitators were the tool's potential to increase screening uptake, reduce patient risk, improve resource allocation, and facilitate discussion about CRC screening. PCP-identified barriers included concerns about the tool's accuracy, consistency with guidelines, and time constraints.
Patients and PCPs found the risk prediction tool useful, with potential to increase uptake, safety, and efficiency of CRC screening, indicating potential acceptability and feasibility of implementation into clinical practice.
尽管结直肠癌（CRC）筛查已被证实有效，但至少有 35%的符合筛查条件的成年人未进行当前的筛查。决策辅助工具和风险预测工具可通过向低危患者提供比结肠镜检查侵入性更小的选择，从而有助于提高 CRC 筛查的接受率、依从性和效率。本定性研究的目的是确定患者和提供者对使用高级结直肠肿瘤（CRC 和高级、癌前息肉）风险预测工具的看法，以最大程度地提高其成功临床实施的机会。
我们于 2016 年 10 月至 2017 年 3 月，在中西部地区的一所学术和美国退伍军人事务医疗中心，对未进行 CRC 筛查的 50-75 岁患者和初级保健提供者（PCP）进行了定性、半结构化访谈。参与者被问及他们目前讨论 CRC 筛查的经验，然后向他们展示风险工具，并询问其可接受性、障碍、促进因素，以及他们是否会使用它来指导他们选择筛查测试。持续比较法指导了分析。
共有 30 名患者和 PCP 参与。其中的促进因素包括该工具提高筛查参与度、降低患者风险、改善资源分配和促进 CRC 筛查讨论的潜力。PCP 确定的障碍包括对工具准确性、与指南的一致性以及时间限制的担忧。
患者和 PCP 认为风险预测工具很有用，具有提高 CRC 筛查的接受率、安全性和效率的潜力，表明其在临床实践中的潜在可接受性和可行性。
