Department of Family Medicine and Community Health, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA.
Department of Medicine, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA.
Am J Health Promot. 2022 May;36(4):697-705. doi: 10.1177/08901171211064492. Epub 2021 Dec 31.
To understand patient experiences and persistent barriers to colorectal cancer (CRC) screening amid centralized outreach at urban family medicine practices.
Following a pragmatic trial assessing mailed fecal immunochemical test (FIT) outreach, we invited a subset of participants to complete a semi-structured qualitative interview and structured questionnaire.
Single urban academic healthcare system.
Sixty patients who were eligible and overdue for CRC screening at the time of trial enrollment.
Using Andersen's Behavioral Model, we developed an interview guide to systematically assess factors shaping screening decisions and FIT uptake. Close-ended responses were analyzed using descriptive statistics. Qualitative data were analyzed using the constant comparative method.
Most participants (82%) self-reported that they had ever completed any modality of CRC screening, and nearly half (43%) completed the mailed FIT during the trial. Most patients (60%) preferred FIT to colonoscopy due to its private, convenient, and non-invasive nature; however, persistent barriers related to screening beliefs including fear of test results and cancer treatment still prevented some patients from completing any form of CRC screening.
Mailed FIT can overcome many structural barriers to CRC screening, yet clear communication and follow-up amid centralized outreach are essential. For some patients, tailored outreach or navigation to address screening-related fears or other screening beliefs may be needed to ensure timely completion of CRC screening.
了解集中在城市家庭医疗实践中的大肠癌（CRC）筛查的患者体验和持续存在的障碍。
在评估邮寄粪便免疫化学测试（FIT）外展的务实试验之后，我们邀请了一部分参与者完成半结构化定性访谈和结构化问卷。
在试验招募时符合条件且 CRC 筛查逾期的 60 名患者。
大多数参与者（82%）自述曾完成过任何形式的 CRC 筛查，近一半（43%）在试验期间完成了邮寄 FIT。大多数患者（60%）由于 FIT 具有隐私、方便和非侵入性的特点，更喜欢 FIT 而不是结肠镜检查；然而，与筛查信念相关的持续障碍，包括对检测结果和癌症治疗的恐惧，仍然阻止了一些患者完成任何形式的 CRC 筛查。
邮寄 FIT 可以克服 CRC 筛查的许多结构性障碍，但在集中外展期间，明确的沟通和后续行动至关重要。对于一些患者，可能需要有针对性的外展或导航服务，以解决与筛查相关的恐惧或其他筛查信念问题，以确保及时完成 CRC 筛查。
