Zhu Xuan, Weiser Emily, Jacobson Debra J, Griffin Joan M, Limburg Paul J, Finney Rutten Lila J
Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Rochester, MN, USA.
Exact Sciences Corporation, Madison, WI, USA.
Prev Med Rep. 2021 Dec 27;25:101681. doi: 10.1016/j.pmedr.2021.101681. eCollection 2022 Feb.
Average-risk colorectal cancer (CRC) screening remains underutilized in the US. Provider recommendation is strongly associated with CRC screening completion. To inform interventions aimed at improving screening uptake, we examined providers' perspectives on patient and health system barriers to CRC screening adherence, along with associated system-level interventions to improve uptake.
We conducted an online survey between November and December 2019 with a sample of primary care clinicians (PCCs) and gastroenterologists (GIs) from a validated panel of US clinicians (814 PCCs, 159 GIs; completion rates: 25.3% for PCCs, 29.6% for GIs). Clinicians rated the extent to which each patient and health system factor interferes with patient adherence with CRC screening recommendations and the availability of practice interventions to improve screening rates.
Provider-reported top barriers to CRC screening included patient discomfort with offered screening method (66%), cost (62-64%), and perceived low importance of screening (62%). Additional barriers included providers prioritizing urgent health concerns over screening (45-48%), not offering a choice of screening options (42-48%), lacking time to educate patients about screening (38-45%), and lacking education about available screening options (37-40%). Most frequently reported system-level interventions to improve CRC screening rates included patient education materials (57-62%) and point of care prompts (56-61%). Other interventions were less frequently reported, although variations existed by clinical specialty regarding barriers and interventions.
Addressing barriers to CRC screening requires system-level interventions, including provider training on shared decision-making, automated scheduling and reminder processes, and policies to increase clinician time for preventive screening consultations.
在美国，平均风险的结直肠癌（CRC）筛查的利用率仍然较低。医生的建议与CRC筛查的完成情况密切相关。为了为旨在提高筛查接受率的干预措施提供信息，我们研究了医生对患者和卫生系统阻碍CRC筛查依从性的看法，以及相关的系统层面干预措施以提高接受率。
我们在2019年11月至12月期间对来自美国经过验证的临床医生小组的初级保健临床医生（PCC）和胃肠病学家（GI）进行了在线调查（814名PCC，159名GI；完成率：PCC为25.3%，GI为29.6%）。临床医生对每个患者和卫生系统因素干扰患者遵循CRC筛查建议的程度以及提高筛查率的实践干预措施的可用性进行了评分。
医生报告的CRC筛查的主要障碍包括患者对所提供的筛查方法感到不适（66%）、成本（62 - 64%）以及认为筛查重要性低（62%）。其他障碍包括医生将紧急健康问题置于筛查之上（45 - 48%）、不提供筛查选项的选择（42 - 48%）、缺乏时间对患者进行筛查教育（38 - 45%）以及缺乏对可用筛查选项的了解（37 - 40%）。最常报告的提高CRC筛查率的系统层面干预措施包括患者教育材料（57 - 62%）和即时护理提示（56 - 61%）。其他干预措施的报告频率较低，尽管不同临床专业在障碍和干预措施方面存在差异。
解决CRC筛查的障碍需要系统层面的干预措施，包括对医生进行共同决策培训、自动化预约和提醒流程，以及增加临床医生进行预防性筛查咨询时间的政策。
