Schwartz Jessie, Wangen Mary, Odebunmi Olufeyisayo O, Waters Austin, Ferrari Renée, Marciniak Macary, Brenner Alison T, Wheeler Stephanie B, Shah Parth D
Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, USA.
Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Cancer Causes Control. 2025 Aug 15. doi: 10.1007/s10552-025-02045-9.
Fecal immunochemical tests (FIT) are recommended for routine colorectal cancer (CRC) screening because they are cost-effective, non-invasive, and convenient. Pharmacy-based CRC screening using FIT kits could be effective to improve screening rates, particularly in medically underserved communities. However, data on follow-up procedures and barriers after positive FIT results in this context remain sparse.
We conducted a national survey of 1,045 US adults aged 45-75 to assess preferences for follow-up care in a pharmacy-based CRC screening program we call PharmFIT™ and identify perceived barriers to follow-up colonoscopy after positive FIT results. We evaluated patient preferences and barriers using descriptive statistics. We used multinomial logistic regressions to identify correlates of patient preferences for follow-up and multiple logistic regressions to identify correlates of perceived psychosocial and structural barriers to follow-up colonoscopy.
Participants showed a strong preference for digital communication for negative FIT results and reminders, but favored direct, interpersonal communication from healthcare providers for positive results and follow-up. Psychosocial barriers, such as fear of colonoscopy or cancer diagnosis, were more prevalent than structural barriers like cost and transportation. Older adults, those with a regular healthcare provider, and higher-income individuals were less likely to report barriers, while non-white and Medicaid patients showed lower preferences for automated notifications.
PharmFIT should use tailored, multimodal communication strategies to address patient preferences and include strategies, like patient navigation, to address potential barriers to follow-up colonoscopy. This study reinforces the potential of pharmacy-based CRC screening programs to increase screening access and opportunities, particularly in medically underserved communities.
粪便免疫化学检测（FIT）因其具有成本效益、非侵入性且方便等特点，被推荐用于常规结直肠癌（CRC）筛查。使用FIT试剂盒在药房进行CRC筛查可能有助于提高筛查率，尤其是在医疗服务不足的社区。然而，在这种情况下，关于FIT检测结果呈阳性后的后续程序和障碍的数据仍然很少。
我们对1045名年龄在45 - 75岁的美国成年人进行了一项全国性调查，以评估他们对我们称为PharmFIT™的基于药房的CRC筛查项目中后续护理的偏好，并确定FIT检测结果呈阳性后进行后续结肠镜检查的感知障碍。我们使用描述性统计评估患者的偏好和障碍。我们使用多项逻辑回归来确定患者对后续护理偏好的相关因素，并使用多元逻辑回归来确定后续结肠镜检查的感知心理社会和结构障碍的相关因素。
参与者对FIT检测结果为阴性及提醒的数字通信方式表现出强烈偏好，但对于检测结果为阳性及后续情况，更倾向于医疗保健提供者的直接人际沟通。心理社会障碍，如对结肠镜检查或癌症诊断的恐惧，比成本和交通等结构障碍更为普遍。老年人、有固定医疗保健提供者的人以及高收入个体报告障碍的可能性较小，而非白人和医疗补助患者对自动通知的偏好较低。
PharmFIT应采用量身定制的多模式沟通策略来满足患者的偏好，并包括患者导航等策略来解决后续结肠镜检查的潜在障碍。这项研究强化了基于药房的CRC筛查项目在增加筛查机会方面的潜力，尤其是在医疗服务不足的社区。
