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Barriers to Screening Colonoscopy for Low-income Latino and White Patients in an Urban Community Health Center

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Summary

Background

Colonoscopy is a screening modality for the early detection of colonic polyps and cancers but is underutilized, particularly among minorities.

Objective

To identify potential barriers to screening colonoscopy among low income Latino and white non-Latino patients in an urban community health center.

Design, participants, and approach

We conducted semistructured interviews with a convenience sample of patients 53 to 70 years old, eligible for colorectal cancer screening that spoke English or Spanish. Open-ended questions explored knowledge, beliefs, and experience with or reasons for not having screening colonoscopy. We performed content analysis of transcripts using established qualitative techniques.

Results

Of 40 participants recruited, 57% were women, 55% Latino, 20% had private health insurance, and 40% had a prior colonoscopy. Participants described a wide range of barriers categorized into 5 major themes: (1) System barriers including scheduling, financial, transportation, and language difficulties; (2) Fear of pain or complications of colonoscopy and fear of diagnosis (cancer); (3) Lack of desire or motivation, including “laziness” and “procrastination”; (4) Dissuasion by others influencing participants’ decision regarding colonoscopy; and (5) Lack of provider recommendation including not hearing about colonoscopy or not understanding the preparation instructions.

Conclusions

Understanding of the range of barriers to colorectal cancer screening can help develop multimodal interventions to increase colonoscopy rates for all patients including low-income Latinos. Interventions including systems improvements and navigator programs could address barriers by assisting patients with scheduling, insurance issues, and transportation and providing interpretation, education, emotional support, and motivational interviewing.

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References

  1. Greiner K, Born W, Nollen N, Ahluwalia J. Knowledge and perceptions of colorectal cancer screening among urban African Americans. J Gen Intern Med. 2005;20(11):977–83. Nov.

    Article  PubMed  Google Scholar 

  2. Walsh J, Kaplan C, Nguyen B, Gildengorin G, McPhee S, Perez-Stable E. Barriers to colorectal cancer screening in Latino and Vietnamese Americans. Compared with non-Latino white Americans. J Gen Intern Med. 2004;19(2):156–66. Feb.

    Article  PubMed  Google Scholar 

  3. Goodman M, Ogdie A, Kanamori M, Canar J, O’Malley A. Barriers and facilitators of colorectal cancer screening among Mid-Atlantic Latinos: focus group findings. Ethn Dis. 2006;16(1):255–61.

    PubMed  Google Scholar 

  4. Shokar N, Vernon S, Weller S. Cancer and colorectal cancer: knowledge, beliefs, and screening preferences of a diverse patient population. Fam Med. 2005;37(5):341–7. May.

    PubMed  Google Scholar 

  5. American Cancer Society. Cancer Facts and Figures 2006. Atlanta, GA: American Cancer Society; 2006.

    Google Scholar 

  6. U.S. Preventive Services Task Forces. The Guide to Clinical Preventive Services. Rockville, MD: Agency for Healthcare Research and Quality; 2006.

    Google Scholar 

  7. Lieberman DA, Weiss DG. One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon. N Engl J Med. 2001;345(8):555–60.

    Article  PubMed  CAS  Google Scholar 

  8. Vijan S, Hwang E, Hofer T, Hayward R. Which colon cancer screening test? A comparison of costs, effectiveness, and compliance. Am J Med. 2001;111(8):593–601. Dec 1.

    Article  PubMed  CAS  Google Scholar 

  9. Green P, Kelly B. Colorectal cancer knowledge, perceptions, and behaviors in African Americans. Cancer Nurs. 2004;27(3):206–15. May–Jun.

    Article  PubMed  Google Scholar 

  10. Ries L, Eisner M, Kosary C, et al. SEER Cancer Statistics Review, 1975–2000. Bethesda, MD: National Cancer Institute; 2003.

    Google Scholar 

  11. Jemal A, Clegg L, Ward E, et al. Annual report to the nation on the status of cancer, 1975–2001, with a special feature regarding survival. Cancer. 2004;101(1):3–27. Jul 1.

    Article  PubMed  Google Scholar 

  12. Hoffman-Goetz L, Breen N, Meissner H. The impact of social class on the use of cancer screening within three racial/ethnic groups in the United States. Ethn Dis. 1998;8(1):43–51.

    PubMed  CAS  Google Scholar 

  13. Gilliland F, Hunt W, Key C. Trends in the survival of American Indian, Hispanic, and Non-Hispanic white cancer patients in New Mexico and Arizona, 1969–1994. Cancer. 1998;82(9):1769–83. May 1.

    Article  PubMed  CAS  Google Scholar 

  14. Denberg T, Melhado T, Coombes J, et al. Predictors of nonadherence to screening colonoscopy. J Gen Intern Med. 2005;20(11):989–95. Nov.

    Article  PubMed  Google Scholar 

  15. O’Malley AS, Beaton E, Yabroff KR, Abramson R, Mandelblatt J. Patient and provider barriers to colorectal cancer screening in the primary care safety-net. Am J Prev Med. 2004;39(1):56–63. July.

    Article  CAS  Google Scholar 

  16. Klabunde C, Schenck A, Davis W. Barriers to colorectal cancer screening among Medicare consumers. Am J Prev Med. 2006;30(4):313–9. Apr.

    Article  PubMed  Google Scholar 

  17. Klabunde C, Vernon S, Nadel M, Breen N, Seeff L, Brown M. Barriers to colorectal cancer screening: a comparison of reports from primary care physicians and average-risk adults. Med Care. 2005;43(9):939–44. Sep.

    Article  PubMed  Google Scholar 

  18. Brouse C, Basch C, Wolf R, Shmukler C. Barriers to colorectal cancer screening: an educational diagnosis. J Cancer Educ. 2004;19(3):170–3.

    Article  PubMed  Google Scholar 

  19. Holmes-Rovner M, Williams GA, Hoppough S, Quillan L, Butler R, Given CW. Colorectal cancer screening barriers in persons with low income. Cancer Pract. 2002;10(5):240–7.

    Article  PubMed  Google Scholar 

  20. Wolf R, Zybert P, Brouse C, et al. Knowledge, beliefs, and barriers relevant to colorectal cancer screening in an urban population: a pilot study. Fam Commun Health. 2001;24(3):34–47. Oct.

    CAS  Google Scholar 

  21. Lawsin C, Duhamel K, Weiss A, Rakowski W, Jandorf L. Colorectal cancer screening among low-income African Americans in East Harlem: a theoretical approach to understanding barriers and promoters to screening. J Urban Health. 2007;84(1):32–44.

    Article  PubMed  Google Scholar 

  22. Lipkus I, Rimer B, Lyna P, Pradhan A, Conaway M, Woods-Powell C. Colorectal screening patterns and perceptions of risk among African-American users of a community health center. J Commun Health. 1996;21(6):409–27. Dec.

    Article  CAS  Google Scholar 

  23. Katz M, James A, Pignone M, et al. Colorectal cancer screening among African American church members: a qualitative and quantitative study of patient-provider communication. BMC Public Health. 2004;4:62. Dec 15.

    Article  PubMed  Google Scholar 

  24. James A, Campbell M, Hudson M. Perceived barriers and benefits to colon cancer screening among African Americans in North Carolina: how does perception relate to screening behavior? Cancer Epidemiol Biomarker Prev. 2002;11(6):529–34. Jun.

    Google Scholar 

  25. Agrawal S, Bhupinderjit A, Bhutani M, et al. Colorectal cancer in African Americans. Am J Gastroenterol. 2005;100(3):515–23. Mar.

    Article  PubMed  Google Scholar 

  26. Powe B, Finnie R, Ko J. Enhancing knowledge of colorectal cancer among African Americans: why are we waiting until age 50? Gastroenterol Nurs. 2006;29(1):42–9. Jan–Feb.

    Article  PubMed  Google Scholar 

  27. Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess R, eds. Analysing Qualitative Data. London: Routledge; 1993:173–94.

    Google Scholar 

  28. Yepes-Rios M, Reimann J, Talavera A, Ruiz de Esparza A, Talavera G. Colorectal cancer screening among Mexican Americans at a community clinic. Am J Prev Med. 2006;30(3):204–10. Mar.

    Article  PubMed  Google Scholar 

  29. Polite B, Dignam J, Olopade O. Colorectal cancer model of health disparities: understanding mortality differences in minority populations. J Clin Oncol. 2006;24(14):2179–87. May 10.

    Article  PubMed  Google Scholar 

  30. Coronado G, Thompson B. Rural Mexican American men’s attitudes and beliefs about cancer screening. J Cancer Educ. 2000;15(1):41–5.

    PubMed  CAS  Google Scholar 

  31. Thompson B, Coronado G, Neuhouser M, Chen L. Colorectal carcinoma screening among Hispanics and non-Hispanic whites in a rural setting. Cancer. 2005;103(12):2491–8. Jun 15.

    Article  PubMed  Google Scholar 

  32. Nash D, Azeez S, Vlahov D, Schori M. Evaluation of an intervention to increase screening colonoscopy in an urban public hospital setting. J Urban Health. 2006;83(2):231–43. Mar.

    Article  PubMed  Google Scholar 

  33. Battaglia TA, Roloff K, Posner MA, Freund KM. Improving follow-up to abnormal breast cancer screening in an urban population. A patient navigation intervention. Cancer. 2007;109(2 Suppl):359–67. Jan 15.

    Article  PubMed  Google Scholar 

  34. Steinberg ML, Fremont A, Khan DC, et al. Lay patient navigator program implementation for equal access to cancer care and clinical trials: essential steps and initial challenges. Cancer. 2006;107(11):2669–77. Dec 1.

    Article  PubMed  Google Scholar 

  35. Freeman HP, Muth BJ, Kerner JF. Expanding access to cancer screening and clinical follow-up among the medically underserved. Cancer Pract. 1995;3(1):19–30. Jan–Feb.

    PubMed  CAS  Google Scholar 

  36. Rahm AK, Sukhanova A, Ellis J, Mouchawar J. Increasing utilization of cancer genetic counseling services using a patient navigator model. J Genet Couns. 2007;16(2)171–7. Apr.

    Article  PubMed  Google Scholar 

  37. Jandorf L, Gutierrez Y, Lopez J, Christie J, Itzkowitz S. Use of a patient navigator to increase colorectal cancer screening in an urban neighborhood health clinic. J Urban Health. 2005;82(2)216–24. Jun.

    PubMed  Google Scholar 

  38. Beeker C, Kraft J, Southwell B, Jorgensen C. Colorectal cancer screening in older men and women: qualitative research findings and implications for intervention. J Commun Health. 2000;25(3)263–78. Jun.

    Article  CAS  Google Scholar 

  39. Price JH. Perceptions of colorectal cancer in a socioeconomically disadvantaged population. J Commun Health. 1993;18(6)347–62. Dec.

    Article  CAS  Google Scholar 

  40. Wong-Kim E, Sun A, DeMattos M. Assessing cancer beliefs in a Chinese immigrant community. Cancer Control. 2003;10(5 Suppl):22–8. Sep–Oct.

    PubMed  Google Scholar 

  41. Morgan C, Park E, Cortes D. Beliefs, knowledge, and behavior about cancer among urban Hispanic women. J Natl Cancer Inst. 1995;18:57–63. (Monographs).

    Google Scholar 

  42. Powe B, Hamilton J, Brooks P. Perceptions of cancer fatalism and cancer knowledge: a comparison of older and younger African American women. J Psychosoc Oncol. 2006;24(4)1–13.

    Article  PubMed  Google Scholar 

  43. Spurlock W, Cullins L. Cancer fatalism and breast cancer screening in African American women. ABNF J. 2006;17(1)38–43. Jan–Feb.

    PubMed  Google Scholar 

  44. Greiner K, James A, Born W, et al. Predictors of fecal occult blood test (FOBT) completion among low-income adults. Prev Med. 2005;41(2)676–84. Aug.

    Article  PubMed  Google Scholar 

  45. Powe B, Finnie R. Cancer fatalism: the state of the science. Cancer Nurs. 2003;26(6):454–65. (quiz 466–457), Dec.

    Article  PubMed  Google Scholar 

  46. Powe B. Perceptions of cancer fatalism among African Americans: the influence of education, income, and cancer knowledge. J Natl Black Nurses Assoc. 1994;7(2):41–8. Fall–Winter.

    PubMed  CAS  Google Scholar 

  47. Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005;55(513):305–12. Apr.

    PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Elyse Park for help with the qualitative methodology and Sarah Abernathy-Oo and Joan Quinlan for assisting in the early conceptualization of the study and ongoing support. This paper was presented at the 30th Annual Meeting of the Society of General Medicine in April 2007. This study was funded by Jane’s Trust and the Clinical Innovation Award: Translating Clinical Insights into Improved Patient Care at the Massachusetts General Hospital.

Conflict of Interest

None disclosed.

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Correspondence to Alexander R. Green MD, MPH.

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Green, A.R., Peters-Lewis, A., Percac-Lima, S. et al. Barriers to Screening Colonoscopy for Low-income Latino and White Patients in an Urban Community Health Center. J GEN INTERN MED 23, 834–840 (2008). https://doi.org/10.1007/s11606-008-0572-6

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  • DOI: https://doi.org/10.1007/s11606-008-0572-6

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