Early detection is critical for preventing colon cancer–related deaths, it's essential to understand why some patients are reluctant to undergo colorectal cancer screening and diagnosis. This article shows how clinicians can play an instrumental role in helping overcome the barriers to early colorectal cancer detection.

Barriers to colorectal cancer screening

Due to increased screening, national rates of colorectal cancer diagnosis and death have steadily decreased since the mid-1980s, according to a Healthcare Journal of Arkansas report.

Why don’t more patients take advantage of screening?

To find out, the authors of the Preventive Medicine Reports study recruited 483 patients from primary care sites who were asked to complete self-report surveys that assessed barriers to colorectal cancer screening.

Overall, 65.2% reported being screened for colorectal cancer at some point. Still, only 46.4% were considered current, ie, with either a faecal occult blood test (FOBT) within the last year or a sigmoidoscopy/colonoscopy within the last 5 years.

The study authors identified the top four self-reported barriers to colorectal cancer screenings:

1. Fear or worry

Anxiety or fear was the most common self-reported barrier to colorectal cancer screening, affecting 29.5% of study participants. Some reported feeling concerns about certain aspects of the screening procedure, such as worries about anaesthesia. Others were concerned about the procedure’s potential negative outcomes, such as getting a cancer diagnosis.

2. Lack of provider referral or recommendation

Out of the 198 patients who reported barriers, 22.9% said they were not due for a screening, or their clinician had not recommended colorectal cancer screening.

Physicians play a critical role in ensuring patients get screened for colorectal cancer. A market research study conducted by the National Colorectal Cancer Roundtable found that the top six sources of trusted information about colorectal cancer screening were a personal doctor (68%), most doctors (48%), most medical professionals (40%), national health organisations (31%), government health organisations (25%), and family (20%).

3. Financial difficulties

A quarter of the study participants reported that finances constituted a barrier to colorectal cancer screening. Some lacked health insurance and were not able to afford the cost of screening. Others reported a lack of access to assistance programs.

4. Logistical challenges

Other self-reported obstacles to screenings included logistical challenges, which affected 19.1% of those who reported barriers. These challenges included difficulty finding transportation or not having someone available to accompany them to their screening appointment. Participants also reported not having the time to schedule and attend an appointment.

Disparities in screening, outcomes

The role of HCPS

1. Various studies suggest that the most important factor that influences a patient’s screening behaviour is a recommendation from a PCP or someone on their team. Because of this, the onus is on HCPs to remain up to date on colorectal cancer screening guidelines and to ensure that patients are aware of their colorectal screening options.
2. HCPs should also understand the benefits of presenting multiple screening options to patients. In a survey of 180 clinicians cited by the National Colorectal Cancer Roundtable, the majority of participants (92%) viewed colonoscopies as “highly effective.”
3. However, only 25% felt the same about the faecal immunochemical test (FIT), and less than 10% viewed guaiac FOBT (gFOBT) as “highly effective.” The surveyed clinicians still favoured colonoscopies, even when 51% reported that this option was not readily available to their patients, and 82% acknowledged that their patients could not afford a colonoscopy.
4. Keep in mind that patients with an average risk of developing colorectal cancer are more likely to get screened when given a choice, according to the NCCRT. Being offered a stool test over a colonoscopy can significantly nudge patients into getting screened, especially if they can take the test in the comfort of their own homes.
5. The key to providing a screening recommendation that a patient will accept is to use shared decision-making, taking into consideration the patient’s risk factors as well as their individual preferences.
6. By avoiding medical jargon and highlighting the benefits, clinicians can help patients buy into their recommendations.

Disclaimer: This story is contributed by Samar Mahmoud and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.