Lower Adherence: A Description of Colorectal Cancer Screening Barrier Talk

Abstract

Understanding how patients and physicians discuss screening barriers may illuminate reasons for non-adherence to recommended colorectal cancer (CRC) screening. The goal of the present study was to describe patients’ reporting of and physicians’ responses to CRC screening barriers and examine their associations with patients’ CRC screening behaviors. Audio-recorded primary care consultations (N = 413) with patients due for CRC screening were used to identify CRC screening-related barrier talk and physician responses. Presence of barrier talk was associated with less patient adherence to CRC screening (OR = 0.568, p = 0.007). Neither CRC screening talk (n = 413) nor physician responses (n = 151) were associated with patients’ CRC screening. Among the consultations in which barrier talk occurred (n = 151), patients most often reported test-related (28.9%) and psychological (26.1%) barriers. Barriers were most often reported in the context of CRC screening discussions (45.7%) or in direct response to a physician’s question about CRC screening (48.6%). Results indicated that patients rarely raised CRC screening barriers unprompted and that presence of barrier talk was predictive of CRC screening behavior. These findings may help improve future clinical practice by highlighting that patients may benefit from physicians initiating and facilitating discussions of CRC screening barriers and directly helping patients overcome known barriers to CRC screening.

Authors’ contributions

All authors have contributed substantially to the conceptualization, data analysis, and writing of this manuscript. JEL contributed to the design, collection, analysis, and interpretation of the data as well as the writing of this manuscript. TA and CB contributed to the conceptualization and analysis of data as well as the writing of this manuscript. All authors have approved the final article. MJS led conceptualization, writing, and analysis of data.

Conflicts of interest

The authors have not conflicts of interest to report.

Ethics statement

All study procedures were approved at each Institution’s IRB. All procedures were conducted in accordance with required ethical guidelines for protection of human subjects in research. Informed consent was obtained from each participant in the present study.

Notes

¹ Note original 19 categories are listed in Table 2.

Additional information

Funding

This work was supported by grants from the National Cancer Institute (R01-CA112379, R01-CA197205, K07-CA140778; and K07-CA207580).