Barriers to Colorectal Cancer Screening: A Comparison of Reports From Primary Care Physicians & Average-Risk Adults
Barriers to colorectal cancer (CRC) screening are not well understood.
We sought to compare barriers to CRC screening reported by primary care physicians (PCPs)
and by average-risk adults, and to examine characteristics of average-risk adults who
identified lack of provider recommendation as a major barrier to CRC screening.
This was a comparative study using data from the 1999-2000 Survey of Colorectal Cancer
Screening Practices and the 2000 National Health Interview Survey (NHIS).
We recruited nationally representative samples of PCPs (n = 1235) from the SCCSP and
average-risk adults (n = 6497) from the NHIS.
We measured barriers to CRC screening identified by PCPs and average-risk adults who were
not current with screening.
Both PCPs and average-risk adults identified lack of patient awareness and physician
recommendation as key barriers to obtaining CRC screening. PCPs also frequently cited
patient embarrassment/anxiety about testing and test cost/lack of insurance coverage, but
few adults identified these as major barriers. Of adults not current with testing, those
who had visited a doctor in the past year or had health insurance were more likely to
report lack of physician recommendation as the main reason they were not up-to-date
compared with their counterparts with no doctor visit or health insurance. Only 10% of
adults not current with testing and who had a doctor visit in the past year reported
receiving a screening recommendation.
A need exists for continued efforts to educate the public about CRC and the important role
of screening in preventing this disease. Practice-based strategies to systematically
prompt health care providers to discuss CRC screening with eligible patients also are
Klabunde CN, Vernon SW, Nadel MR, Breen N, Seeff LC, Brown ML.
Barriers to colorectal cancer screening: a comparison of reports from primary care physicians and average-risk adults.
Med Care 2005 Sep;43(9):939-44.
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