Barriers to Colorectal Cancer Screening: A Comparison of Reports From Primary Care Physicians and Average-Risk Adults

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Background:Barriers to colorectal cancer (CRC) screening are not well understood.Objectives: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.Research Design: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).Subjects:We recruited nationally representative samples of PCPs (n= 1235) from the SCCSP and average-risk adults (n = 6497) from the NHIS.Measures:We measured barriers to CRC screening identified by PCPs and average-risk adults who were not current with screening.Results: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.Conclusions: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 required.

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