Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2021; 9(21): 5850-5859
Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.5850
Facilitators and barriers to colorectal cancer screening in an outpatient setting
Gbeminiyi Samuel, MaryKate Kratzer, Oghale Asagbra, Josef Kinderwater, Shiva Poola, Jennifer Udom, Karissa Lambert, Muna Mian, Eslam Ali
Gbeminiyi Samuel, Karissa Lambert, Eslam Ali, Division of Gastroenterology, East Carolina University/Vidant Medical Center, Greenville, NC 27834, United States
MaryKate Kratzer, Josef Kinderwater, Jennifer Udom, Muna Mian, Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, NC 27834, United States
Oghale Asagbra, Department of Health Services and Information Management, East Carolina University, Greenville, NC 27834, United States
Shiva Poola, Department of Internal Medicine/Pediatrics, Brody School of Medicine/Vidant Medical Center, Greenville, NC 27834, United States
Author contributions: Samuel G contributed conceptualization, formal analysis, methodology, project administration and writing; Kratzer M contributed project administration, data curation and writing; Asagbra O contributed methodology, formal analysis and software; Kinderwater J, Poola S and Udom J contributed data curation; Lambert K contributed conceptualization and data curation; Mian M contributed supervision; Ali E contributed conceptualization and supervision.
Institutional review board statement: The study was reviewed and approved by the East Carolina University Institutional Review Board (approval No. UMCIRB 19-000848).
Informed consent statement: Due to the retrospective nature of this study, waiver for informed consent was approved.
Conflict-of-interest statement: There is no conflict of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: MaryKate Kratzer, MD, Doctor, Department of Internal Medicine, East Carolina University/Vidant Medical Center, 2100 Stantonsburg Road, Greenville, NC 27834, United States.
Received: February 23, 2021
Peer-review started: February 23, 2021
First decision: April 18, 2021
Revised: May 7, 2021
Accepted: June 1, 2021
Article in press: June 1, 2021
Published online: July 26, 2021
Processing time: 147 Days and 16.6 Hours

Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related deaths in the United States. Still, 1 in 3 adults aged 50 years to 75 years have not been screened for CRC. Early detection and management of precancerous or malignant lesions has been shown to improve overall mortality.


To determine the most significant facilitators and barriers to CRC screening in an outpatient clinic in rural North Carolina. The results of this study can then be used for quality improvement to increase the rate of patients ages 50 to 75 who are up to date on CRC screening.


This retrospective study examined 2428 patients aged 50 years to 75 years in an outpatient clinic. Patients were up to date on CRC screening if they had fecal occult blood test or fecal immunochemical test in the past one year, Cologuard in the past three years, flexible sigmoidoscopy/virtual colonoscopy in the past five years, or colonoscopy in the past ten years. Data on patient socioeconomic status, comorbid conditions, and other determinants of health compliance were included as covariates.


Age [odds ratio (OR) = 1.058; P = 0.017], no-show rate percent (OR= 0.962; P < 0.05), patient history of obstructive sleep apnea (OR = 1.875; P = 0.025), compliance with flu vaccinations (OR = 1.673; P < 0.05), compliance with screening mammograms (OR = 2.130; P < 0.05), and compliance with screening pap smears (OR = 2.708; P < 0.05) were important factors in determining whether a patient will receive CRC screening. Race, gender, insurance or employment status, use of blood thinners, family history of CRC, or other comorbid conditions including diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and end-stage renal disease were not found to have a statistically significant effect on patient adherence to CRC screening.


Patient age, history of sleep apnea, and compliance with other health maintenance tests were significant facilitators to CRC screening, while no-show rate percent was a significant barrier in our patient population. This study will be of benefit to physicians in addressing and improving the CRC screening rates in our community.

Keywords: Colorectal cancer screening, Screening colonoscopy, Health maintenance, Colonoscopy, Colorectal cancer, Patient adherence

Core Tip: Only about 2 of 3 adults from ages 50 to 75 are up-to-date with colorectal cancer screening. Factors which influenced screening adherence included patient age, history of obstructive sleep apnea, clinic no-show rate and adherence to other health screening exams. Gender, ethnicity, tobacco use, and other common comorbid conditions did not correlate with the rate of colorectal cancer screening adherence.