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
Research background

Colorectal cancer (CRC) remains the third most common cancer in the United States. With appropriate screening, early lesions can be identified before they have developed into malignancy. Unfortunately, only about 2 of 3 Americans between the ages of 50 and 75 are up to date on CRC screening. We developed this study to determine the barriers and facilitators to CRC screening.

Research motivation

By completing this study, we aimed to determine which factors lead to increased or decreased adherence to CRC screening in our patients. By learning these facilitators or barriers to screening, we can implement practices to increase screening rates and hopefully decrease rates of CRC.

Research objectives

The main objective was determining facilitators and barriers to CRC screening. As we established these factors, we are opening our minds to changes that can be generalized to all cancer screening tests, to make a difference in our communities.

Research methods

We performed a retrospective analysis, reviewing the electronic medical records for every patient between the ages of 50 and 75 who visited our internal medicine clinic in a 1-year period. We recorded data pertaining to demographics, comorbid conditions, and adherence with other medical screening tests to look for correlations with screening adherence or nonadherence. Multivariate analysis was performed using STATA v. 15.

Research results

Advanced age was associated with increased adherence to CRC screening. A diagnosis of obstructive sleep apnea was also associated with increased adherence to CRC screening, but no other comorbid condition shared this finding. Higher no-show rates to the clinic was consistent with lower CRC screening adherence. Finally, adherence with other health maintenance screenings was associated with increased adherence with CRC screening.

Research conclusions

We concluded that patients with obstructive sleep apnea likely had multiple providers who encouraged screening for CRC, and were compliant with other outpatient studies (sleep studies for example) which may be why these patients had higher rates of CRC screening. With advanced age likely comes more frequent visits to the physician and hence more opportunities for counseling on cancer screening tests. Conversely, if a patient has a high no-show rate to routine clinic appointments, then they likely will also have poor adherence to screening tests and have less counseling on the importance of these tests. Finally, if a patient is adherent with other health maintenance exams like mammograms or pap smears, then they likely will also be adherent to screening for CRC.

Research perspectives

We now know some of the factors that influence adherence to CRC screening. Future research should focus on those patients who are not up-to-date on screening, and determine what personal, religious, or physician-related factors have kept them from completing CRC screening.