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Cited by 150Colorectal Cancer Screening and DetectionGlobal Cancer Incidence and ScreeningHealth Promotion and Cardiovascular Prevention

The Relative Importance of Patient-Reported Barriers to Colorectal Cancer Screening

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Jones, Resa M., Woolf, Steven H., Cunningham, Tina D., Johnson, Robert E., Krist, Alex H., Rothemich, Stephen F., Vernon, Sally W.·2010·American Journal of Preventive Medicine
DOI 10.1016/j.amepre.2010.01.020PMC PMC2946819
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Abstract

Background Colorectal cancer (CRC) screening rates are suboptimal. The most important barriers identified by patients are poorly understood. A comprehensive assessment of barriers to all recommended modalities is needed. Methods In 2007, a questionnaire was mailed to 6100 patients, aged 50-75 years, from 12 family medicine practices in the Virginia Ambulatory Care Outcomes Research Network. People aged 65-75 years and African Americans were oversampled. Patients were asked to rate 19-21 barriers to each of four recommended tests. In 2008, responses were coded on a 5-point scale; higher scores reflected stronger barrier endorsement. Results The response rate was 55% (n=3357). Approximately 40% of respondents were aged >/=65 years, 30% were African-American, and 73% were adherent to screening. A clinician's failure to suggest screening and not knowing testing was necessary received the highest mean scores as barriers. Financial concerns and misconceptions were also cited. Barrier scores differed depending on whether respondents were never screened, overdue for screening, or adherent to guidelines. The top five barriers for each modality included test-specific barriers (e.g., handling stool, bowel preparation), which often outranked generic barriers to screening. Not knowing testing was necessary was a top barrier for all tests but colonoscopy. Conclusions Although physician advice and awareness of the need for screening are important, barriers to screening are not homogenous across tests, and test-specific barriers warrant consideration in designing strategies to improve screening rates. Barrier scores differ by screening status, highlighting the need to address prior screening experience. Evidence that patients are more familiar with colonoscopy than with other modalities suggests an opportunity to improve screening rates by educating patients about alternative tests.

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  • Anticipated dislike or discomfort can negatively influence completion of the CRC stool test at home.

    “Anticipated dislike or discomfort [27,28] and disgust related to handling stool [27,29] can negatively influence completion of the CRC stool test at home.”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [27]

    The Results (Test-specific barriers) and Discussion identify distaste for handling stool and stool cards as leading patient-reported barriers to FOBT, supporting anticipated dislike as a barrier to the stool test. They associate discomfort with endoscopy, not FOBT, and do not establish an effect on completion of an at-home test. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • For CRC self-sampling, logistics of sampling and storage can be viewed as too difficult.

    “For CRC self-sampling, logistics of sampling and storage (e.g., mailing stool samples) can be viewed as too difficult [27].”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [27]

    The Results (Test-specific barriers; page not available) report that concerns about handling stool and stool cards were among the top five barriers to fecal occult blood testing, supporting difficulty with part of CRC self-sampling. Our copy does not identify sample storage or mailing stool samples as barriers; its reference to mailing concerns the study questionnaire. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Disgust related to handling stool can negatively influence completion of the CRC stool test at home.

    “Anticipated dislike or discomfort [27,28] and disgust related to handling stool [27,29] can negatively influence completion of the CRC stool test at home.”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [27]

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Cited by

Sorted by citations

Authors
Jones, R. M., Woolf, S. H., Cunningham, T. D., Johnson, R. E., Krist, A. H., Rothemich, S. F., & Vernon, S. W.
Affiliations
Virginia Commonwealth University (US)
Corresponding author
Jones, Resa M.
ORCID
Venue
American Journal of Preventive Medicine
Publisher
Elsevier BV
Published
2010-05
Volume
38
Issue
5
Pages
499-507
ISSN
0749-3797 (ISSN-L)
DOI
10.1016/j.amepre.2010.01.020
PMC
PMC2946819
OpenAlex
W2013307494
Cited by
150
References
1
Citations by year
2026: 7 · 2025: 8 · 2024: 12 · 2023: 11 · 2022: 9 · 2021: 12 · 2020: 6 · 2019: 11 · 2018: 3 · 2017: 10 · 2016: 11 · 2015: 13 · 2014: 11 · 2013: 8 · 2012: 6
FWCI
3.73
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • American Journal of Preventive Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Cancer Institute (R21CA100517)
Topics
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
Keywords
colorectal cancer screening, barriers to screening, patient-reported barriers, colonoscopy, fecal occult blood test, sigmoidoscopy, flexible sigmoidoscopy, bowel preparation, financial concerns, physician recommendations, African Americans, older adults, screening adherence
MeSH terms
Aged, Attitude to Health, Awareness, Communication Barriers, Female, Humans, Male, Mass Screening, Middle Aged, Patient Acceptance of Health Care, Surveys and Questionnaires, Virginia, Colorectal Neoplasms

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