Purpose: A promising strategy to increase colorectal cancer (CRC) screening includes the use of new generation high sensitivity-high specificity immunochemical fecal occult blood test (I-FOBT or FIT) among patients receiving primary care in Federally Qualified Health Centers (FQHC). This approach was recognized by the Tampa Bay Community Cancer Network (TBCCN) Community Network Program Center (CNPC) as a highly feasible method for impacting cancer health disparities in our community. Despite physician recommendations to increase screening uptake, finding effective ways to increase patients’ awareness about different types of CRC screening (CRCS) is needed. This study reports qualitative findings from focus groups with patients in FQHCs to inform the development of a low literacy DVD and photonovella booklet to prepare patients for provider discussions about CRCS, particularly I-FOBT use.
Methods: Six focus groups were conducted with men and women, of diverse background (ages 50–75 years) with no diagnosis of CRC. In collaboration with our community partners who identified a need to increase CRCS and using community-based participatory research (CBPR) methodology to develop a focus group guide and recruitment materials, participants were recruited from partnering FQHCs in Hillsborough County, FL. The focus group guide assessed patients’ knowledge and perceptions about CRC and screening, particularly I-FOBT and colonoscopy, as well as participants’ views about in clinic CRCS preparatory education process and factors that impede CRCS uptake. All focus groups were audio taped, transcribed verbatim and reviewed by two independent coders. Thematic coding, using a crystallized-immersion framework was conducted. A combination of hand-coding and Atlas TI software were employed using content from the patient focus group guide as priori codes.
Results: Thirty-nine patients participated in focus groups to date (51% male; 59% black; 36% white; 5% Hispanic/Latino; mean age = 56.18 years). Seventeen reported being up-to-date on CRCS per recommendations and 22 were not current. Consistent with previous studies, we found poor knowledge and awareness about CRC risks and different screening modalities. Commonly reported barriers included: 1) no doctor recommendation; 2) cost; 3) fear of the test or abnormal findings; and 4) a lack of symptoms. While all participants had heard of colonoscopy and traditional FOBT, very few were aware of I-FOBT. Concerns about colonoscopy included a dislike of the test prep and affordability. Most men reported feelings of embarrassment, personal invasion, and threatened masculinity regarding the colonoscopy procedure itself. Upon learning about I-FOBT the majority felt the test seemed to be simple, easy to do, and private. Most participants who had prior FOBT screening reported use of the older 3-card home test or office-based guaiac test. Reported limitations to the older version of FOBT included diet restrictions, dislike of “handling” one's own feces during sample collection and the complexity of multiple test applications. Doctor recommendation was the main reason participants completed CRCS tests.
Conclusions: Our findings suggest patients’ overall receptivity to I-FOBT, and provide a basis for developing educational content for an intervention that addresses test specific barriers, and promotes the more patient-friendly IFOBT. Results also show support for a preparatory education intervention that will educate patients in clinic before their provider visit about the need for CRCS. Such preparatory materials are expected to enhance patients’ awareness about CRCS, facilitate patient-provider communication, and contribute to the overall uptake of CRCS.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A9.