Purpose: Disparities in colorectal cancer screening (CRCS) are partially rooted in reduced access to health care and screening tests. One strategy under investigation within the Tampa Bay Community Cancer Network Community Network Program Center is the promotion of the now widely available and evidence-based immunochemical fecal occult blood test (i-FOBT or FIT) in community-based federally qualified health centers (FQHC) using easy-to-understand video and photo-novella materials customized for this setting. The purposes of this qualitative study were to identify key issues from the perspectives of providers regarding common barriers that patients face regarding the i-FOBT screening test, identify successful strategies to prime patients to use the i-FOBT test, and explore the best timing sequence of patient preparatory education about CRCS.
Methods: Two focus groups and three individual interviews were conducted among 17 community health care providers working with medically underserved populations in FQHCs in Hillsborough County, FL. A community-based participatory research (CBPR) methodology was used to develop the focus group guide and recruitment materials. Eighty two percent were either family medicine physicians, physician assistants or nurse practitioners. Other job titles included registered nurse (n=1) and certified nurse assistant/medical assistant (n=2). Using a semi-structured interview guide, providers were asked to discuss barriers patients may face regarding CRCS, issues related to educating patients in clinics about CRCS, and importance of communication in motivating patients to consider screening. Discussions were audio-taped and transcribed verbatim and lasted between 30–60 minutes. Transcriptions were independently hand-coded using priori codes from the guides and emergent themes were identified using a crystallized-immersion methodology, across multiple raters.
Results: Results showed the majority of providers agreed their patients could benefit from more health education prior to provider discussion about CRCS. Providers described the main concerns experienced by their patients as: lack of insurance, lack of transportation, fear and embarrassment associated with colonoscopy, lack of access to screening and the need for more resources for learning about CRC and CRC related services. The most compelling concern expressed among providers was that patients often feared screening results, and perceived they would not have access to further follow-up colonoscopy if i-FOBT was abnormal or resources to treat CRC. Most providers wanted to see more cultural and literacy relevant CRC educational materials in their clinics. In addition, when patients are informed about their risks, the importance of early detection, and are given examples of people to whom they can relate, providers felt that preparatory education could increase the likelihood of following through with recommended screening with i-FOBT as an initial strategy.
Conclusions: Findings from health care providers support the need for priming education to address patients’ concerns about CRC screenings. Results also reinforce the development of educational materials that address test-specific fears and how to access available resources. Timing of CRCS education of patients in clinics is crucial. Providers’ perspectives are an integral component of designing relevant educational materials and interventions.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B91.