Colorectal cancer (CRC) is the third-most commonly diagnosed cancer among American adults and is estimated to cause the second-most deaths among all types of cancer. However, compliance with the American Cancer Society guidelines for CRC screening remains low. Many authors have studied reasons for screening non-compliance within specific populations, but a consistent understanding of non-compliance among the general population remains elusive. In order to determine the major patient-reported barriers to CRC screening, we conducted a literature review of studies of patient-reported barriers to CRC screening. PubMed and Google Scholar were searched with the terms: “(colorectal cancer OR CRC) AND screening AND (decisions OR uptake OR barriers OR participation OR compliance OR adherence)” and “patient reported barriers to CRC screening”. Inclusion criteria for the literature review were: Original research on patient reported barriers to CRC screening, patient population includes adults with no history of CRC, research quantifies responses. Individual barriers reported in each study were coded into eight author-defined categories of commonly-cited barriers: lack of awareness of screening (awareness), cost of screening (cost), lack of doctor order, psychosocial barriers (fear, embarrassment, disgust, etc.), lack of time for screening (time), logistical problems to screening (logistics), belief that screening is unnecessary (beliefs), and other barriers (other). Of 9,718 studies assessed, 46 met quality and relevance standards. 28 analyzed barriers exclusively in the US; the rest analyzed barriers elsewhere in the world. Worldwide, lack of doctor order was the most commonly cited barrier to CRC screening. In the US, this is followed by awareness, cost, beliefs, logistics, time, psychosocial barriers, and other barriers. Elsewhere in the world, barriers follow a similar order, in particular and from most to least relevant: lack of doctor order, beliefs, psychosocial barriers, awareness, time, logistics, cost, and other barriers. This review shows that lack of doctor order is a significant barrier to screening. Thus, it would appear that the most effective screening compliance intervention would be aimed at clinician education, as increased clinician education should increase screening suggestions made in consultation which appear in this research to have a significant impact on patient behavior. Furthermore, health providers should be cognizant of these patient-reported barriers to CRC screening when developing interventions. Future research should analyze differences in compliance among populations of different socioeconomic status (SES), as low SES is a commonly cited predictor of poor screening compliance.
Citation Format: Colin Small, Victoria Raymond, Mark Jacobstein, Kathryn Lang. Understanding patient-reported barriers to colorectal cancer screening: A literature review [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B051.