Acceptance of flexible sigmoidoscopy as a screening examination for colorectal cancer in an outpatient clinic

Barriers to flexible sigmoidoscopy colorectal cancer screening in low uptake socio-demographic groups: A systematic review

OBJECTIVE

To synthesise qualitative evidence related to barriers and facilitators of flexible sigmoidoscopy screening (FSS) intention and uptake, particularly within low socio-demographic uptake groups. FSS uptake is lower amongst women, lower socio-economic status (SES), and Asian ethnic groups within the United Kingdom (UK) and United States of America.

METHODS

A total of 12 168 articles were identified from searches of four databases: EMBASE, MEDLINE, PsycINFO and Web of Science. Eligibility criteria included: individuals eligible to attend FSS and empirical peer-reviewed studies that analysed qualitative data. The Critical Appraisal Skills Program tool evaluated the methodological quality of included studies, and thematic synthesis was used to analyse the data.

RESULTS

Ten qualitative studies met the inclusion criteria. Key barriers to FSS intention and uptake centred upon procedural anxieties. Women, including UK Asian women, reported shame and embarrassment, anticipated pain, perforation risk, and test preparation difficulties to elevate anxiety levels. Religious and cultural-influenced health beliefs amongst UK Asian groups were reported to inhibit FSS intention and uptake. Competing priorities, such as caring commitments, particularly impeded women's ability to attend certain FSS appointments. The review identified a knowledge gap concerning factors especially associated with FSS participation amongst lower SES groups.

CONCLUSIONS

Studies mostly focussed on barriers and facilitators of intention to participate in FSS, particularly within UK Asian groups. To determine the barriers associated with FSS uptake, and further understand how screening intention translates to behaviour, it is important that future qualitative research is equally directed towards factors associated with screening behaviour.

Rapid review of factors associated with flexible sigmoidoscopy screening use

Flexible sigmoidoscopy (FS) screening has been shown to reduce colorectal cancer (CRC) incidence and mortality among screened adults. The aim of this review was to identify patient-related factors associated with the screening test's use. We searched PubMed for studies that examined the association between FS screening use and one or more factors. To determine the eligibility of studies, we first reviewed titles, then abstracts, and finally the full paper. We started with a narrow search, which we expanded successively (by adding 'OR' terms) until the number of new publications eligible after abstract review was <1% of the total number of publications. We then abstracted factors from eligible papers and reported the number of times each was found to be positively or negatively associated with FS screening use. We identified 42 papers, most of which reported studies conducted in the United States of America (n = 21, 50%) and the United Kingdom (n = 13, 31%). Across studies, a wide range of factors were examined (n = 123), almost half of which were found to be associated with FS screening use at least once (n = 60). Sociodemographic and health and lifestyle factors that were frequently positively associated with FS screening use included: male gender, higher socioeconomic status and a family history of CRC. Frequently positively associated psychosocial factors included low perceived barriers and high perceived benefits. Findings suggest that future research should focus on developing a theoretical framework of cancer screening behaviour to allow a greater level of consistency and specificity in measuring key constructs.

Reported barriers to cancer screening: Montana Behavioral Risk Factor Surveillance System 2007

PURPOSE

To determine self-identified barriers to cancer screening participation in Montana among respondents to the Behavioral Risk Factor Surveillance System (BRFSS).

DESIGN

The 2007 BRFSS survey.

SETTING

State of Montana.

SUBJECTS

A total of 3433 respondents (2020 women) 50 years and older.

MEASURES

Respondents who had never had an endoscopy and women who had not had a recent mammogram were asked why they had not been screened.

ANALYSIS

Associations between health care access variables and screening participation were assessed using chi2 tests. Joint effects of multiple independent predictors of screening participation were assessed using odds ratios (ORs) and 95% confidence intervals (CIs) from multiple logistic regression analysis.

RESULTS

The strongest predictor of having an endoscopy (OR, 23.62; 95% CI, 18.42-30.28) or recent mammogram (OR, 10.87; 95%, CI, 6.42-18.40) was provider recommendation. The most common reasons for not being screened were respondent's belief that it was not necessary (44% for endoscopy and 39% for mammography), no provider recommendation (22% for endoscopy), and cost (12% for endoscopy and 19% for mammography). Among unscreened respondents whose providers recommended endoscopy and mammography, 30% and 36%, respectively, believed that it was not necessary.

CONCLUSIONS

Many Montanans remain unaware of the importance of cancer screening Health care providers and public health officials must increase patient education, and providers must continue to refer patients for screening.