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2014 Pennsylvania Chapter Eastern Region Abstract Winner

2014 Pennsylvania Chapter Eastern Region Abstract Winner

Residents Quality Improvement
First Place

Barriers to Colorectal Cancer Screening Colonoscopy in a Suburban Low Income Pennsylvania Clinic

Author: Shelini Sooklal, MBBS
Co-Authors: Susannah Stair, MD, Harvey Hakim, MD
Department of Internal Medicine, Easton Hospital

Purpose: Colorectal cancer (CRC) is the third most common cause of cancer death in the United States. National surveys show that only about 63% of adults ages 50 and older have had screening colonoscopy. At our internal medicine resident clinic, records albeit somewhat incomplete, report only 20% of eligible patients have had screening colonoscopy. We sought to identify factors which may affect CRC screening rates.

Methods: All patients aged 50 years and older who visited our internal medicine resident clinic were invited to anonymously participate in the study. A questionnaire was administered, amongst which participants were asked to identify the most applicable reason for the lack of CRC screening. A cutoff value of 'low income' as less than $30 000 was based on the 2012 US Census Bureau report of poverty thresholds.

Results: There were 103 study participants. Males (46%) and females (54%) were roughly equally represented. The 50-55 age group (30%) and the 61-65 age group (26%) comprised the majority. Fifty percent of participants had completed high school, and 92% reported a maximum annual household income of $30 000. Fifty seven percent of participants had not received screening colonoscopy in the previous ten years. The most commonly identified barriers to CRC screening colonoscopy were: perception of the procedure (16% of responders) or procedure preparation (11%) being unpleasant, and lack of medical insurance (12%). Hispanic patients in particular felt that their physician did not adequately stress the need for CRC screening (p=0.036).

Conclusions: Compliance with USPTF guidelines for colorectal cancer screening using colonoscopy was suboptimal in our resident clinic. Residents should aim to dispel misconceptions about the colonoscopy preparation process and basic procedure details, possibly by incorporating simply written educational material. Cost effective alternatives to colonoscopy e.g. fecal occult blood testing may be offered to those who refuse the procedure.