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Residents Quality Improvement
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