National VHA data show a significant performance gap in colorectal cancer (CRC) screening rates. This study reports findings of an in-depth qualitative analysis of male veterans’ perceptions of CRC screening options and addresses the possible implications for implementation-oriented research and patient education in order to increase screening rates among the US veteran population.
Six focus groups were conducted to elicit information about barriers and facilitators to screening and to assess perceptions about what information is most important when making decisions about CRC screening. The groups were stratified by screening status (screened/unscreened). Two of the six groups were made up of African Americans. The remaining groups were non-African Americans. Six to eight men participated in each group.
Several perceptions about CRC and screening were consistent across groups and provide insight to improve screening. Despite evidence to the contrary, individuals perceived prostate cancer as more prevalent than colorectal cancer, and therefore, a higher priority for screening. Preparation for screening was perceived to have direct and indirect costs to low-income patients that providers do not recognize. Contrary to prior published findings and despite necessary time, preparation, and escort requirements necessary for completion, colonoscopy was the overwhelmingly preferred screening mode. Barriers and facilitators to screening differed by race. African Americans emphasized individual sensitivities (e.g. stool handling, introduction of scope), non-African Americans emphasized social embarrassment (e.g. passing gas and stool). Given these perceptions, participant’s suggestions to improve CRC include the following:
1.Future research should focus on the direct out-of-pocket financial costs and the opportunity costs to patients of having the test done. 2. Implementation efforts could focus on testing various transportation resources and non-kin social support mechanisms to facilitate screening. 3. Implementation research could focus on the impact of patient-to-patient education. Direct and on-site patient education may increase testing while providing passive information in brochures may not. 4. Educational materials should be targeted and address barriers to screening that are most salient to specific underserved or vulnerable populations. 5. Implementation research should focus on differential outcomes by race of various screening facilitators such as physician recommendation and education.