Assessment of Patient Barriers to and Facilitators of Screening Colonoscopy: Utilizing Patient Perspectives to Formulate Recommendations to Improve Colorectal Cancer Screening Rates

A pilot study was conducted that utilized focused patient interviews to determine patient barriers to and facilitators of screening colonoscopy. The interviews were transcribed and systematically analyzed to detect recurring patterns and themes related to screening colonoscopy completion or lack thereof. Descriptive statistics were used to summarize additional sample characteristics such as gender, education level, and income level. Among those who had received a screening colonoscopy (44%, 11 of 25), provider recommendation was the most influential factor for procedure completion, followed by the combination of provider plus family member recommendation. Additional findings revealed that due to medical necessity, several patients (32%, 8 of 25) had obtained a colonoscopy for non-screening purposes and were past due for screening at the time of completion (75%, 6 of 8). Of the six patients who received an initial colonoscopy out of medical necessity and were past due, half had never received a prior recommendation, while the other half reported Lack of Insurance/Financial Concern(s) and Refusal/Fear as reasons for not completing colonoscopy at the time of initial recommendation. Among those that had never had a colonoscopy for any reason (24%, 6 of 25) barriers that were identified include 1) Lack of Recommendation/Knowledge (50%, 3 of 6), 2) Lack of Insurance/Financial Concern(s) (16.7%, 1 of 6), 3) Scheduling conflict (16.7%, 1 of 6), and 4) Refusal/Fear (16.7%, 1 of 6). Overall study findings reveal that CRC screening rates in primary care may be improved with the implementation of an evidence-based multi-strategy practice program that ensures its interventions are 1) based upon utilizing the patient-identified facilitators and 2) address the patient-identified barriers to CRC screening exams. Implications for future research and policy were also revealed

Barriers to Colorectal Cancer Screening in Adults: An Integrative Review

Colorectal Cancer (CRC) is the third leading cause of death among American men and women. Colorectal cancer is a preventable cancer, with CRC screening recommended from the age of 50. The percentage of people who complete the recommended CRC screening is low. Individuals throughout the United States (US) are rarely offered the opportunity to discuss screening options with their provider and may never complete CRC screening due to multiple barriers. The purpose of this scholarly integrative review is to explore the reasons individuals are not completing CRC screening, including those related to different US populations, and discuss interventions that can be implemented to increase CRC screening rates. A total of 17 articles, published during the period 2010-2020 were identified using five different databases, internet searches, and secondary references, and were included in an integrated review of literature. Themes were identified and analyzed using a theme matrix. Three main themes were discovered in relation to barriers to CRC screening: patient, system, and provider-related barriers. Many of the identified barriers related to CRC screening are interrelated and complex. The Health Belief Model (HBM) was the theoretical framework used to understand why individuals may not participate in CRC screening. The HBM is used to predict if individuals will adhere to screening recommendations depending on their perceived susceptibility to CRC, perceived severity of the condition, and whether perceived barriers are high. If perceived benefits are greater than perceived barriers, confidence in completing CRC screening will be higher. A multicomponent intervention is discussed, including a protocol for a nurse-led visit that was developed to identify a gap in patient education to address the individual barriers that were identified from the literature review. A framework was identified to evaluate the organization’s metrics and population barriers to assist in implementation of the multicomponent interventions. The strategies included were: assessing the infrastructure, interventions identified by the organization, process measures and quantifiable metrics, CRC screening phases, performance, outcome, and cost measures. The goal of implementing interventions is to increase the percentage of individuals who complete CRC screening. These recommendations will be most beneficial to populations with health disparities due to low social economic status, decreased health literacy, poor social networks, and being underinsured

Systematic Review: Evaluating the effectiveness of patient-directed educational interventions on the uptake of colorectal cancer screening

Background: Colorectal cancer is the third most common neoplasm in the United States, with over 150,000 people receiving a new diagnosis every year. Colorectal cancer is also the second-leading cause of all cancer-associated mortality, attributed to deaths totaling nearly 50,000 annually. Despite the morbidity and mortality of colorectal cancer and the effectiveness early detection, colorectal cancer screening lags behind other types of screening. Patient education and health literacy are posited to play a role in the lack of colorectal cancer screening in American adults. Purpose: To evaluate the effectiveness of patient-oriented educational materials, including small media and decision aids on the outcomes of screening uptake, patient knowledge, and patient intent. Data Sources: MEDLINE, CINAHL, hand-searched reference list Study Selection: One reviewer independently selected studies addressing the study questions and met eligibility criteria. Data Extraction: Information on study design, setting, intervention, comparators, study population, outcomes, and quality were extracted by one reviewer. The reviewer assigned a quality rating for each study. Data Synthesis: The reviewer found that with regards to increasing colorectal cancer screening uptake, the evidence is mixed, with two studies demonstrating the a positive effect, three demonstrating no effect, and one showing a negative effect. All three studies investigating patient knowledge suggest an increase in knowledge. Patient intent for screening was mixed, with one study showing a positive effect, one showing a negative effect and two showing no effects at all. Limitations Only investigated randomized controlled trials as opposed to pre-post test interventions. Articles used different measurement tools/methods for assessing outcomes of interest. Limited the number of outcomes to only three. Investigated only educational materials while excluding other interventions. Conclusion: Evidence is mixed regarding the effectiveness of patient-directed educational interventions on CRC screening uptake. More evidence and standardization of outcomes/methods and educational content are needed in order to assess patient intent and uptake of screening. Nevertheless, patient educational materials are effective at improving patient knowledge, important especially when informed consent and informed decision-making are goals for appropriate care.Master of Public Healt

Aid-Assisted Decision-Making and Colorectal Cancer Screening: A Randomized Controlled Trial

Shared decision-making (SDM) is a widely recommended yet unproven strategy for increasing colorectal cancer (CRC) screening uptake. Previous trials of decision aids to increase SDM and CRC screening uptake have yielded mixed results

Is This Going to Be the End? Understanding Problematic Integration Among Appalachian Patients in Colorectal Cancer Screening Navigation

Colorectal cancer (CRC) is preventable through regular screening; however, incidence and mortality rates in Appalachia are among the highest in the United States. Public health programs and interventions meant to mitigate the higher CRC burden and increase screening rates are ongoing in the U.S. and Appalachia. In continuing the efforts to reduce the burden of CRC in Appalachian communities, this dissertation uses a two-part study to investigate communication practices relative to problematic integration and health beliefs in CRC screening conversations from the perspective of both patients and patient navigators in the region. As part of efforts directed by the Rural Cancer Prevention Center (RCPC; 2009-2019), patients who received a positive fecal immunochemical test (FIT) and the patient navigators assigned to connect them with direct visualization follow-up testing were interviewed one-on-one to better understand the role of problematic integration in CRC screening communication. Study 1 investigates patient navigators\u27 (n = 9) perspectives of their efforts to connect patients with appropriate CRC screening, while Study 2 analyzes the accounts of patients (n = 10) with positive FIT who refused follow- up colonoscopy testing (at the time of recruitment) after engaging in patient navigation services. With problematic integration theory and the health belief model as a guide, data from these two studies in the Appalachian Kentucky context support an overarching model for how patient navigators and patients address uncertainty in CRC screening. Analyzing these phenomena at the intersection of communication and health behavior theories highlights the utility of health communication research expertise in guiding interventions across the healthcare continuum. In addition, data from the studies may be used to understand the nature of participation in CRC screening conversations and how these dynamics contribute to patient-centered care and shared decision-making, which is especially important with the additional challenges for screening exacerbated by a global COVID-19 pandemic. The findings from these studies are discussed in terms of contributing to more effective clinical and patient navigation communication practices and providing public health practitioners with essential considerations for shaping interventions to support shared decision-making and improve CRC screening rates in similar populations

Testing a Spanish-language colorectal cancer screening decision aid in Latinos with limited English proficiency: Results from a pre-post trial and four month follow-up survey

Abstract Background Compared with non-Latinos, Latinos in the US have low rates of colorectal cancer (CRC) screening and low rates of knowledge regarding CRC screening tests and guidelines. Spanish speaking Latinos have particularly low CRC screening rates and screening knowledge. Our purpose was twofold: (1) to evaluate the effect of a computer-based, Spanish-language CRC screening decision aid on screening knowledge, intent to obtain screening, and screening self-efficacy in a community sample of Latinos with limited English proficiency (LEP); and (2) to survey these decision aid viewers at four months to determine their rates of CRC discussions with a health care provider as well as their rates of screening test completion. Methods We recruited 50-75 year old Latinos with LEP who were not current with CRC. Participants screening viewed a 14 minute multimedia decision aid that addresses CRC screening rationale, recommendations, and options. We conducted an uncontrolled (pre-post) study in which we assessed screening knowledge, self-efficacy, and intent at baseline and immediately after decision aid viewing. We also conducted a follow-up telephone survey of participants at four months to examine rates of patient-provider screening discussions and test completion. Results Among n = 80 participants, knowledge scores increased from 20% (before) to 72% (after) decision aid viewing (absolute difference [95%CI]: 52% [46, 59]). The proportion with high screening self-efficacy increased from 67% to 92% (25% [13, 37]); the proportion with high screening intent increased from 63% to 95% (32% [21, 44]). We reached 68 (85%) of 80 participants eligible for the follow-up survey. Of these 36 (53%) reported discussing screening with a provider and 13 (19%) completed a test. Conclusion Viewing a Spanish-language decision aid increased CRC screening knowledge, self-efficacy, and intent among Latinos with LEP. Decision aid viewing appeared to promote both CRC screening discussions with health care providers and test completion. The decision aid may be an effective tool for promoting CRC screening and reducing screening disparities in this population

Surgical Smoke Evacuation Guidelines: Compliance Among Perioperative Nurses

Smoke (plume) is produced when tissue is cut or coagulated with lasers or electrosurgery devices during surgery. Research has documented that surgical smoke creates a serious workplace hazard for over 500,000 healthcare workers. Toxic gases create an offensive odor, small particulate matter causes respiratory complications, and pathogens may be transmitted within the surgical smoke to the surgical team. Previous research notes that smoke evacuation recommendations are not being consistently followed by perioperative nurses. The purpose of this study is to determine key indicators that are associated with compliance with smoke evacuation recommendations by perioperative nurses. The Diffusion of Innovation theory by Rogers serves as the model since it describes key indicators for the adoption of an innovation, including individual innovativeness, perceptions of the innovation attributes, and organizational innovativeness. A descriptive explanatory/exploratory study was conducted using a validated and piloted survey that consisted of both expert-generated questions and adaptations of previously proven measures. A population of AORN (Association of periOperative Registered Nurses) staff nurse members who have e-mail addresses (N=20,272) was targeted as the universe. A random sampling consisting of 4000 nurses were invited to respond to a web-based survey during a two-month period. There were 777 completed responses representing a 19.4 percent response rate. The SPSS statistical computer package was employed to analyze the data using frequency/descriptive statistical techniques and bivariate analyses to examine the relationship between the key indicators and compliance with smoke evacuation recommendations. Major findings reveal that specific key indicators influencing compliance include increased knowledge and training, positive perceptions about the complexity of the recommendations, and larger facilities with increased specialization, interconnectedness, and leadership support. The study outcomes are planned to be disseminated via lectures and articles. Promoting a safe surgical environment is a top priority for perioperative nurses. By identifying key predictors that influence compliance with smoke evacuation practices, a better understanding of the many factors that influence perioperative nurse practices is fostered. Nurse training programs can be developed that directly target and address these key predictors so that a safe and healthy surgical environment free from surgical smoke can be promoted

Endoscopic Procedures in Colon and Rectum

Endoscopic procedures in colon and rectum presents nine chapters which start with introductory ones like screening by colonoscopy as the preparation and monitoring for this exam. In addition to these approaches the book aims in the last four chapters to explain endoscopic diagnostic and therapeutic aspects in the colon and rectum. The description of each text is very comprehensive, instructive and easy to understand and presents the most current practices on the topics described. This book is recommended for general and colorectal surgeons as it presents guidelines for diagnosis and treatment which are very well established

Preventive Screenings Gap Analysis

Prepared for: Alaska Department of Health and Social Services Division of Public Health Chronic Disease Prevention and Health Promotion Sectio