Factors affecting decision to screen for colorectal cancer: A qualitative assessment

Background: Factors affecting colorectal cancer (CRC) screening decision stage (SDS) (i.e., decided against or never heard of (DA/NHO), not considering or undecided (NCU), decided to do (DTD), screened) are not well-documented. We seek to address this literature gap. Methods: Primary care patients ages 50-79 reported sociodemographic background, CRC screening perceptions, and SDS at baseline. Respondents were randomized to usual care, a standard intervention (mailed screening kit), or tailored navigation intervention (TNI) (mailed screening kit and telephone contact). At navigation, TNI participants reported current SDS and primary reason for SDS. Reasons were categorized using triangulation and classified either as a barrier or facilitator. Categories included: worry about CRC risk, belief in screening efficacy, perceived screening convenience, concern about screening procedure, social support, and cost. We analyzed associations between reported barriers versus facilitators and SDS. Results: TNI participant (n=242) sociodemographic background: white (80%), female (67%), 50-59 years of age (69%), > HS education (56%), married (64%). Baseline SDS: DA/NHO (3%), NCU (17%), DTD (80%). Navigation SDS: DA/NHO (3%), NCU (9%), DTD (75%), screened (13%). DA/NHO respondents reported only screening barriers. NCU respondents reported more barriers than facilitators (73% vs. 27%). DTD respondents reported more facilitators than barriers (87% vs. 13%). Screeners reported more facilitators than barriers (87% vs. 13%). Reporting a screening facilitator versus a barrier was positively and significantly associated with SDS (OR=34.4, 95% CI:11.4,104.2). Conclusion: Participants with lower SDS tended to report screening barriers, while those with higher SDS tended to report screening facilitators. Further research may elucidate these findings.