P-238 Colorectal cancer screening: understanding the patients' perspective

Abstract

Introduction: Colorectal cancer (CRC) is the third-leading cause of cancer death for adults in the USA. Despite consensus recommendations for screening, only 59% of eligible adults have undergone screening. We conducted this survey study to determine rates of colonoscopy in our outpatient internal medicine clinic and to assess patients' attitudes towards CRC screening. Methods: The study was approved by the IRB at the University of Florida. All patients visiting our internal medicine clinic were eligible to participate. We developed a 26-item survey. Participation in the study was anonymous and voluntary. We analyzed the data to determine screening rates, patients' attitudes towards colonoscopies, and variables associated with colonoscopies. Results: Seventy-eight patients participated in the study. The average age of the patients was 52.8 years (range 19-87). While 82.1% of participants agreed that undergoing colonoscopy «makes sense» and 67.9% accepted that colonoscopy can prevent CRC by removing polyps, only 50% thought colonoscopy would be important in «protecting their health.» Participants reported concern about colonoscopy revealing abnormal results (46.2%) or CRC (55.2%), as well as procedure-related discomfort (30.8%), pain (39.8%), vulnerability (48.7%), or embarrassment (61.5%). Perceived barriers to colonoscopies included difficulty finding the time for the procedure (16.6%) or arranging it (16.7%) as well as lack of insurance (2.6%). While only 16.7% agreed that they were at high risk of developing CRC and 6.4% thought routine labs would detect CRC, the majority (79%) reported they would undergo colonoscopy if recommended by their provider. Interestingly, 61 participants (78.2%) reported a flu shot within the past 12 months. Of the 53 participants who were 50 or older, 45 (84.9%) reported having had a colonoscopy. The reported rate for Caucasian participants was 94% (33/35), compared to 70% (7/10) for African American participants. Agreeing that CRC testing «makes sense» and is important for health, perceived ease of arranging one's schedule for colonoscopy, and agreeing with the statement «I am going to have a colonoscopy if my doctor recommends it» had a positive association with having had a colonoscopy. Conversely, reporting difficulty finding the time for screening as well as concern about procedure-related physical discomfort, pain, and vulnerability were associated with lower likelihood of having undergone colonoscopy. Conclusion: We found higher than expected rates for health maintenance behavior (colonoscopy and flu vaccination) in our study population. Our results highlight the importance of patient-provider discussions about CRC screening as the majority of our patients agreed that they would undergo screening if recommended by their physician. These discussions can further increase screening rates by enhancing patients' understanding of the importance of CRC screening as well as alleviating their anxieties about the procedure. Our findings can inform future studies as well as development of interventions and programs aimed towards increasing CRC screening.