Table 3.
Physician Ratings of Patient, Provider, and System Barriers to Colorectal Cancer Screening, New Mexico Primary Care Physician Survey of Colorectal Cancer Screening Barriers (N = 216), 2006a
| Perceived Barrier | Mean (SD)b |
|---|---|
| Patient | |
| Embarrassment or anxiety | 4.7 (1.0) |
| Fear of pain | 4.5 (1.1) |
| Inadequate insurance | 4.0 (1.6) |
| Lack of knowledge about screening tests | 3.8 (1.2) |
| Lack of knowledge about CRC risk | 3.8 (1.2) |
| Lack of perceived CRC susceptibility | 3.8 (1.2) |
| Lack of benefit for CRC screening | 3.7 (1.2) |
| Logistical barriers | 3.7 (1.2) |
| Low utilization of annual health maintenance visits | 3.7 (1.2) |
| Fear of finding cancer | 3.6 (1.2) |
| Competing demands | 3.6 (1.2) |
| Lack of benefit for CRC treatment | 3.4 (1.3) |
| Low literacy | 3.2 (1.3) |
| Fatalism | 3.2 (1.2) |
| Poor patient adherence | 3.2 (1.3) |
| Cultural factors | 3.2 (1.2) |
| Inability to perform preparation for procedures | 3.1 (1.1) |
| Family or friends had bad CRC experience | 2.9 (1.1) |
| Language (non- or weak English speaker) | 2.7 (1.2) |
| Non-US citizenship status | 2.5 (1.7) |
| Colonoscopy complications | 2.3 (1.1) |
| Barium enema complications | 1.7 (1.1) |
| Flexible sigmoidoscopy complications | 1.6 (1.0) |
| Provider | |
| Limited accuracy of FOBT | 3.1 (1.4) |
| Lack of time to discuss screening | 2.5 (1.1) |
| Lack of sigmoidoscopy skills | 2.1 (1.8) |
| Lack of time to arrange screening | 2.0 (1.1) |
| Difficulty counseling about screening | 1.8 (1.0) |
| Complexity of screening options | 1.7 (1.0) |
| Questions about efficacy of screening | 1.7 (1.0) |
| System barriers: implementing screening | |
| Lack of screening system reminder | 2.8 (1.4) |
| Lack of support staff for follow-up | 2.6 (1.5) |
| Lack of FOBT result tracking system | 2.4 (1.3) |
| Lack of patient educational material | 2.3 (1.3) |
| Inadequate reimbursement for screening | 2.0 (1.4) |
| System barriers: obtaining lower endoscopy | |
| Long waits to get lower endoscopy | 3.0 (1.5) |
| Lack of resources for screening procedures | 2.6 (1.7) |
| Difficulty scheduling lower endoscopy | 2.6 (1.4) |
| Lack of resources for diagnostic procedures | 2.3 (1.5) |
| Poor feedback on procedural results | 2.2 (1.2) |
Abbreviations: SD, standard deviation; CRC, colorectal cancer; FOBT, fecal occult blood test.
a
Barriers were rated by providers for perceived frequency using a 6-point scale from 1 = "never"/"not" to 6 = "most"/"very".
b
A multivariate analysis of variance showed that means differing by ≥0.2 were significantly different at P < .05 by Fisher's least significant difference method for all barriers except for system barriers, for which means differing by ≥0.3 were significant.