Article Title

Reasons for Never and Intermittent Completion of Colorectal Cancer Screening After Receiving Multiple Rounds of Mailed Fecal Tests

Publication Date



cancer, qualitative research, patient experience/satisfaction


Background: Long-term adherence to colorectal cancer (CRC) screening is particularly important for fecal testing. As few as a quarter of patients repeat fecal testing the next year in some U.S. settings. The purpose of this qualitative study was to identify barriers and facilitators reported by patients with suboptimal screening adherence to refine interventions for ongoing adherence to CRC screening. We also explored whether participants, particularly never screeners, would be willing to do a CRC screening blood test.

Methods: 41 patients who previously enrolled in the Systems of Support to Increase CRC Screening (SOS) trial were interviewed 4–5 years later. Participants were purposively selected to include men and women with diverse race/ethnicities who had either been inconsistent screeners or had never screened during the first 3 years of SOS, despite receiving at least 2 rounds of mailed fecal tests. Two interviewers conducted an approximately 30-minute telephone interview using a semi-structured interview guide. An iterative thematic analysis approach was used.

Results: Barriers were more pervasive among never-screeners: 1) Avoidance; 2) Aversion to stool; 3) Health concerns; and 4) Fear. Facilitators were more often mentioned by repeat-screeners: 1) The simpler 1-sample test; 2) Mailings and testing at home convenience; 3) Prevention; and 4) Social influence. Participants had diverse preferences for types (phone, mail) with some not preferring email links to the electronic health record. A nurse not from their clinic calling was acceptable if the nurse was knowledgeable about their records and could communicate with their physician. Participants, especially never-screeners, were enthusiastic about a screening blood test.

Conclusion: Future CRC screening programs should be designed to minimize these barriers and maximize facilitators to improve long-term screening adherence.




June 20th, 2017


August 10th, 2017