Provider-perceived barriers to patient adherence to colorectal cancer screening

Background: Average-risk colorectal cancer (CRC) screening remains underutilized in the US. Provider recommendation is strongly associated with CRC screening completion. To inform interventions aimed at improving screening uptake, we examined providers' perspectives on patient and health system barriers to CRC screening adherence, along with associated system-level interventions to improve uptake. Methods: We conducted an online survey between November and December 2019 with a sample of primary care clinicians (PCCs) and gastroenterologists (GIs) from a validated panel of US clinicians (814 PCCs, 159 GIs; completion rates: 25.3% for PCCs, 29.6% for GIs). Clinicians rated the extent to which each patient and health system factor interferes with patient adherence with CRC screening recommendations and the availability of practice interventions to improve screening rates. Results: Provider-reported top barriers to CRC screening included patient discomfort with offered screening method (66%), cost (62-64%), and perceived low importance of screening (62%). Additional barriers included providers prioritizing urgent health concerns over screening (45-48%), not offering a choice of screening options (42-48%), lacking time to educate patients about screening (38-45%), and lacking education about available screening options (37-40%). Most frequently reported system-level interventions to improve CRC screening rates included patient education materials (57-62%) and point of care prompts (56-61%). Other interventions were less frequently reported, although variations existed by clinical specialty regarding barriers and interventions. Conclusions: Addressing barriers to CRC screening requires system-level interventions, including provider training on shared decision-making, automated scheduling and reminder processes, and policies to increase clinician time for preventive screening consultations.