Endeavour College: BIOC211 Journal Review - CRC Screening Barriers

This journal review analyzes a study that investigated self-reported barriers to colorectal cancer (CRC) screening among low-income, uninsured patients from federally qualified health centers (FQHCs). The study aimed to identify the barriers and assess their relationship with factors such as gender, age, race, income, education, insurance, and employment. Data was collected through surveys administered to 483 adults aged 50 and older. The research found that the most common barriers included fear, logistical issues, and the perception that screening was unnecessary. The study highlights the importance of addressing these barriers to improve CRC screening rates and reduce mortality, emphasizing the impact of early detection and prevention through procedures like colonoscopy and fecal testing. The research used statistical methods, including the chi-square test, to analyze the relationship between barriers and demographic data. The findings underscore the need for targeted interventions to increase screening among underserved populations, aligning with broader efforts to reduce healthcare disparities and improve public health outcomes. The study references several key studies and data from the American Cancer Society to support its findings and contextualize the importance of CRC screening.

Journal Review 1
1. The purpose of the study is to identify self-reported barriers to colorectal cancer (CRC)
in lower income, below and un-insured patients screened from federally qualified health
centers (FQHCs) and also to evaluate the involvement of these barriers with gender,
age, race, income, education, insurance and employment. This study specifically
focused on medically underserved population who possibly encounter other difficulties
(Muthukrishnan, Arnold, & James, 2019).
2. In this cross sectional analysis recruitment was done by cluster randomized trial across
two health systems. Eleven urban (St. Louis) and rural (Southeastern Missouri) FQHCs
were enlisted on a rolling basis. Collection of data was done by surveys which integrated
with one open end and close ended question administered by phone, mail or in-person.
A total 959 (n) English or Spanish speaking adults aged ≥50 were selected for survey.
The consented sample size was 490 in which 7 were excluded due to age (2),
incompletion (1) or duplicate enrollment (4). The concluding sample size was 483
subjects (Muthukrishnan et al., 2019).
Data on sexual category, age, ethnicity, monthly earnings, employment type and
schooling were included in demographic information.
Yes, there was a gift card of $20 gift for the subjects who completed the survey
(Muthukrishnan et al., 2019).
3. As stated by ACS (2017), customary screening and early location through procedures
like colonoscopy and fecal testing are powerful in lessening CRC occurrence and
mortality. Likewise, past patterns of colorectal disease screening in the US populace
recommend that in excess of 50% of the diminish in colorectal malignant growth death
can be credited to the expanded acknowledgment and take-up in colorectal malignancy
screening, a huge effect on diminishing colorectal malignant growth mortality (Zauber,
2015 and Muthukrishnan et al., 2019). A study conducted by Levin and team (2018)
stated that screening rates were manageable and related with significant reductions in
CRC occurrence and mortality inside brief time interims, predictable with early
identification and malignancy anticipation. Similarly in 2016, another study affirmed that
screening colonoscopy was related with a considerable and similarly diminished death

chance for both right-sided and left-sided malignant growths (Doubeni et al., 2016 and
Muthukrishnan et al., 2019).
.
4. Chi-square test was used to find out dissimilarity among subjects who reported barriers
with who did not report. Codes were given to all variables, obtained from literature
reviewed. Double code was given to answers which addressed various areas. All the
codes and topics were double checked to ensure consistency. Barriers divided into
category to find connections with demographic data and CRC status screening by
means of chi-square test. The data were analyzed using SPSS v.24 (Muthukrishnan et
al., 2019).
5. The list of self-identified barriers are as follows:
a. Self-identified barriers ever screened (%)
Fear 35%
Logistics 35%
Unnecessary 27.5%
No recommendations/referrals 25%
Discomfort/disgust with procedure 20%
Finances 18.8%
Others* 11.3%
Discomfort/disgust with preparation 7.5%
b. Self-identified barriers not screened (%)
No recommendations/referrals 33.1%
Fear 25.4%
Finances 25.4%
Unnecessary 15.3%
Logistics 14.4%
Discomfort/disgust with procedure 10.2%
Discomfort/disgust with preparation 7.6%
Others* 7.6%

*Other barriers comprise of medical mistrust, be deficient in of information on CRC
screening, holy grounds, or they just “don't want to” (Muthukrishnan et al., 2019).

References
ACS, 2017. Cancer Facts & Figures 2017. American Cancer Society, Atlanta, GA.
Doubeni, C., Corley, D., Quinn, V., Jensen, C., Zauber, A., & Goodman, M. et al. (2016).
Effectiveness of screening colonoscopy in reducing the risk of death from right and left
colon cancer: a large community-based study. Gut, 67(2), 291-298. doi: 10.1136/gutjnl
2016-312712
Levin, T., Corley, D., Jensen, C., Schottinger, J., Quinn, V., & Zauber, A. et al. (2018). Effects of
Organized Colorectal Cancer Screening on Cancer Incidence and Mortality in a Large
Community-Based Population. Gastroenterology, 155(5), 1383-1391.e5. doi:
10.1053/j.gastro.2018.07.017
Muthukrishnan, M., Arnold, L. D., & James, A. S. (2019). Patients' self-reported barriers to colon
cancer screening in federally qualified health center settings. Preventive Medicine
Reports, (15), 1-5.
Zauber A. G. (2015). The impact of screening on colorectal cancer mortality and incidence: has
it really made a difference?. Digestive diseases and sciences, 60(3), 681–691.
doi:10.1007/s10620-015-3600-5