Barriers to Colorectal Cancer Screening in Adults: An Integrative Review

Colorectal Cancer (CRC) is the third leading cause of death among American men and women. Colorectal cancer is a preventable cancer, with CRC screening recommended from the age of 50. The percentage of people who complete the recommended CRC screening is low. Individuals throughout the United States (US) are rarely offered the opportunity to discuss screening options with their provider and may never complete CRC screening due to multiple barriers. The purpose of this scholarly integrative review is to explore the reasons individuals are not completing CRC screening, including those related to different US populations, and discuss interventions that can be implemented to increase CRC screening rates. A total of 17 articles, published during the period 2010-2020 were identified using five different databases, internet searches, and secondary references, and were included in an integrated review of literature. Themes were identified and analyzed using a theme matrix. Three main themes were discovered in relation to barriers to CRC screening: patient, system, and provider-related barriers. Many of the identified barriers related to CRC screening are interrelated and complex. The Health Belief Model (HBM) was the theoretical framework used to understand why individuals may not participate in CRC screening. The HBM is used to predict if individuals will adhere to screening recommendations depending on their perceived susceptibility to CRC, perceived severity of the condition, and whether perceived barriers are high. If perceived benefits are greater than perceived barriers, confidence in completing CRC screening will be higher. A multicomponent intervention is discussed, including a protocol for a nurse-led visit that was developed to identify a gap in patient education to address the individual barriers that were identified from the literature review. A framework was identified to evaluate the organization’s metrics and population barriers to assist in implementation of the multicomponent interventions. The strategies included were: assessing the infrastructure, interventions identified by the organization, process measures and quantifiable metrics, CRC screening phases, performance, outcome, and cost measures. The goal of implementing interventions is to increase the percentage of individuals who complete CRC screening. These recommendations will be most beneficial to populations with health disparities due to low social economic status, decreased health literacy, poor social networks, and being underinsured