Barriers to colorectal cancer screening: a single-center prospective cohort study

Abstract

Objective. Determine barriers to colorectal cancer (CRC) screening before colonoscopy in patients. Materials and methods. We conducted a prospective, open-label cohort study at a single center, involving 200 patients from the endoscopic department between June 2020 and January 2024. Patients were divided into two groups: those undergoing colonoscopy with sedation (n = 100) and those without sedation (n = 100). We conducted a questionnaire of patients about the reasons for colonoscopy and an analysis of the most difficult period of the study depending on procedural sedation (PS). The intensity of the pain syndrome was assessed using a numerical rating scale (NRS). Patient satisfaction with the study was estimated on a ten-point scale. The percentages were compared using Pearson’s χ2 criterion. For quantitative measures not normally distributed, the Mann - Whitney U-test was used to compare the two groups. Results. Abdominal pain during primary and repeated colonoscopies without sedation, fear of general anesthesia, lack of awareness of patients about the indications of colonoscopy with sedation and financial difficulties are among the barriers to CRC screening before colonoscopy. The pain level in the patients of the group without sedation was 5.00 (3.00-6.00) points according to NRS. The satisfaction of patients in the PS group was 100%. Patients in the sedated group expressed their readiness to undergo a second colonoscopy under conditions of drug-induced sleep. Conclusion. Fear of pain is one of the main barriers to CRC screening in patients before primary and repeat colonoscopies. Patients with chronic diseases, insufficient social support, fears, and fatalists need medical consultations and the elimination of screening barriers. Patients’ awareness of colonoscopy insurance is one of the effective motivating factors.