319 Barriers to Colorectal Cancer Screening With FIT in a Safety-Net Primary Care Clinic

Abstract

INTRODUCTION: Colorectal cancer (CRC) screening participation remains suboptimal, particularly among underserved populations. The Fecal Immunochemical Test (FIT) is the primary CRC screening test utilized in the primary care clinic at our large safety-net hospital. The clinic’s surveillance data shows that there is only a 20% FIT return rate within 4-6 weeks. To identify key barriers to FIT completion, we adopted a community-based participatory research (CBPR) approach to identify challenges to FIT completion in this safety net setting. METHODS: The CBPR approach included forming relationships with pertinent stakeholders including patients, resident physicians, nursing leadership, clinic directors and staff, and laboratory personnel. An eight-item survey assessing patient awareness of CRC screening and barriers to FIT completion was administered to randomly selected patients between the ages of 50-75 in the primary care clinic. A process map for FIT collection was subsequently devised after conducting interviews with the aforementioned stakeholders. RESULTS: The study population (n = 126) was comprised of a diverse population: 73% Hispanic (n = 93), 9% Black (n = 11), 9% White (n = 11), and 9% other races/ethnicities (n = 11). Among the cohort, 60.3% (n = 76) were up-to-date with FIT screening. 57% (n = 72) preferred Spanish when speaking to a healthcare provider. 22% (n = 27) reported not knowing the purpose of a FIT while 33% (n = 42) reported that their provider had not spoken to them about a FIT. We did not find a statistically significant difference among patients who completed and did not complete their FIT when analyzing for language barriers, lack of awareness, lack of provider communication, and understanding of instructions. When asked how the FIT could be made easier, 22% (n = 23) preferred to complete the FIT on the same day as their appointment. A discrepancy was found between the clinic-reported and patient-reported one-year FIT completion rates (60.3% vs. 76.7%, respectively). We found that the discordance was due to mislabeled/expired FITs which were discarded by the lab without notifying providers. CONCLUSION: By using CBPR grounded methods, the study identified potential areas of improvement to increase the FIT return rate, including proper handling of FITs and implementing a same-day FIT return policy. Interventions informed by this study are currently underway to increase same-day and same-week FIT return.