Fear as a Barrier to Asymptomatic Colonoscopy Screening in an Urban Minority Population with Health Insurance

This study identified barriers to colonoscopy in a high-risk population and examined associations between barriers and both intention to comply with physician recommendation to receive colonoscopy and documented receipt of colonoscopy. Participants, enrollees in a randomized controlled trial assessing the effectiveness of educational interventions to promote colorectal cancer screening, were all 50+ years old and out of compliance with recommended screening guidelines. Direct financial cost of the procedure was not a barrier. The most commonly cited barriers were being afraid of the colonoscopy procedure (43.1 %), embarrassment (42.3 %), having to take a powerful laxative (36.2 %), fear of cancer (31.2 %), and fear of sedation (30.3 %). There were dose-response relationships between barriers and both intention to comply with physician recommendation of colonoscopy: 0, 1, 2, 3 barriers, 88.9, 79.0, 69.2 and 60.0 % intending to comply, respectively (linear trend χ(2) = 27.9, p = .000) and documented receipt of a colonoscopy: 0, 1, 2, 3 barriers, 21.7, 21.6, 8.5, 12.0 %, respectively (linear trend χ(2) = 8.4, p = .004). Only 6.9 % of the 102 expressing both fear of procedure and concern about taking a powerful laxative had a colonoscopy. These findings highlight the need to address patients' fear and suggest the importance of offering alternative colorectal cancer screening tests. ClinicalTrials.gov Identifier: NCT02392143.