Perceptions of Barriers and Facilitators of Cancer Early Detection: RESULTS part 2

Posted by James

Social Network Experience
Social network experience as a facilitator of cancer (Generic Nolvadex 10mg treating breast cancer that has spread to other sites in the body) screening. Some patients regarded their friends or family as a source of encouragement to undergo cancer screening. The concepts grouped under this category included advice from family members (spouse, children or siblings), advice from friends, family history of cancer, knowing someone with cancer (Xeloda drug used to treat stage III colon cancer in patients who had surgery to remove the cancer) or other related health-promotion programs in the popular media. Another source of encouragement that was found to be even more important than advice from family and friends was medical advice from healthcare professionals, such as doctors, nurses or medical assistants.

Regarding the influence of friends, one patient said: “Well, I was talking to a friend, and she told me since I was 40 I should start getting one, and ever since then, I’ve gotten a yearly mammogram.” Regarding a family history of cancer, another patient said, “My mom had cancer (Generic Danocrine treating endometriosis, symptoms of fibrocystic breast disease, orgiant hives) of the breast and as an obligation, I have to have the mammogram done every year.” A majority of patients were encouraged to undergo cancer screening if their physician recommended it to them. One patient said, “I always have it when my doctor tells me,” and another said, “I listen to my doctor.”

Social network experience as a barrier to cancer (Revia 50mg is used for treating alcoholism and narcotic (opioid) addiction in adults, as part of a complete treatment program) screening. Knowledge of someone who was harmed by the cancer screening procedure and discouragement from family or friends acted as hindrances to cancer screening for some patients. A patient reported not wanting to undergo screening sigmoidoscopy because of discouragement from a family member about the pain associated with the procedure: “My mom had one and she suffered a lot. It’s painful.” Accessibility of Services Accessibility as a facilitator of cancer (Arimidex canadian is used to treat breast cancer in women who have gone through “the change of life”) screening. Issues related to the category of accessibility of services included a patient’s insurance status or access to care, the availability of affordable screening services, having adequate transportation to screening sites, the location of screening sites, health provider availability and convenient C/MHC practice hours. Regarding cost, one patient said that she has a mammogram every year because her job provides free yearly mammograms.

Table 3. Facilitators Cited by Women

If tested previously, what encouraged you to have the specific test? *
Mammogram			Pap	Home	Sigmoid-
				FOBT	oscopy
	n=178		n=179	n=106	n=35
	N	%	N   %	N   %	N   %
Patient Attitudes and Beliefs
Screening is routine/recommended for women my age	79	45	59   33	11    9	6   18
Wanting to care for one’s self/seeking reassurance about health	55	31	60   34	11   11	4   11
Social Network Experience
Medical recommendation	90	51	70   39	76 72	20  57
Personal health/cancer history	23	13	32   18	26 25	12  34
Family history of cancer	5	3	3    2	2   2
Advice from family and friends/knowing someone with cancer	3	2	1     1	1    1
Information from the media	3	2	2    1
Accessibility
Convenient location of screening/screening covered by insurance	2	2
Don’t know/other/no response	2	2	7    4	6   6	2    6
If not tested previously, what would encourage you to have a home FOB!’/sigmoidoscopy? *
		Home FOBT		Sigmoidoscopy
		n=60		rv	=88
		N	%	N	%
Patient Attitudes and Beliefs
Wanting to care for one’s self/seeking reassurance about health		8	13	13	15
Screening is routine/recommended for women my age		2	4	2	2
Reassurance about pain		1	2	2	2
Social Network Experience
Medical recommendation		22	37	47	54
Personal health/cancer history		12	20	17	19
More Information		3	5
Family history of cancer		3	3
Accessibility
Affordable cost		1	2
Don’t know/other/no response		20	33	16	19
* Women could mention more than one facilitator for each screening behavior. Among respondents, only seven had never previously
had a mammogram and only four had never had a Pap test, so we do not present the frequencies of barriers to these two tests here,
but discuss them in the text.

Accessibility as a barrier to cancer (Hydroxyurea 500mg is an antineoplastic agent) screening. External factors, such as cost, a lack of transportation, and inconvenient practice locations, were cited as barriers to cancer screening. One patient said the following about the mammogram: “I don’t want to go to another place for the exam. I don’t want to travel. It [the screening site] should be easy to get to.”

Frequencies of Barriers and Facilitators
In order to provide context for patients’ responses, we calculated the frequencies of common responses to the open-ended questions asked during the interviews separately for each cancer screening. Tables 3 and 4 show the prevalence of the various concepts elicited from each open-ended question. Because most patients had previously had a mammogram and a Pap test, the number of women who were asked about barriers to these tests was quite low, and we do not present the frequencies of barriers for either test in the tables. As shown in Table 3, medical advice was the most common facilitator cited by patients across all three cancer (Casodex 50mg is an oral non-steroidal anti-androgen for prostate cancer) screening behaviors, followed by routine medical care and caring for one’s self (mammography and Pap) and a patient’s personal medical history (hFOBT and sigmoidoscopy). Less commonly cited facilitators included a family history of cancer and information from the media. If we take the individual screening tests, mammography and Pap smears had similar frequencies for all facilitators. All the factors listed in the table were less frequently cited as facilitators of colorectal cancer screening, except for medical advice and personal medical history. Personal medical history was a more frequently identified facilitator of colorectal screenings than of mammogram and Pap tests. In addition, many more patients considered mammogram and Pap as routine compared to colorectal screenings.

Table 4. Barriers to Obtaining Colorectal Cancer Screening

For those not previously screened: What has kept you from/Why haven’t you considered having home FOB1′/sigmoidoscopy?
Home FOBT    Sigmoidoscopy n=60              n=88 N      %            N      % Patient Attitudes and Beliefs Lack of cancer screening knowledge                                           17     28         38     43 Perception of not needing the test/misinformation                            22     37          26     29 Esthetics/don’t like idea                                                              3      5           3      3 Fear of pain                                                                            1       2          13     15 Low self-efficacy for the screening procedure                                  2      3
Social Network Experience Lack of medical recommendation Family discouragement Knowledge of someone harmed by test	CO	13	9 1 1	10 1 1
Accessibility Cost of test Language barrier	1 1	2 2
Don’t know/other	6	10	1	1
For those who indicate no intent to have a given test in the future: Why don’t you plan to have a (specific test) in the future?* Patient Attitudes and Beliefs Perception of not needing the test/misinformation Esthetics/don’t like idea Lack of cancer screening knowledge Fear of pain Low self-efficacy for the screening procedure Competing priorities	Home FOBT n=18 N      % 5     28 1                6 3      8 2               11 1       6		Sigmoidoscopy n=36 N      % 15     42 4      11 4      11
Social Network Experience Lack of medical recommendation	5	28	6	17
Accessibility Cost of test No transportation	1 1	6 6
Don’t know/other/no response	4	22	5	14
* Women could mention more than one barrier for each screening behavior. Only seven women indicated having no previous mammography and only four indicated no previous Pap. An additional two women who previously had received a Pap test indicated that had no intention to have another in the future. These results are discussed in text.

In general, patients cited fewer barriers than facilitators. As described above, because most patients interviewed had received at least one mammogram or a Pap test, only a small number of patients were asked about barriers to having these tests (those patients who had received a screening were not asked about barriers to having that test). The most commonly cited barrier to breast and cervical cancer screening behavior was the perception of not needing the test due to good health or an absence of symptoms attributable to ill health. For colorectal cancer (Generic Xeloda is the only FDA-approved oral chemotherapy for both metastatic breast cancer and adjuvant and metastatic colorectal cancer), the perception of not needing the test due to good health or an absence of symptoms and a lack of knowledge were the main barriers cited for not obtaining or considering screening. Another important barrier elicited from patients was the fear of pain and fear of having the test. Fear of pain was the most commonly cited reason for not planning to have a mammogram in the future and the third most commonly cited reason for not having had a sigmoidoscopy. Lack of clinician recommendation and the perception of not needing the test were the two main reasons cited for not planning to have a hFOBT in the future. Other less frequently cited barriers included cost of screening test, lack of transportation, and not having enough time (competing priorities).