Colorectal cancer screening at community health centers: A survey of clinicians' attitudes, practices, and perceived barriers

Tiffany Brown, Ji Young Lee, Jessica Park, Christine A. Nelson, Mary Ann McBurnie, David T. Liss, Erin O. Kaleba, Eric Henley, Padmini Harigopal, Laura Grant, Phil Crawford, Joseph E. Carroll, Kari Alperovitz-Bichell, David W. Baker*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Objective: Colorectal cancer (CRC) screening rates remain lower among some racial/ethnic groups and individuals with low income or educational attainment who are often cared for within community health centers (CHCs). We surveyed clinicians in a network of CHCs to understand their attitudes, practice patterns, and perceived barriers to CRC screening. Methods: A clinician survey was conducted in 2013 within the Community Health Applied Research Network (CHARN). Results: 180 clinicians completed the survey (47.9% response rate). Participants had an average of 11.5 (SD: 9.8) years in practice, 62% were female, and 57% were physicians. The majority of respondents somewhat agreed (30.2%) or strongly agreed (57.5%) that colonoscopy was the best screening test. However, only 15.8% of respondents strongly agreed and 32.2% somewhat agreed that colonoscopy was readily available for their patients. Fecal immunochemical testing (FIT), a type of fecal occult blood test (FOBT), was viewed less favorably; 24.6% rated FIT as very effective. Conclusions: Although there are no data showing that screening colonoscopy is superior to FIT, CHC clinicians believe colonoscopy is the best CRC screening test for their patients, despite the high prevalence of financial barriers to colonoscopy. These attitudes could be due to lack of knowledge about the evidence supporting long-term benefits of fecal occult blood testing (FOBT), lack of awareness about the improved test characteristics of FIT compared to older guaiac-based FOBT, or the absence of systems to ensure adherence to regular FOBT screening. Interventions to improve CRC screening at CHCs must address clinicians' negative attitudes towards FIT.

Original languageEnglish (US)
Pages (from-to)886-891
Number of pages6
JournalPreventive Medicine Reports
StatePublished - Jan 1 2015


  • Colorectal cancer screening
  • Community health centers
  • Healthcare disparities
  • Preventive medicine
  • Primary care providers

ASJC Scopus subject areas

  • Health Informatics
  • Public Health, Environmental and Occupational Health


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