Table 2.

Physicians’ Reasons for Specific Patients Not Being Up to Date With CRC Guidelines

ReasonIllustrative Quotation
Factors that hindered screening discussions
    Lack of opportunity to discuss screening
        Patients came in only for acute visits or problems[The patient] has always been a very acute care oriented patient and probably has only come to see me on maybe 3 occasions over the past 15 years. Hence, again, his inconsistent seeking of health care has led to failure to screen for colorectal cancer.
        Patients came in sporadically or saw other providers for health maintenance careHe gets his physicals at the VA hospital, so I really haven't considered myself in the position to offer him screening [since] I don't do [his] routine physicals, [which] is when I bring up this subject.
        No tracking systemShe generally presents for acute care, and honestly with … the intermittent few times I see her, I forgot to even bring up colorectal cancer screening. And so, I would put her down as an office system issue with no reminder tracking system.
        Not enough time during appointmentsI think the reason that he wasn't screened, and probably several other [patients], was just a matter of time in not getting everything done.
    Physician forgetfulnessSee quote above for “no tracking system”
    Assessment that cost or lack of insurance would be prohibitive to patientAnyway, the bottom line is he doesn't have any insurance and he doesn't have any money, and he's a truck driver kinda just barely scraping by.
    Patient had life issues or other health problems that distracted from screeningSo, basically, we're distracted and he's distracted by other [health] problems. I don't believe I've ever really pushed getting colon cancer screening.
    Expected patient refusal and/or lack of interestHe has no complaints, and I would suspect that he doesn't think that it is necessary, and he's not one that reads papers or talks about health care. I don't believe I've ever really pushed getting colon cancer screening 'cause I didn't think he would probably be real keen on it.
When CRC screening was discussed, but patient declined
    Cost of screening tests[She] won't do it because she doesn't have the finances and doesn't have insurance [that] will pay for the procedure.
    Lack of interest in screeningI think basically he's just your proverbial older rural Iowa retired farmer guy who kind of likes to leave things well enough alone … and so I'm not too surprised if he doesn't do everything that I tell him to do. [He] has not been screened because he has no interest in health prevention.
    Patient autonomyHis father actually died of colon cancer. I discussed this with him during a visit in 3/02, and he personally refused to undergo any type of screening. He's a clinical psychologist which means that he's actually given more latitude in running his own health care under the assumption that he has more inside information about health care, which may or may not actually be very true. The plan for him is to bring up colon cancer screening again in the future when he is here for an unrelated visit or perhaps a health maintenance visit.
    Patients had life issues or other health problemsHer husband had recently died. She had a depressive reaction associated with it and did not think it was necessary to do the screening.
    Fear of screening test procedureShe was not screened and … is resistant to have the colonoscopy due to the fear of the procedure.
    No symptoms or family history of CRC[He] has not been screened because he has no interest in … having a colonoscopy done unless he was having some symptoms that would require it.
  • CRC, colorectal cancer.