Table 2 Barriers to colorectal cancer screening^a

Avoidance

“That know we should, but don’t do it anyway? It’s like I have 17 things to do on my to-do list in a day, and I never get more than eight of them done and it’s a matter of propelling it up into the top eight.”

“I probably wait a little bit. I probably get them and then don’t think about them right away. Usually my wife will find them and say, are you going to do this?”

“You don’t want to think about it.”

“I think if I recall, when I did it, it kind of wasn’t such a big deal. Almost like shaking my finger at myself. Why did you put it off so long? I do know that when I decided to do it and I set aside the time to do it, there was not a sense of urgency that I had.”

“I’d not been actually taking care of myself, that guy thing of ignoring the doctors and all… Basically just ignoring the fact that I was getting older.”

Test Specific Barriers

“I don’t want to test my poo at all, I don’t want to go anywhere near it. I want it in the toilet getting flushed. I just don’t want to deal with that part of it at all, that’s what I found disgusting about the whole thing was that you had to get samples of it to send in.”

“Just the idea of putting that in the mail somehow bothers me. Back when they were having problems with people supposedly sending anthrax in the mail, I was kind of almost horrified that you can send that in the mail and I was thinking it doesn’t seem sanitary…”

“Well, I didn’t go in and have a colonoscopy or anything like that. But I thought about it. But everybody I talked to, they said it hurts real bad.”

“I could probably produce a stool sample and take it in to them and let them deal with whatever comes after [that], but me having to poke the little sticky thing into it and put it in the bottle? That was very difficult for me.”

“I have a really strong gag reflex, I came really close to throwing up, but I did it anyway.”

“So I was thinking how in the world can someone go through these steps, go through this test [colonoscopy], and have it done comfortably? It would really help to make it a little less, I don’t know, arduous preparation?”

“Most of the time as an adult, from the time you’re a child, you were told not to play with your stool. Now here you are, you’re an adult and all these years have gone by where you’ve never played with your stool, and somebody’s asking you to play with your stool.”

“I know I was supposed to have a complete colonoscopy, but with my work schedule I couldn’t get that much time off to where - the day before you drink all the goop, you got to have that one and then the day of.”

“…it’s hard to put into words, but my best description of it is when you actually wipe yourself and you take a sample from it… and go through the procedure, following the basic steps as far as putting [it] in the little vial… It’s a little awkward.”

“They have you lay out the paper in the bowl and then just take the sample right off the paper. The only concern is it going to fall off the paper or whatever. But I’ve never had a problem with it so it’s not a concern anymore.”

“Having to flush yourself out for a few days, you do that and the day before, on the pot, on the toilet. Then you go in and the only thing you can think about the whole time is you’re starving. That’s about the size of it [colonoscopy].”

Fear

“Initially, I didn’t really understand it as a screening. For whatever reason ... I was thinking... if it comes up positive they’re going to whisk me into surgery or something.”

“I think people who are African American you have to let them know it’s not nothing scary, because we’re kind of leery and afraid, so information would be good.”

“I’m a positive person primarily and I probably would not want to introduce something into my world that’s negative. If I only have a month to live, I’d rather not know about it for about three weeks.”

“It’s not I would fear what the results might be, that’s one thing about it. I fear they might discover something, and then on the flipside of the coin I fear that if I don’t have it [colonoscopy] and there is something, that I waited too long.”

Health Concerns

“I just haven’t been able to really – with my irritable bowel syndrome, it’s really hard for me to even – some days I don’t produce a stool...”

“Yeah, I deal with diabetes, COPD… I got some other health issues. They kind of coincide and swirl around each other, and that pulls me down… I know it’s my weight. If I could get my weight off, I’d feel a ton better. I gained weight too because I’ve been sick. The doctor says it’s like sitting in the middle of a spinning circle…Just one big thing after another, going around and around my body.”

“Well, the reason that I haven’t in the past is if I have hemorrhoids really bad, they’re bleeding. ….Other than that, it would be no problem.”

“I’ve reached the point now – this is a foot injury which causes some side effects of using the toilet, and now I’m reaching the point where I can actually do the sample without risking injury.”