Finally, reinforcement is critical. Screening cannot be effective if measures are not in place to remind physicians when patients are due for screening or if physicians forget to act on abnormal results. The same framework explains patient behavior. Knowledge is the first problem. Some Americans have never heard of colorectal cancer, let alone the screening measures for this malignancy.
Attitudes pose an even bigger barrier for patients.
They find fecal occult blood testing distasteful, and they anticipate discomfort and embarrassment with endoscopy or barium enema. Those who want to be screened may lack ability. Reading and language barriers can make instructions useless. Older patients with poor vision or manual dexterity cannot collect stool specimens. Limited insurance and lack of access to physicians can create further impediments.