Barriers and Strategies to Improve Colorectal Cancer Screening: Insights from a National Survey of African American Clinicians

Document Type

Journal Article

Publication Date

12-4-2025

Journal

Journal of the National Medical Association

DOI

10.1016/j.jnma.2025.11.001

Keywords

African American clinicians; Colorectal cancer screening; Health disparities; Health equity; Structural barriers

Abstract

INTRODUCTION: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality in the United States, with African Americans experiencing disproportionately higher incidence and worse outcomes. Despite modest gains following the Affordable Care Act, racial disparities in screening and follow-up persist. Few studies have centered the perspectives of African American clinicians, who are uniquely positioned to provide culturally concordant care and address structural barriers. METHODS: A cross-sectional electronic survey was administered to healthcare professionals attending the 2025 National Medical Association Annual Convention and Scientific Assembly in Chicago, IL. Eligible participants included physicians (MD/DO) and advanced practice practitioners (APPs) involved in adult patient care. The 23-item survey assessed clinician demographics, practice characteristics, CRC screening practices, patient education strategies, and perceived barriers. Responses were summarized using descriptive statistics, and open-text data were thematically categorized. RESULTS: A total of 141 clinicians (97.8% African American; 95.7% physicians) participated. Most respondents (82.1%) reported initiating CRC screening at age 45 in accordance with U.S. Preventive Services Task Force guidelines. Colonoscopy was the most commonly used modality (94.2%), with stool-based tests (86.2%) also widely implemented. Despite guideline adherence, only 30.4% estimated that >75% of their patients were up to date with screening. Completion of follow-up colonoscopy after abnormal stool-based testing was reported as a major gap, with fewer than half of clinicians indicating that most patients completed diagnostic evaluation. Patient-level barriers included test preparation (68.1%), fear of diagnosis (63.8%), and fear of pain (62.3%). Systemic barriers included insurance status (51.9%), cost (44.4%), and limited specialty access (45.2%). While nearly all clinicians (97.7%) reported counseling patients directly, fewer used supplemental educational tools or communitybased outreach. CONCLUSIONS: African American clinicians demonstrate high adherence to CRC screening guidelines but continue to face systemic and patient-level barriers that limit completion and follow-up. Racial concordance and cultural humility facilitate patient trust but are insufficient to overcome structural inequities. Findings highlight the need for multilevel strategies, including patient navigation, community outreach, EMR-based reminders, and insurance reform, to bridge the gap between guideline recommendations and real-world outcomes.

Department

Medicine

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