BACKGROUND Despite proven effectiveness of colorectal cancer (CRC) screening, at least 35% of screen-eligible adults are not current with screening. Decision aids and risk prediction tools may help increase uptake, adherence, and efficiency of CRC screening by presenting lower-risk patients with options less invasive than colonoscopy. The purpose of this qualitative study was to determine patient and provider perceptions of facilitators and barriers to use of a risk prediction tool for advanced colorectal neoplasia (CRC and advanced, precancerous polyps), to maximize its chances of successful clinical implementation. METHODS We conducted qualitative, semi-structured interviews with patients aged 50-75 years who were not current with CRC screening, and primary care providers (PCPs) at an academic and a U.S. Department of Veterans Affairs Medical Center in the Midwest from October 2016 through March 2017. Participants were asked about their current experiences discussing CRC screening, then were shown the risk tool and asked about its acceptability, barriers, facilitators, and whether they would use it to guide their choice of a screening test. The constant comparative method guided analysis. RESULTS Thirty patients and PCPs participated. Among facilitators were the tool's potential to increase screening uptake, reduce patient risk, improve resource allocation, and facilitate discussion about CRC screening. PCP-identified barriers included concerns about the tool's accuracy, consistency with guidelines, and time constraints. CONCLUSIONS Patients and PCPs found the risk prediction tool useful, with potential to increase uptake, safety, and efficiency of CRC screening, indicating potential acceptability and feasibility of implementation into clinical practice.

中文翻译：

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大肠癌筛查的风险预测工具：对患者和提供者的促进因素和障碍的定性研究。

背景技术尽管已证明结直肠癌（CRC）筛查的有效性，但至少35％的筛查合格成人目前尚不接受筛查。决策辅助工具和风险预测工具可能会为低风险患者提供比结肠镜检查更具侵入性的选择，从而有助于提高CRC筛查的吸收率，依从性和效率。这项定性研究的目的是确定患者和提供者对促进晚期结直肠瘤形成（CRC和晚期癌前息肉）的风险预测工具的便利性和障碍的认识，以最大程度地实现成功实施临床的机会。方法我们在学术界和美国对50-75岁未接受CRC筛查的患者以及初级保健提供者（PCP）进行了定性，半结构化访谈。从2016年10月至2017年3月，在中西部的退伍军人事务医疗中心进行了调查。向参与者询问了他们目前关于CRC筛查的经验，然后向他们展示了该风险工具，并询问了该工具的可接受性，障碍，促进者，以及他们是否将其用于指导他们选择筛查测试。常数比较法指导分析。结果30名患者和PCP参加。促进者中的工具有可能增加筛查的吸收，降低患者风险，改善资源分配并促进有关CRC筛查的讨论。PCP确定的障碍包括对工具准确性，与准则的一致性以及时间限制的担忧。结论患者和PCP认为风险预测工具很有用，可以增加摄入量，安全性，