1. The 2011 Iowa Dialogue on Colorectal Cancer Iowa Colorectal Cancer Focus Groups: What We Learned Iowa Dialogue on Colorectal Cancer September 16, 2011 Lorrie Graaf, American Cancer Society

2. The 2011 Iowa Dialogue on Colorectal Cancer ACKNOWLEDGEMENT Focus groups were conducted and the final report was prepared by: Kellee Thorburn McCrory, MPH Project Director National Resource Center for Family Centered Practice University of Iowa School of Social Work

3. The 2011 Iowa Dialogue on Colorectal Cancer Research Question Why are people who have health insurance and access to care not getting screened for colorectal cancer?

4. The 2011 Iowa Dialogue on Colorectal Cancer Project Overview Received University of Iowa IRB approval Determined participant eligibility criteria Recruited and screened potential participants Focus Group Participation by Site SiteTotal recruitedTotal participated Garner, IA65 Des Moines, IA106 Iowa City, IA103 Iowa City75 Total3119

5. The 2011 Iowa Dialogue on Colorectal Cancer About the Participants Age – Mean age 55 years Place of residence – Majority suburban Education – Majority; college at some level Employment – 89% employed full or part-time Race/ethnicity – Caucasian and Asian

6. The 2011 Iowa Dialogue on Colorectal Cancer Focus Group Questions What do you think of when you think about colorectal cancer (CRC) screening? When it comes to getting screened for CRC, who do you trust to give you the most up-to-date information about the available screening tests? Have your family or friends talked about getting a CRC screening? What would help you make the decision to get screened for CRC?

7. The 2011 Iowa Dialogue on Colorectal Cancer What Participants Said: Thinking About CRC Screening Prep Time off work Considered self healthy Colonoscopy limitations NO ONE mentioned any of the other tests available for CRC Screening. All references were to Colonoscopy. “Also, my doctor has said it is not foolproof. That it can give you false readings that there is something there and can also not catch if there is something there” “I’ve been wanting to do it, but just to get the time and I think a lot of it is the fear factor, as far as might find”

8. The 2011 Iowa Dialogue on Colorectal Cancer What Participants Said Trust Information and Barriers Sources Physician Internet websites Barriers High deductibles Physician had not “pushed screening hard enough” “And so I’ve just been waiting for the doctor to ask again, but they never, they never mention it”

9. The 2011 Iowa Dialogue on Colorectal Cancer What Participants Said: Talked With Family or Friends Stories that influenced opinion Prep, several days off work, transporting, colonoscopy complications Peer or spouse pressure

10. The 2011 Iowa Dialogue on Colorectal Cancer What Participants Said: Decision to be Screened Eventually might be screened Reasonable cost/insurance covers cost Type of prep Physician “pushing” screening Symptoms Not interested in being screened Cost Current health status and behaviors Perceived test reliability

11. The 2011 Iowa Dialogue on Colorectal Cancer Survey Questions: Screening and Awareness QuestionYesNo Can’t Recall Has your doctor ever talked to you about colorectal screening? 42.152.65.3 Have you declined an opportunity to be screened for colorectal cancer? 15.878.95.3 Have you ever seen any advertising about colorectal cancer screening? 68.426.35.3

12. The 2011 Iowa Dialogue on Colorectal Cancer Conclusions Knowledge of need to be screened. Health insurance not a “green light”. Prep continues to be an issue. Repeated screening message from physician. Advertising provides the screening message, but it is not a motivator.