Perceived Barriers to Colorectal Cancer Screening among Physicians Who Routinely Recommend Screening in Tertiary Hospitals in Jos, Plateau State, Nigeria

Background: Colorectal cancer (CRC) is a leading cause of cancer related mortality worldwide. Increased incidence and mortality are projected in low-and-middle-income countries (LMICs) in the near future. Screening is suboptimal in LMICs and hindered by a multifactorial combination of barriers. This study assessed physicians perceived barriers to CRC screening on the provider, patient and system levels. Methods: This cross-sectional study was conducted among physicians who routinely screen patients for CRC in two tertiary hospitals in Plateau state, Nigeria. The study assessed provider, patient and system-related barriers to CRC screening from providers’ perspectives. Seventy-three physicians were selected using a multi-stage sampling technique. Data was collected using a semi-structured self-administered questionnaire. Results: A lack of knowledge of screening (63%) and lack of training to carry out screening tests (61.6%) were considered major physician-related barriers. Surveyed physicians identified a high number of patient-related factors such as financial constraints (86.3%), lack of insurance cover (75.3), low literacy (75.3%) and limited access to screening (71.2%) as major barriers. Most of the system-related barriers in the questionnaire were considered major barriers to screening including high screening costs (71.2%), lack of resources for screening (71.2%), long waits for GI endoscopy (68.5%), a shortage of trained doctors (60%) and lack of hospital screening policy (68.5%). Conclusions: Systemic barriers were the most identified barriers in this study, a pattern commonly seen in LMICs. Patient related barriers which are commonly associated with lower socioeconomic groups were also perceived to play a more prominent role than provider related barriers.