Quantify patient-reported barriers relevant to diagnostic colonoscopy and describe recognition of colonoscopy as a CRC screening test to inform endoscopy service improvement.

Cross-sectional bilingual survey (community and hospital). Adults ≥18 years. Analysis restricted a-priori to respondents who had heard of CRC. Outcomes: (1) recognition of colonoscopy as a screening method (Yes/No/Don’t know); (2) prevalence of barrier domains (pain/bleeding concerns, embarrassment, bowel-prep aversion, anaesthesia concerns, access/distance, cost, information gaps, “unnecessary if asymptomatic,” no doctor advice, time constraints, personal/psychological factors). Likert items dichotomised (Agree/Strongly agree = barrier present). Descriptives and exploratory comparisons.

N=304; analysis set n=208 (heard of CRC). Median age 58 (IQR 53–62); 51% male; health-insurance 53%. Recognition of colonoscopy as a screening method: 62.5%. Most prevalent barriers: doctor did not advise screening 73%, unaware of benefits 72%, screening expensive 61%, unnecessary if asymptomatic 59%, fear of diagnosis 46%, pain/bleeding concerns 45%, distance/unavailability 42%, embarrassment 30%, time constraints 30%. Exploratory comparisons showed lower recognition among those endorsing “I do not deserve screening” (52% vs 64%).

Table 1. Cohort characteristics, primary outcome, and barrier prevalence

Analysis set: respondents who had heard of colorectal cancer (n = 208).

Barrier domains (Agree/Strongly agree)

Note: Barrier items measured on a 5-point Likert scale; Agree/Strongly agree treated as barrier present.

Fewer than two-thirds recognise colonoscopy as a screening test; information, access, and cost barriers dominate. Endoscopy services should implement standardised pre-assessment education, referrer prompts, cost/transport pathways, and targeted counselling on pain/anaesthesia to improve booking conversion and reduce DNAs for diagnostic colonoscopy.