Multisite Evaluation of Cancer Screening Adherence, Barriers, and Predictors Among Emergency Department Patients

Emergency departments (EDs) are critical points of contact for patients at risk of missed preventive care, yet patient-level barriers to cancer screening remain poorly defined. We evaluated likelihood of scheduling cancer screening, perceived barriers, and predictors of screening willingness in our cohort.

We conducted a prospective, cross-sectional survey of adult ED patients (≥18 years) in 11 EDs in the National Alliance of Research Associate Programs (NARAP) network from March 2017 to December 2025. Patients reported cancer screening history; those not up to date were asked their likelihood of scheduling cancer screening within 30 days and perceived barriers. Multivariable ordinal logistic regression associations between screening likelihood and demographics and insurance status.

Among 31,740 surveyed patients, median age 51 (IQR 34-65), 57.5% female, 29.6% African American, and 19.4% Hispanic; 44.8% had Medicare/Medicaid, 40.3% private,8.7% none, and 6.2% unknown. Among patients not up to date, likelihood of scheduling screening was 36.7% for lung, 62.2% breast, 56.8% cervical, and 49.5% colorectal cancer. African American patients had higher odds of greater screening likelihood than White patients for breast (OR 1.76, p<0.001), cervical (OR 1.25, p=0.043), and colorectal cancer (OR 1.63, p<0.001). Compared with private insurance, Medicare/Medicaid was associated with lower likelihood of scheduling breast (OR 0.64, p<0.001) and colorectal screening (OR 0.70, p<0.001), with further reductions among patients with no or other insurance for breast (OR 0.40, p<0.001) and colorectal screening (OR 0.54, p<0.001). Among hesitant patients, lack of readiness was the most reported barrier (lung 22.5%, breast 21.4%, cervical 27.0%, colorectal 29.5%), followed by time constraints (14.7%, 16.8%, 19.8%, 16.7%, respectively). Transportation barriers (≤2.7%) and childcare needs (≤1%) were reported.

In this, multi-center ED cohort, fewer than two-thirds of eligible patients reported high likelihood of scheduling recommended cancer screening. Lower likelihood among patients with non-private insurance may indicate structural barriers. These findings suggest that ED-based cancer prevention efforts may benefit from system-level interventions beyond referral alone to address access and readiness-related barriers.