INTRODUCTION: Colorectal cancer is the second leading cause of cancer deaths in the USA. Although early detection through screening has been shown to be effective in preventing colorectal cancer mortality, adherence to screening guidelines remains low. Among certain populations--namely those with lower socioeconomic status, a greater number of chronic conditions or multiple morbidity, and those living in rural locations-- colorectal cancer screening is particularly underused. This study explored the prevalence of such screening and explanations for how multiple chronic conditions might affect colorectal cancer screening among an especially vulnerable group of middle-aged and older adults.

METHODS: In total, 41 participants were recruited aged 50-76 years with two or more chronic conditions, from three rural health clinics in Appalachian Kentucky, USA. Using semi-structured and structured questions and instruments, participants engaged in two interviews.

RESULTS: Study results demonstrate colorectal cancer screening rates lower than state and national averages. In addition to commonly expressed barriers including unpleasant screening modality, lack of health insurance, and shortage of gastroenterologists to perform colonoscopy, participants described the ways in which multiple morbidities undermine screening. Barriers specific to multiple morbidity include competing demands from other conditions, such as financial pressures, physical limitations, and worries over regimen interference.

CONCLUSION: The window of opportunity left open by more frequent visits to health care professionals should be used to patients' advantage, especially as people with multiple morbidity are living longer with their chronic conditions. Efforts must accelerate to establish clinical guidelines and practices incorporating both management of existing conditions and the prevention of additional future morbidity.