Introduction: African Americans are less likely than other racial/ ethnic groups to receive appropriate surveillance, an important component of care to achieve better long-term outcomes and wellbeing after colorectal cancer (CRC) treatment. This study explored survivors' understanding of surveillance instructions and purpose. Patients and Methods: Interviews with 60 African American CRC survivors were recorded and transcribed. Compliance with surveillance guidelines was defined by disease stage and selfreported tests. Four coders (blind to compliance status) independently reviewed transcripts. Frequency of themes was reported by compliance status. Results: Survivors (4 to 6 years postdiagnosis; women, 57%; age ≥ 65 years, 60%; rural location, 57%; early-stage disease, 62%) were 48% noncompliant. Most survivors reported receiving surveillance instructions from providers (compliant, 80%; noncompliant, 76%). There was variation in recommended frequency of procedures (eg, every 3 or 12 months)andin importance of surveillance stressed by physicians. Most survivors understood theneedfor follow-up (compliant, 87%;noncompliant, 79%). Lack of knowledge of/interest in surveillance was more common among noncompliant individuals (compliant, 32%; noncompliant, 52%). Conclusion: Patients' limited understanding about the importance of CRC surveillance and procedures may negatively affect compliance with recommendations in African American CRC survivors. Clear and enhanced communications about post-treatment recommendations in this population are warranted. Copyright © 2014 by American Society of Clinical Oncology.