Purpose: 1) to explore variations in patient-physician conversations about colorectal cancer screening modality preferences and screening modality recommendation by their physician during an annual well visit; 2) to determine whether patients’ intent to follow up on a colorectal cancer screening recommendation is associated with patients’ preferred screening modality and physician recommendations.
Method: Eligible patients were aged 50-80, insured, and due for colorectal cancer screening at a scheduled well visit with an internal or family medicine physician practicing in Southeast Michigan. Study enrollment included a pre- and post-visit interview and office visit audio-recording. Enrolled patients’ (N=415) colorectal cancer screening modality preferences were identified using attribute rankings in the pre-visit interview. Self-reported intent to follow up on screening recommendation was evaluated with a post-visit interview (N=361).
Result: At baseline 48% of patients indicated a preference for colonoscopy, 30% for FOBT, and 22% had no clear preference. Most (69%) expressed a preference for a shared decision-making approach to colorectal cancer screening. However during the visit only 14% of patients expressed a clear colorectal cancer screening test preference to their physician, and this preference was generally for FOBT (70% of those who expressed a preference). In cases where patients expressed preferences for either FOBT or colonoscopy, these preferences were acknowledged by the physician 93% of the time. The most recommended test by physicians was colonoscopy; it was discussed in all visits, and recommended in 99% of visits. A test other than colonoscopy was mentioned in 47% of visits and recommended in 30% of visits; this other test was most often FOBT. When multiple screening modalities were discussed during the appointment, physicians typically (70% of these visits) offered the patients a choice among them. Following their appointment, an overwhelming majority (95%) of patients reported they were likely to follow up on the screening recommendation. Patient modality preferences and physician modality recommendations were not associated with the intent to be screened, possibly due to a ceiling effect.
Conclusion: Patients continue to have preferences for different colorectal cancer screening options. On the other hand, physicians appear to be overwhelmingly recommending colonoscopy screening, despite their willingness to acknowledge patient modality preferences if they are raised during appointments. Further efforts to encourage patients to clarify their preferences may improve colorectal cancer screening decision making.