DECREASING VETERANS DESIRE FOR EARLY REPEAT COLONOSCOPIES

Purpose: People often prefer to undergo cancer screening tests more frequently than recommended. This study tested whether a health message promoting altruism could influence Veteran patients’ willingness to following screening recommendations, delay inappropriate early repeat colonoscopies and ensure maximal resource availability for all Veterans. 

Method: In a national survey of 757 VA patients exploring response to genetic tests that predict colorectal cancer risk, we asked participants to imagine having completed an initial colonoscopy, receiving results of a hypothetical genetic test that predicts colon cancer risk and then discussing their preferences with their physician about when to return for a repeat colonoscopy. Participants were told that the test suggested average genetic risk and that they should get colonoscopies “every 10 years.” Half of the participants were randomly assigned to receive additional information about potential resource constraints (e.g., scheduling delays) that can occur when patients at average risk return more frequently than recommended. Outcome measures included when the participant wanted to return for the next colonoscopy, whether they were OK being told they were not allowed to have a colonoscopy earlier than every 10 years based on an average genetic test result, and whether or not the participant would be willing to wait additional time to ensure that high risk patients could be screened first. 

Result: Despite receiving an average genetic risk test result and a clear recommendation for screening every 10 years, 52% of participants wanted to return earlier than 10 years. However, 73% were “Definitely OK or Probably OK” with the possibility that their average genetic test result would mean that they would not be allowed to have a colonoscopy more frequently than every 10 years. Furthermore, participants randomized to the group that received additional information on how returning earlier than recommend for colonoscopies can impact appoint times were more likely to be willing to voluntarily wait up to 2 years longer for an appointment (91% vs. 82%, p<0.001).

Conclusion: Even after being told that they have an average genetic risk of colon cancer, a majority of patients want to come back more frequently than recommended for their colonoscopy screen. However, this preference appears malleable, as the altruism intervention focusing on resource constraints had significant effects on screening timing intentions.