IMPACT OF MULTIPLE TEST OPTIONS ON INTENT-TO-SCREEN AMONG A PREVIOUSLY UNSCREENED POPULATION

Purpose: Colorectal cancer (CRC) screening is recommended for persons aged 50-75 who are at average risk of CRC. However, compliance with this recommendation has been historically low. In light of the introduction of a new stool-based CRC screening test, this study sought to understand the impact of educating patients on CRC screening test options on self-reported intent-to-screen within the next year.

Method: A web-based survey was developed for persons aged 50-75, who were at average risk of CRC, but who have not yet undergone screening. Respondents were asked a series of questions to gauge their perspectives on CRC screening, their knowledge of CRC screening tests, and, using a 5-point Likert-type scale, their baseline intent-to-screen in the next year (1=definitely not, 3=maybe, 5=definitely). Respondents were then introduced to the profiles of 5 available CRC screening tests: colonoscopy, flexible sigmoidoscopy (FS), fecal occult blood testing (FOBT), fecal immunochemical testing (FIT), and stool DNA testing. Each profile contained a brief description about the test, and information on dietary preparation, time requirements, physical discomfort, complication risk, frequency of testing, accuracy, and follow up. After reviewing the test profiles, respondents were asked another series of questions to elicit their preferred CRC screening option and the test attributes influencing their choice. They were then asked again, on the same Likert-type scale, their intent to undergo CRC screening in the next year.

Result: To date, 415 eligible persons have completed the survey, representing a diverse population in terms of gender, race/ethnicity, education, and income. Prior to reviewing the test profiles, the majority of respondents were unaware of CRC screening options other than colonoscopy. Following their introduction to various CRC screening tests, self-reported intent-to-screen increased significantly (p<0.05), using a one-tailed, paired t-test, from a mean (SD) of 2.89 (SD=1.20) to 3.61 (SD=1.19). 67% of patients indicated they had never discussed CRC screening with their physicians in the past; of the 33% of patients who had been counseled on CRC screening, most were recommended only colonoscopy.

Conclusion: Awareness of CRC screening options other than colonoscopy may increase patients’ intentions to undergo screening in the next year. These findings affirm the need to educate patients on the importance of CRC screening and to provide alternate test options to patients unwilling or unable to undergo colonoscopy.