PREFERENCES FOR COLORECTAL SCREENING TESTS AMONG A PREVIOUSLY UNSCREENED POPULATION

Purpose: The current USPSTF CRC guidelines recommend screening for individuals aged 50-75 who are at average risk of CRC, and yet CRC screening rates in the US remain relatively low relative to other cancer screening rates in the US. In light of the recent approval of a new stool-based colorectal cancer (CRC) screening test, this study sought to understand patient preferences for CRC screening options in a previously unscreened population.

Method: A web-based survey was developed for persons aged 50-75 who were at average risk of CRC, but screening naive. Respondents were asked a series of questions to gauge their perspectives on CRC screening and knowledge of five existing CRC screening tests (colonoscopy, flexible sigmoidoscopy (FS), fecal occult blood testing (FOBT), fecal immunochemical testing (FIT), and stool DNA testing). Respondents were then introduced to a series of CRC test profiles, each of which contained a description, as well as information on dietary preparation, time requirements, physical discomfort, complication risk, frequency of testing, accuracy, and follow up of abnormal results.  After reviewing the test profiles, respondents were asked another series of questions to elicit their preferred screening option and the CRC test attributes influencing their choice.

Result: To date, 415 eligible persons have completed the survey. Among the 83% of respondents indicating their likelihood of undergoing screening in the next year was a 3 or higher on a 5-point Likert-type scale (1=definitely not, 3=maybe, 5=definitely) after being introduced to the test profiles, 40% would choose to receive colonoscopy and 37% would choose the new stool DNA test. Few respondents indicated they would choose FOBT (10%), FOBT (9%), or FS (4%). Among persons choosing colonoscopy, accuracy of the test at detecting cancer and polyps and frequency of testing were cited as the main drivers of preference (64%, 63%, and 41% of respondents, respectively). Among respondents choosing stool DNA, the low level of discomfort associated with the test, amount of time required to do the test, and test process were cited as the primary drivers of preference (45%, 41%, and 25% of respondents, respectively).

Conclusion: Educating patients about the full menu of recommended screening options, including stool DNA testing, and eliciting patient preferences that reflect the importance they place on individual test features can potentially increase participation among the unscreened population.