Colorectal Cancer Screening: Insights from A Prospective National Survey of Patients and Healthcare Providers

Abstract

Offering screening for colorectal cancer (CRC) to all age-appropriate and medically suitable patients is the standard of medical care in the United States. Provider advice is important for patients to accept screening for CRC. Previous research suggests that physicians’ self-directed screening practices might influence the screening choices they recommend for their patients. The way physicians discuss CRC screening also might influence what method patients select. This 2-part, web-based survey evaluated (a) whether screening options recommended to the patients of primary care physicians (PCPs), obstetricians, and gynecologists aligned with screening choices they selected for themselves, and (b) provider-patient communication factors that predict patient selection of colonoscopy for CRC screening. Results suggest that PCPs’ recommendations to their patients for CRC screening is not correlated with what PCPs select for themselves. PCPs elect to discuss screening options and let the patient choose. The second part of the study showed from the patient perspective, when multiple CRC screening options are presented, patients are less likely to select colonoscopy even though patients place high value on detection of precancerous polyps for which colonoscopy is the gold standard. Education to address these findings will require a better understanding of patients’ decision-making processes. Furthermore, strategies to better align physician-recommended patient CRC screening with what they select as “best practice” for themselves may be needed. However, education could be offered to better inform patients of the benefits and limitations of different CRC screening methods and help clinicians understand their implicit biases that may present in discussions with patients about options for CRC screening.