Article Figures & Data
Tables
Characteristic % No. FOBT=fecal occult blood test. Race/ethnicity White 35.7 60 Black 35.7 60 Hispanic 28.6 48 Sex, male 48.2 81 Education Less than high school 10.7 18 High school 41.1 69 More than high school 48.2 81 Have health insurance 88.1 148 Past testing FOBT 58.3 98 Colonoscopy 54.8 92 Flexible sigmoidoscopy 30.4 51 Barium enema 35.1 59 Family history of colorectal cancer 11.3 19 Attributes Mean Rank r̄a DCBE = double-contrast barium enema; COL = colonoscopy; FOBT = fecal occult blood test; FS = flexible sigmoidoscopy. a All significant at P <.001. Accuracy This test can find 24 to 50 of 100 cancers or advanced growths (FOBT) 3.58 0.63 This test can find 95 of 100 cancers or advanced growths (COL) 1.22 This test can find 70 to 80 of 100 cancers or advanced growths (FS) 2.18 This test can find 40 to 50 of 100 cancers or advanced growths (DCBE) 3.02 Amount of colon examined The colon is not examined directly (FOBT) 2.77 0.64 The entire colon is examined with these tests (COL, DCBE) 1.18 The lower third of the colon is examined with this test (FS) 2.04 Complications There are no complications with this test (FOBT) 1.52 0.38 For every 20,000 tests, 40 to 60 may result in a serious complication For every 100,000 tests done, 5 complications may result in death (COL) 3.33 For every 20,000 tests, 1 may result in a serious complication (FS) 2.20 For every 20,000 tests, 2 may result in a serious complication. For every 100,000 tests done, 1 to 2 complications may result in death (DCBE) 2.94 Cost and Insurance coverage The cost of the test is $10 to $25. Most insurance plans cover the cost of this test, and if you have Medicare you pay nothing (FOBT) 1.87 0.15 The cost of the test is $800 to $1,600. Most insurance plans cover the cost of this test. If you have Medicare, you pay about $42 after Part B deductible (COL) 2.90 The cost of this test is $150 to $300. Most insurance plans cover the cost of this test. If you have Medicare, you pay about $12 after Part B deductible (FS) 2.32 The cost of the test is $250 to $500. Most insurance plans cover the cost of this test. If you have Medicare, you pay about $28 after Part B deductible (DCBE) 2.90 Discomfort There is no discomfort with this test (FOBT) 1.35 0.50 If you have this test, you will experience cramping abdominal pain, diarrhea, and gas before and after the test but not during the test (COL) 1.91 If you have these tests, you will experience cramping abdominal pain, diarrhea, and gas before, during, and after the test (FS, DCBE) 2.74 Frequency It is recommended that you have this test done every year (FOBT) 2.15 0.07 It is recommended that you have this test once every 10 years (COL) 2.82 It is recommended that you have this test once every 3 to 5 years (FS) 2.26 It is recommended that you have this test once every 5 to 10 years (DCBE) 2.76 Location and person performing test The test is done by you at home, and a laboratory technician checks the cards (FOBT) 2.40 0.08 The test is done in the hospital by a physician specialist (COL) 2.11 This test can be done by a primary care doctor or a physician specialist in a doctor’s office or in a hospital (FS) 2.45 This test is done by a radiology technician in a hospital or outpatient facility DCBE) 3.03 Need for further testing If the test is abnormal, you would need to have another test (COL) to confirm the diagnosis (FOBT, FS, BE) 1.73 0.21 There is no need for further tests with this test (COL) 1.27 Need for sedation A shot to make you sleepy will not be given when you have this test (FOBT) 2.73 0.20 A shot is given to make you sleepy (COL) 1.81 A shot to make you sleepy will not be given when you have this test (FS) 2.73 A shot to make you sleepy will not be given when you have this test (DCBE) 2.73 Preparation for the test For 5 days before the test, you cannot eat red meat, certain fruits and vegetables, or vitamin C. You can take your medications (FOBT) 2.36 0.04 For 7 days before the test, you can’t take aspirin, Motrin, Advil, iron or vitamins. The day before the test, you can only have a clear liquid diet. The night before this test and between 5 and 6 on the morning of the test, you drink a glass of solution and 6 to 8 glasses of clear liquids that cause diarrhea, which empties your colon. On the day of the test, you cannot eat breakfast but can take your medications (COL) 2.77 After midnight on the night before the test, you cannot eat or drink anything. One hour before the test, you need to give yourself 2 enemas, which cause diarrhea and empty your colon. An enema is when you place liquid medicine into your bottom. On the day of the test, you cannot eat breakfast but can take your medications (FS) 2.71 The day before the test, you can only have a clear liquid diet. The night before and on the morning of the test, you drink a solution that causes diarrhea, which empties your colon. On the day of the test, you cannot eat breakfast but can take your medications (DCBE) 2.16 Scientific evidence Scientific studies show that having this test regularly in people aged 50 to 80 years will reduce the number of deaths from colon cancer (FOBT) 1.22 0.59 The scientific evidence is still being evaluated for these tests. There are as yet no studies showing that use of these tests reduce deaths from colon cancer (COL, DCBE) 2.75 Scientific studies suggest that regular testing after the age of 50 years might reduce deaths from colon cancer (FS) 2.02 Time for test Time required for the test is a few minutes on 3 separate occasions. You will not miss time off from your regular activities (FOBT) 1.68 0.09 It takes 45 minutes to have this test, but you will need a whole day off from your regular activities (COL) 2.29 It takes about 30 minutes to have either of these tests. You will need half a day off from your regular activities (FS, DCBE) 2.03 Patient’s responsibilities When you decide to have this test, you will have to alter your diet, pick up the test kit, put a sample of your bowel movement on the cards, and mail them or bring them to the laboratory (FOBT) 2.07 0.06 When you decide to have this test, you will have to alter your diet, make an appointment, buy the solution, and take the solution at home according to the instructions. You need to bring a responsible adult who can drive you home (COL) 2.48 When you decide to have this test, you will have to alter your diet, make an appointment, buy the enema solution, and give yourself the enemas at home according to the instructions (FS) 2.82 When you decide to have this test, you will have to alter your diet, make an appointment, buy the solution, and drink it at home according to the instructions (DCBE) 2.63 Attributes Totala (N=168) Non-Hispanic Whiteb (n=60) African Americanc (n=60) Hispanicd (n=48) a Reliability=0.96, r̄=0.13; P <.001. b Reliability=0.94, r̄=0.21; P <.001. c Reliability=0.85, r̄=0.09; P <.001. d Reliability=0.86, r̄=0.11; P <.001. Accuracy 4.30 3.40 4.62 5.03 Scientific evidence 5.31 4.72 6.16 4.99 Amount of colon examined 5.99 5.66 6.39 5.89 Need for sedation 6.66 6.33 7.17 6.44 Need for further testing 6.68 6.18 6.70 7.28 Your responsibilities 6.92 7.29 7.02 6.32 Complications 7.02 7.83 6.58 6.55 Location and who performs the test 7.05 6.94 7.14 7.08 Discomfort 7.52 7.86 6.46 8.41 Preparation 7.71 8.07 7.56 7.45 Cost 8.12 8.74 7.75 7.80 Frequency 8.35 8.18 8.38 8.52 Time for test 9.24 9.82 8.87 8.99 Short Description Ranking After Short Descriptiona Ranking After Short Description and all 13 Attributesb a Reliability=0.97, r̄=0.21; P <.001. b Reliability=0.98, r̄=0.19; P <.001. Fecal occult blood testing 1.89 2.60 This test checks if your bowel movement contains blood. It is done at home using a test kit with 3 cards. You smear a sample of your bowel movement onto a card. This is done for 3 different bowel movements. The 3 cards are then returned to the laboratory Colonoscopy 2.22 1.79 A doctor checks for growths or cancer in your whole colon using a flexible, long, narrow, lighted tube with a camera on the end. It is inserted into your bottom and then passed into your whole colon, which can be seen on a television screen. You are given medicine through a needle in your arm to make you sleepy during the test Flexible sigmoidoscopy 2.61 2.46 A doctor checks for growths or cancer in the lower third of your colon using a short, flexible, narrow, lighted tube with a camera on the end. It is inserted into your bottom and then passed only into your lower colon, which can be seen on a television screen. You are awake during the test Double-contrast barium enema 3.28 3.15 The doctor checks the outline of your colon for growths or cancers. A white liquid called barium is put into your bottom through a tube by a radiology technician. You must hold the liquid in while air is also put into your bottom. You are on a table that is moved around and then X-rays are taken with you in different positions. You are awake during the test
Additional Files
The Article in Brief
Informed Decision Making Changes Test Preferences for Colorectal Cancer Screening in a Diverse Population
Navkiran K. Shokar , and colleagues
Background Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Discussing colorectal cancer screening is challenging, however, because multiple tests are recommended, and the tests are very different and complex. This study set out to better understand patient preferences and decision making about colorectal cancer screening options.
What This Study Found Patients are clear about the qualities that they prefer in a colorectal cancer screening test, but no one test has them. Preferences vary across individuals and are not predictable. When making decisions about colorectal cancer screening, patients consider test accuracy, scientific evidence of effectiveness, amount of colon examined, and need for sedation.
Implications
- Because patient preferences for colorectal cancer screening tests vary and are not predictable, clinicians should discuss all available screening tests with patients. They should be sure to address test accuracy, since this is an important element in patient decision making.
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