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Patient preferences for colon cancer screening

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Abstract

OBJECTIVE: To measure patient preferences for four different screening strategies: annual fecal occult blood testing (FOBT) alone; flexible sigmoidoscopy (FSIG) every 5 years alone; both annual FOBT and FSIG every 5 years; or no screening.

DESIGN: Survey.

SETTING: University internal medicine clinic.

PATIENTS: Convenience sample of 146 adults (aged 50–75 years) with no previous history of colon cancer.

INTERVENTION: Three-part educational program on colon cancer screening administered verbally by trained research assistants.

MEASUREMENTS AND MAIN RESULTS: Patient preferences for screening were measured at three points: after descriptive information about colon cancer and screening options (testing procedure information); after information about test performance but with no out-of-pocket costs (test performance information); and finally with hypothetical out-of-pocket costs (cost information). After only descriptive test information, the most popular strategies were FOBT alone (45%) or both tests (38%). Fewer patients preferred FSIG alone (13%). After information about test performance, more subjects preferred both tests (47%), and fewer subjects preferred FOBT alone (36%) (p=.12). With hypothetical out-of-pocket costs, the proportion preferring FOBT alone increased to 53%, while those preferring both tests decreased to 31% (p<.001). Less than 5% of patients preferred no screening.

CONCLUSIONS: Patient preferences for colon cancer screening were modestly sensitive to information about test performance and strongly sensitive to out-of-pocket costs. The heterogeneity of patients’ preferences for how to be screened supports informed shared decision making as a possible means of improving colon cancer screening.

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References

  1. US Preventive Health Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Alexandria, Va: International Medical Publishing; 1996.

    Google Scholar 

  2. Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology. 1997;112:594–642.

    Article  PubMed  CAS  Google Scholar 

  3. Mandel J, Bond J, Church T, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl J Med. 1993;328:1365–71.

    Article  PubMed  CAS  Google Scholar 

  4. Kronborg O, Fenger C, Olsen J, Jorgensen D, Sondergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348:1467–71.

    Article  PubMed  CAS  Google Scholar 

  5. Hardcastle J, Chamberlain J, Robinson M, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348:1472–7.

    Article  PubMed  CAS  Google Scholar 

  6. Selby J, Friedman GD, Quesenberry CP, Weiss NS. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992;326:653–7.

    Article  PubMed  CAS  Google Scholar 

  7. Centers for Disease Control and Prevention. Screening for colon cancer. MMWR. 1996;45:107–10.

    Google Scholar 

  8. Pignone M, Harris R, Kinsinger L. Changing cancer screening practice: physician or patient activation? J Gen Intern Med. 1997;14(Suppl 1):110.

    Google Scholar 

  9. Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? Soc Sci Med. 1997;44:681–92.

    Article  PubMed  CAS  Google Scholar 

  10. Coulter A, Entwhistle V, Gilbert D. Sharing decisions with patients: is the information good enough? BMJ. 1999;318:318–22.

    PubMed  CAS  Google Scholar 

  11. Greenfield S, Kaplan S, Ware J, Yano E, Frank H. Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3:448–57.

    Article  PubMed  CAS  Google Scholar 

  12. Flood A, Wennberg JE, Nease RF, Fowler FJ, Ding J, Hynes LM. The importance of patient preference in the decision to screen for prostate cancer. J Gen Intern Med. 1996;11:342–9.

    Article  PubMed  CAS  Google Scholar 

  13. Leard L, Savides T, Ganiats T. Patient preferences for colorectal cancer screening. J Fam Pract. 1997;45:211–8.

    PubMed  CAS  Google Scholar 

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Pignone, M., Bucholtz, D. & Harris, R. Patient preferences for colon cancer screening. J GEN INTERN MED 14, 432–437 (1999). https://doi.org/10.1046/j.1525-1497.1999.00018.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.1999.00018.x

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