Attitudes toward colorectal cancer screening tests

Abstract

Objective: To examine patient and physician preferences in regard to 5 colorectal cancer screening alternatives endorsed by a 1997 expert panel, determine the impact of patient and physician values regarding certain test features on screening preference, and assess physicians' perceptions of patients' values.

Design: Cross-sectional survey.

Setting: A general internal medicine practice at an academic medical center in 1998.

Participants: Patients (N=217; 76% response rate) and physicians (N=39; 87% response rate) at the study setting.

Measurements and main results: Patients preferred fecal occult blood testing (43%) or colonoscopy (40%). In patients for whom accuracy was the most important test feature, colonoscopy (62%) was the preferred screening method. Patients for whom invasive test features were more important preferred fecal occult blood testing (76%; P <.001). Patients and physicians were similar in their values regarding the various test features. However, there was a significant difference between physicians' perceptions of which test features were important to patients compared with the patients' actual responses (P <.001). The largest discrepancy was for accuracy (patient actual 54% vs physician opinion 15%) and discomfort (patient actual 15% vs physician opinion 64%).

Conclusions: Patients have distinct preferences for colorectal cancer screening tests that are associated with the importance placed on certain test features. Physicians incorrectly perceive those factors that are important to patients. Physicians should incorporate patient values in regard to certain test features when discussing colorectal cancer screening with their patients and when eliciting their screening preferences.

FIGURE 1

Patient and physician screening method preferences and physician recommendations. FOBT, fecal occult blood test; FS, flexible sigmoidoscopy; FOBT/FS, combination method; CS, colonscopy; DCBE, double-contrast barium enema. Patients preferred FOBT or CS, whereas physicians preferred FOBT, FOBT/FS, or CS (P = .001). Physicians recommend FOBT/FS most often, which is statistically different from patient preferences (P < .001) and physicians' preferences for themselves (P < .001).

FIGURE 2

Most important test feature in selecting a screening method. Percentages reflect the number of respondents who answered that the particular test feature was most important in selecting a colorectal cancer screening test. Patients and physicians are similar in valuing certain test features. Physicians' opinion of what patients value is statistically different from what patients say is important to them (P < .001).

FIGURE 3

Patients' most valued test feature and the screening method selected. Each column is a reflection of only those patients selecting a particular test feature as most important. For example, of the patients who value “discomfort” the most, 90% preferred fecal occult blood testing and 10% preferred colonoscopy. Not all columns add to 100% because only preferences for fecal occult blood testing and colonoscopy were included in this figure. The other screening methods were excluded from the data presentation because they were preferred in a minority of instances and also to simplify the presentation of the data. The preferred screening method chosen (fecal occult blood testing or colonoscopy) depends upon the test feature most valued by patients (P < .001).

FIGURE 4

Physicians' most important test feature in selecting a screening method. The preferred screening method chosen (fecal occult blood testing, combination method, or colonoscopy) depends upon the test feature most valued by physicians (P < .001). For example, the majority of physicians who valued discomfort selected fecal occult blood testing whereas those who valued accuracy selected the combination method or colonoscopy.