Patient-rated importance of key information on screening colonoscopy in Germany: a survey of statutory health insurance members

Abstract

Background: Primary colonoscopic screening is considered to be of great benefit but also has the potential to cause severe harm. Thus, eligible subjects should be supported in making an informed choice whether to participate.

Objectives: To identify information on screening colonoscopy that colonoscopy-naïve subjects rate as particularly important for decision making.

Design: Survey of German statutory health insurance members using a written questionnaire in November 2015.

Study population: Colonoscopy-naïve individuals aged 50 to 65 years.

Main outcome measures: Importance of key information about screening colonoscopy, including potential risks and benefits, baseline risk of colorectal cancer/polyps and practical aspects of the procedure, as well as associations between participants' characteristics and their judgement of information as to being 'very important'.

Results: Of 1871 respondents (overall response rate: 31%), a subgroup of 370 colonoscopy-naïve subjects was eligible for inclusion (average age: 55 years, 47% male). Information on the risks was rated as very important by most respondents, unimportant by 6%. Information on the benefits was considered unimportant by 26%. Regression analysis showed that less educated persons regarded most items to be more often relevant than highly educated subjects. A greater proportion of women than men rated details regarding pain and practical aspects as very important. Subjects with a low educational level living alone were identified as the group with the least interest in information on risks.

Conclusion: Cultivating awareness around the central meaning of the (quantitative) benefits of screening in informed decision making should be focused on more in future information materials. The high requirement of less educated people to become more informed provides a strong motivation for further efforts to develop evidence-based information that adequately informs this group. Tailoring information according to gender-specific needs may be warranted in light of the observed differences in information preferences between women and men.

Keywords: colonoscopy; colorectal cancer; decision aids; early diagnosis; preventive medicine; screening.

Figure 1

Flow chart of the study population.

Figure 2

Importance of key information about screening colonoscopy (n=354–365). *Responses from employed persons only (n=279).

Figure 3

Importance of key information about screening in women and men (n=352–363). *Responses from employed persons only (n=279).

Figure 4

Importance of key information about screening colonoscopy by educational level (n=346–357). *Responses from employed persons only (n=278).

Figure 5

Information on risks and side effects of colonoscopy: percentage of ‘very important’ ratings stratified by sex, educational level and household size (n=353).