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Randomized Controlled Trial
. 2025 May;40(6):1280-1287.
doi: 10.1007/s11606-024-09128-4. Epub 2024 Oct 18.

Patient Perceptions on the Follow-Up of Abnormal Cancer Screening Test Results

Steven J Atlas  1 , Katherine L Gallagher  2 , Sydney E McGovern  2 , Amy J Wint  2 , Rebecca E Smith  3   4 , David G Aman  5 , Wenyan Zhao  3 , Timothy E Burdick  3   4   6   7 , E John Orav  8 , Li Zhou  8 , Adam Wright  9 , Anna N A Tosteson  3   4   10 , Jennifer S Haas  2
Affiliations
Randomized Controlled Trial

Patient Perceptions on the Follow-Up of Abnormal Cancer Screening Test Results

Steven J Atlas et al. J Gen Intern Med. 2025 May.

Abstract

Background: Timely follow-up after an abnormal cancer screening test result is needed to maximize the benefits of screening, but is frequently not achieved. Little is known about patient experiences with the process of following up abnormal screening results.

Objective: Assess patient experiences and perceptions regarding the process of a diagnostic workup following abnormal breast, cervical, or colorectal cancer screening results.

Design: Survey of participating patients between April 2021 and June 2022 after reaching the primary outcome time point in a randomized controlled trial to improve follow-up of overdue abnormal screening results.

Participants: Patients from 44 participating practices in three primary care practice networks.

Main measures: Self-reported ease of scheduling follow-up, perceived barriers or concerns, provider trust, and satisfaction with communication and care received for the follow-up of abnormal screening results.

Results: Overall, 241 (25.0%) patients completed the survey including 66 (32.8%) with breast, 79 (25.3%) with cervical, and 96 (21.3%) with colorectal screening test; median age 55 years, 79.7% women, 80.5% non-Hispanic white, and 51.0% did not complete recommended follow-up. Most patients were worried that the test would find cancer (63.1%), but fewer worried about discomfort or side effects (34.4%), and neither were associated with completing follow-up. However, 17% of patients did not think they needed follow-up tests or appointments and were less likely to complete follow-up (10.5% vs. 24.0%, respectively, p-value 0.009). Most patients were very satisfied with their overall care (71.0%), but only 50.2% strongly agreed that they trusted their provider to put their medical needs above all else when making recommendations.

Conclusions: Patients with overdue abnormal breast, cervical, and colorectal cancer screening test results reported important deficiencies in the management of recommended follow-up. Addressing patient concerns about fear of cancer and effectively communicating the need for follow-up procedures may improve timely follow-up after an abnormal cancer screening result.

Trial registration: ClinicalTrials.gov NCT03979495.

Keywords: abnormal results; cancer prevention; cancer screening; patient survey; primary care.

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Conflict of interest statement

Declarations:. Conflict of Interest:: The authors report no conflicts of interest relevant to this study. Design and Conduct of the Study:: The study was designed and conducted solely by the study investigators. Collection, Management, Analysis, and Interpretation of the Data:: The collection, management, analysis, and interpretation of the data were under the direction and performed solely by the study investigators. Preparation, Review, or Approval of the Manuscript:: The manuscript was prepared and reviewed by the study investigators. Decision to Submit the Manuscript for Publication:: The decision to submit the manuscript for publication was solely made by the study investigators. Access to Data:: Dr. Atlas had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

References

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