Analysis of Barriers to and Patients' Preferences for CT Colonography for Colorectal Cancer Screening in a Nonadherent Urban Population

Abstract

OBJECTIVE The aim of this study was to evaluate patients' barriers against colorectal cancer screening tests and to assess patients' preferences and cost influences for CT colonography (CTC) in a nonadherent urban subpopulation. SUBJECTS AND METHODS Patients who had been offered colorectal cancer screening but were nonadherent were asked to participate in this questionnaire study. Patients' demographic information was obtained, and patients' reasons for not being screened were explored. Subjects were given an information sheet that described a CTC procedure and then were asked about their willingness to undergo CTC and about other relevant factors, such as fees. RESULTS One hundred seventy-five patients were invited to participate; 53 declined and 54 did not respond, which left 68 subjects to be included in the analysis. After being informed about CTC screening, most (83%) subjects stated that they would be willing to undergo a CTC study. However, 70% stated that they would not be willing to pay out-of-pocket fees if insurance did not cover the study, and even among the 30% who were willing to pay the fees, the average amount they were willing to pay (mean, $244; median, $150) was well below currently charged rates. CONCLUSION Our study suggests that most nonadherent patients would be willing to undergo CTC as long as out-of-pocket fees are reasonable.

Rescreening of Persons With a Negative Colonoscopy Result: Results From a Microsimulation Model

“…In the absence of data for CTC, we assumed adherence with the first CTC was equal to that with a repeat colonoscopy (that is, 52%) and that individuals on average have two CTCs by age 75. Many have suggested that adherence with CTC for initial screening may be higher than with colonoscopy (60–62), although such claims have been based on small single-institution studies. A Dutch population-based study found that screening uptake was higher for CTC vs. colonoscopy (63).…”

CT colonography: accuracy, acceptance, safety and position in organised population screening

“…However, the most decisive reason in colonoscopy was ‘unpleasantness of the examination’ while CTC non-screenees indicated ‘no time/too much effort’ and ‘lack of symptoms’ as most decisive reasons 43. Ho et al 44 found similar results for CTC in the USA: 38% of non-screenees declined screening due to procrastination and 12% because they were too busy.…”

Computed Tomographic and Magnetic Resonance Colonography: Challenge for Colonoscopy

“…A very attractive benefit of CT colonography is that it may provide an additional option for colon cancer screening in some patients. As highlighted above, some patients who have previously refused colon cancer screening would be willing to undergo CT colonography as a screening modality [3]. Further, evidence currently suggests that when patients are offered the option of noninvasive fecal immunochemical testing [73], CT colonography [4], or colonoscopy, colon cancer screening rates are higher with the noninvasive options.…”

“…Additionally, both tests are relatively simple for patients to do. A very important consideration is that since some 40% of patients eligible for colon cancer screening are not being screened, these tests offer an alternative, and some data suggest that some patients who would not otherwise agree to screening may agree to undergo CT colonography [3,4]. …”