Colorectal Cancer Screening: Patients' and Physicians' Perspectives on Decision-Making Factors

Abstract

While patient barriers to colorectal cancer (CRC) screening have been identified, how well this knowledge is utilized during the patient-physician interaction is not fully understood. This study aims to assess among primary care physicians the degree of consensus between perceived and actual patients' CRC screening decision-making influential factors. During 2004-2006, 30 patients were interviewed to identify factors influencing screening decisions and 66 physicians were interviewed to understand what factors they thought were important to patients. The factors were categorized using the PRECEDE-PROCEED framework, and perspectives were compared. The researchers found little consensus on CRC screening decision-making influential factors between family practitioners, general internists, and patients. The recommendations to reach consensus are provided on the individual (e.g., updating the contents of a physician's screening recommendation to proactively address patients' decision-making needs) and population (e.g., providing cross-cultural training to medical students enabling them to better understand their patients) levels.

Systematic Review and Meta-study Synthesis of Qualitative Studies Evaluating Facilitators and Barriers to Participation in Colorectal Cancer Screening

“…And the queue's really long in hospital, right?" (82) Scheduling challenges (34,50,70,76,85,86,92,93) "It was more of a scheduling problem with the endoscopy clinic" (86) Cultural, gender, socioeconomic Natural remedies conquer CRC (11,54,59,68,69) "Back home we have a lot of good home remedies. These remedies can cure most anything.…”

“…Taking time off was not possible (17,42,63,66,84,86,96) "The time when the office or hospital is operand is not a good time for me. I work during the weekday and cannot get a day off" (96) Transportation and finding an escort was a challenge (36,84,85,88,92,96) "We do not have cars or a second car, and there is no public transportation in our area so it is not as easy to go see the doctor."…”

“…PCPs also influenced colorectal cancer screening participation both positively and negatively. PCPs who addressed the importance of asymptomatic screening helped individuals understand and value the purpose of screening (31), but many studies found PCPs did not frequently recommend colorectal cancer screening (17,49,50,52,58,61,62,67,68,70,76,86,96,97,101,102): "I would have been more encouraged to do the screening if I have been talked to by my GP" (18). Studies that explored the way PCPs communicate colorectal cancer screening recommendations found patients who received inadequate information about the pain and discomfort associated with endoscopy did not participate in repeat screening (51,80,81) and those who received inadequate FOBT instruction did not complete the test (97,103).…”

Making It Work: Health Care Provider Perspectives on Strategies to Increase Colorectal Cancer Screening in Federally Qualified Health Centers

“…The interview guide for the qualitative data collection was developed by the research team, based on published literature, [4, 19-21] and in collaboration with community partners, including representatives from FQHCs. The guide assessed providers' perspectives on the following content areas: (1) CRC information needs of patients, (2) factors that prevent or facilitate patient-provider discussion of CRCS, (3) strategies to enhance the efficacy of educational materials to increase CRCS, (4) patient factors that prevent or motivate uptake of CRCS, and (5) communication strategies and resources to enhance follow-up with CRCS recommendations.…”

Evidence, Values, Guidelines and Rational Decision-making

“…3 Weighing these estimates of potential benefits and harms, along with near-certain discomfort and some monetary and opportunity costs, an intelligent, rational, health-conscious adult might very well choose not to be screened. 4 As the doctor I may or may not agree with that decision, but it is the patient's values, not mine, that should drive the decision-making process.…”