Eliciting vulnerable patients’ preferences regarding colorectal cancer screening: a systematic review

Abstract

BackgroundPatient preferences are important to consider in the decision-making process for colorectal cancer (CRC) screening. Vulnerable populations, such as racial/ethnic minorities and low-income, veteran, and rural populations, exhibit lower screening uptake. This systematic review summarizes the existing literature on vulnerable patient populations’ preferences regarding CRC screening.MethodsWe searched the CINAHL, PsycINFO, PubMed, Scopus, and Web of Science databases for articles published between January 1, 1996 and December 31, 2017. We screened studies for eligibility and systematically abstracted and compared study designs and outcomes.ResultsA total of 43 articles met the inclusion criteria, out of 2,106 articles found in our search. These 43 articles were organized by the primary sub-population(s) whose preferences were reported: 27 report on preferences among racial/ethnic minorities, eight among low-income groups, six among veterans, and two among rural populations. The majority of studies (n=34) focused on preferences related to test modality. No single test modality was overwhelmingly supported by all sub-populations, although veterans seemed to prefer colonoscopy. Test attributes such as accuracy, sensitivity, cost, and convenience were also noted as important features. Furthermore, a preference for shared decision-making between vulnerable patients and providers was found.ConclusionThe heterogeneity in study design, populations, and outcomes of the selected studies revealed a wide spectrum of CRC screening preferences within vulnerable populations. More decision aids and discrete choice experiments that focus on vulnerable populations are needed to gain a more nuanced understanding of how vulnerable populations weigh particular features of screening methods. Improved CRC screening rates may be achieved through the alignment of vulnerable populations’ preferences with screening program design and provider practices. Collaborative decision-making between providers and vulnerable patients in preventive care decisions may also be important.

Motives for non-adherence to colonoscopy advice after a positive colorectal cancer screening test result: a qualitative study

“…Several studies found that in making CRC screening decisions most individuals prefer to consult their physician [52][53][54]. This might be especially the case for vulnerable patients such as racial/ethnic minorities and lowincome individuals as these groups exhibit lower screening uptake [55]. This shared decision making should not only focus on the colonoscopy as a yes or no option, but should also function as a counselling opportunity to offer participants emotional support and strategies for coping with the positive FIT in case of not (yet) undergoing the colonoscopy.…”

Comparative cost‐effectiveness of mailed fecal immunochemical testing (FIT)–based interventions for increasing colorectal cancer screening in the Medicaid population

“…For these reasons, fecal testing is a preferred testing modality by many low-income individuals. [9][10][11] Consequently, programs to increase CRC screening in low-income populations have leveraged the relatively simple and low-cost fecal test to encourage participation. 9,12,13 Multiple studies have demonstrated the effectiveness of such strategies, including mailing reminders and mailing fecal immunochemical test (FIT) kits to age-eligible individuals who are not up to date with screening.…”

Evaluating preferences for colorectal cancer screening in individuals under age 50 using the Analytic Hierarchy Process

“…To ensure uptake of recommendations, the choice of screening strategy should depend on the individual's preferences, test availability, and the strategy that the patient is most likely to complete and adhere to [1,6,9]. The existing literature on preferences for screening strategies shows high variability in preferences across studies [10][11][12][13] and, since guidelines have previously recommended screening at age 50, few studies have included younger people or explicitly tested differences in preferences by age.…”