Physician colorectal cancer screening recommendations: An examination based on informed decision making

Abstract

Objective-The purpose of this research was to examine the content of physicians' colorectal cancer screening recommendations. More specifically, using the framework of informed decision making synthesized by Braddock and colleagues, we conducted a qualitative study of the content of recommendations to describe how physicians are currently presenting this information to patients.Methods-We conducted semi-structured interviews with 65 primary care physicians. We analyzed responses to a question designed to elicit how the physicians typically communicate their recommendation.Results-Almost all of the physicians (98.5%) addressed the "nature of decision" element. A majority of physicians discussed "uncertainties associated with the decision" (67.7%). Fewer physicians covered "the patient's role in decision making" (33.8%), "risks and benefits" (16.9%), "alternatives" (10.8%), "assessment of patient understanding" (6.2%), or "exploration of patient's preferences" (1.5%). Conclusion-Wepropose that the content of the colorectal screening recommendation is a critical determinant to whether a patient undergoes screening. Our examination of physician recommendations yielded mixed results, and the deficiencies identified opportunities for improvement.Practice implications-We suggest primary care physicians clarify that screening is meant for those who are asymptotic, present tangible and intangible benefits and risks, as well as make a primary recommendation, and, if needed, a "compromise" recommendation, in order to increase screening utilization. Keywords

Patient–Provider Discussions about Colorectal Cancer Screening: Who Initiates Elements of Informed Decision Making?

“…29 Based on previous studies which have shown that provider recommendation and patient preference are important for completing CRC screening, IDM about CRC screening has been recommended by the USPSTF. [6][7][8]32,33 Our study corroborates other studies that indicate that either no CRC screening discussion occurs or that limited information is exchanged in patient-provider discussions about CRC screening, [9][10][11][12]17,27,28 however, only a few studies have analyzed recorded patient-provider discussions. 10,12,28 In the current study, the IDM element discussed most often (48 %) was the nature of the decision.…”

“…16,17 In addition, the patients' desire for input from trusted others should be considered in the CRC screening informed decision making (IDM) process. 12 To date, however, only a limited number of studies focused on assessing the IDM elements in the decision about getting CRC screening 9,10,12,27,28 and only a few evaluated IDM elements from recorded patient-provider discussions. 10,12,28 Since a patient-provider discussion is critical for a patient to make an informed decision about CRC screening, the evaluation of patient-provider discussions is important to determine the value of informed decisions on improving CRC screening rates.…”

The Effectiveness of a Physician-Only and Physician–Patient Intervention on Colorectal Cancer Screening Discussions Between Providers and African American and Latino Patients

“…13 Discussions of appropriate screening options, however, are often inadequate. [14][15][16] Furthermore, when these discussions are held, primary care physicians routinely recommend colonoscopy as their preferred test and rarely mention other tests. [17][18][19] Recent research, however, demonstrates that providing patients a choice of screening options may increase CRC screening completion, particularly among racial and ethnic minorities.…”

Physician use of persuasion and colorectal cancer screening

“…There have now been over a dozen reports describing patient-physician communication and decisionmaking in the context of CRC screening [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Approximately half of these studies relied on patient reports to understand these processes, while the remainder utilized direct observation methods.…”

“…Of the barriers and facilitators of CRC screening that have been studied, receipt of a physician recommendation has consistently been found to be associated with screening use [2]. Yet, at the same time, overall adherence to physician-recommended CRC screening remains low [3][4][5] and a 2010 National Institutes of Health (NIH) consensus statement on CRC screening specifically highlighted the need for research on the role of physician recommendation and CRC screening adherence [2].There have now been over a dozen reports describing patient-physician communication and decisionmaking in the context of CRC screening [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Approximately half of these studies relied on patient reports to understand these processes, while the remainder utilized direct observation methods.…”