Physician-Patient Colorectal Cancer Screening Discussions by Physicians' Screening Rates

Abstract

Background: Most physicians report routinely recommending colorectal cancer (CRC) screening, but many eligible patients are not screened. To better understand this finding, we explored the relationship between the content of hypothetical patient-physician CRC screening discussions and CRC screening rates in physicians' practices.Methods: Semistructured interviews, including role-playing, with 24 primary care physicians explored their CRC screening approach with average-risk patients. Qualitative analysis examined physician-reported components of the CRC screening discussion, then compared findings between physicians with high (>60%, n ‫؍‬ 16) and low (<45%, n ‫؍‬ 8) CRC screening rates (based on HEDIS criteria). We conducted no statistical tests because of the small sample size and its exploratory aims.Results: High screeners used dramatic language (eg, patient stories) and mentioned risk of death, disability, or surgery from CRC in screening discussion role-plays more often than low screeners. High screeners frequently offered fecal occult blood testing, flexible sigmoidoscopy, and colonoscopy as equally acceptable screening options. High screeners more commonly described solutions for overcoming CRC screening barriers.Conclusions: Encouraging providers to use risk-specific messaging about the consequences of CRC, offering screening option choices, and promoting a problem-solving approach to surmount barriers are potential strategies for increasing CRC screening rates. (J Am Board Fam Med 2012;25:771-781.)

Physician use of persuasion and colorectal cancer screening

“…There is also now consistent evidence showing that only minimal information exchange occurs in the context of patient-physician CRC screening discussions, leaving little doubt that CRC decisions more often than not fall short of that recommended for informed decision-making [7,12,18,49]. Furthermore, prior studies have found associations between CRC screening and patient reports of informative discussions [9], physician enthusiasm [13], not having unanswered questions [6], and physician use of risk-specific messaging about the consequences of CRC [24].…”

“…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.…”

“…Approximately half of these studies relied on patient reports to understand these processes, while the remainder utilized direct observation methods. Among the latter, only four studies have evaluated the association of patient-physician communication content with patients' subsequent use of CRC screening [11,18,24,25]. Collectively, those studies have highlighted opportunities to improve patient-physician CRC screening decision-making processes relative to that which is recommended by experts [26].…”

“…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.…”

Prostate Cancer Decision-Making, Health Services, and the Family Physician Workforce

“…Read some of the telling comments in Xu et al 1 Three articles in this issue are on colon cancer screening. Baldwin et al, 2 in a study with an excellent methodology, observed physicians with high or low patient screening rates with simulated patients and compared the 2 groups of physicians. Their results provide dramatic help in how to get patients to carry through with screening, including consequence messaging and problem solving (see the article for more).…”