Physician use of persuasion and colorectal cancer screening

Abstract

The impact of patient-physician communication on subsequent patient behavior has rarely been evaluated in the context of colorectal cancer (CRC) screening discussions. We describe physicians' use of persuasive techniques when recommending CRC screening and evaluate its association with patients' subsequent adherence to screening. Audio recordings of N =414 periodic health examinations were joined with screening use data from electronic medical records and pre-/post-visit patient surveys. The association between persuasion and screening was assessed using generalized estimating equations. According to observer ratings, primary care physicians frequently use persuasive techniques (63 %) when recommending CRC screening, most commonly argument or refutation. However, physician persuasion was not associated with subsequent screening adherence. Physician use of persuasion may be a common vehicle for information provision during CRC screening discussions; however, our results do not support the sole reliance on persuasive techniques if the goal is to improve adherence to recommended screening. KeywordsColorectal cancer, Screening, Patient-physician communication, Persuasion Colorectal cancer (CRC) screening remains relatively underutilized compared to other evidencebased recommended preventive screening services [1]. 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. 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]. Yet, ambiguities remain regarding key patient-physician conversational content and techniques that may enhance the decision-making processes from the patients' perspective or improve adherence to physicianrecommended CRC screening. For example, Lafata and colleagues found that a physician recommendation that included not only advice to be screened but also a reason for screening, along with verbal assistance obtaining screening, resulted in a greater likelihood of screening use [25]. Ling, on the other hand, found that pa...

Impact of provider-patient communication on cancer screening adherence: A systematic review

“…There are also similarities among the five studies on colorectal cancer screening (13, 34, 36–38). These articles were generally more recent, with four of the five articles published between 2013 and 2015.…”

“…These articles were generally more recent, with four of the five articles published between 2013 and 2015. Three (13, 34, 38) audio-recorded provider-patient encounters and then coded this data using a previously published coding system or framework and measured adherence through chart review. The other two studies (36, 37) used patient self-report to measure the communication and screening adherence.…”

“…One study presented negative findings and reported that discussions of pros and cons and eliciting patient preferences were negatively associated with screening (34). In addition, one study found no significant difference between physicians’ use of various persuasive techniques and subsequent adherence (38). …”

“…Eight articles in this systematic review are noteworthy for examining more granular elements of provider-patient communication about cancer screening (13, 31, 33–38). From these few heterogeneous studies, one of the strongest indicators of screening adherence was the amount of provider enthusiasm and encouragement perceived by patients (33, 35, 37).…”

“…Other communication techniques that correlated with positive screening adherence were addressing patient barriers and clearly and thoroughly explaining screening procedures. Interestingly, providers’ use of persuasion techniques alone was not significantly associated with CRC screening adherence, although such techniques have not yet been studied in combination with other measures of quality of communication during screening discussions (38). …”