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More Choices Increase Colorectal Cancer Screening Use

When people were offered a personal choice of either FOBT or colonoscopy screening by their primary care provider, more actually completed the test they chose than if only one option was offered.

In a study of  1,000 ethnically and racially diverse people, the lowest percentage had a colonoscopy when that was the only test offered.  More completed fecal occult blood testing if it was the single choice. Overall 65 percent of the 1,000 patients studied were screened after their doctor recommended testing.

Primary care providers randomly recommended patients be screened for colorectal cancer by:

  • Colonoscopy alone
  • FOBT alone
  • Their choice of colonoscopy or FOBT

In order to make colonoscopy easier, barriers to having the exam were reduced by:

  • Reducing or eliminating the patient’s cost for colonoscopy.
  • Providing information about the test and preparation for it in the language the patient preferred.
  • Providing rides to and from the exam.
  • Having an open access system with no more than 2 weeks between test recommendation and the scheduled procedure date.

While two out of three participants in the study had a recommended test:

  • 38.4 percent had a colonoscopy when it was the only recommendation.
  • 67.1 percent completed an FOBT when only FOBT was recommended.
  • 70.0 percent completed screening when they were given a choice between FOBT or colonoscopy.

During a follow-up survey, health beliefs that interfered with having a colonoscopy included

  • Fear of test results.
  • Fear of cancer treatment.
  • Concern that they wouldn’t be able to do the necessary prep.

John M. Inadomi and colleagues in the GI Health Outcomes, Policy and Economics (HOPE) Research Program at the University of California,San Francisco concluded:

Recommendation of colonoscopy alone results in lower adherence to any colorectal cancer screening test compared with recommendation for fecal occult blood test alone or choice of FOBT or colonoscopy.

SOURCE: Inadomi et al., Digestive Disease Week Abstract #124.

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