Physicians need better understanding of factors that patients use to decide about colorectal cancer screening
Research Activities, February 2012, No. 378
Although patient barriers to obtaining colorectal cancer (CRC) screening have been identified by researchers, physicians overestimate or underestimate the factors that patients consider in their CRC screening decisions, according to a new study. A better understanding of the influence of these factors may aid physician-patient interactions to encourage such screening, note the researchers. Because CRC is the third most commonly diagnosed cancer and the second leading cause of death in adult men and women, screening is important to detect the disease at an early, treatable stage. The researchers conducted 30-minute, semistructured interviews with patients, general internists, and family practitioners between 2004 and 2006. The interviews used a standardized script in which patients were asked about their knowledge of CRC, the factors influencing their screening decision, and their general decisionmaking process.
Physicians were asked to describe the factors that patients consider when deciding whether or not to have CRC screening. During the interviews, patients mentioned 16 factors (predisposing, enabling, or reinforcing) that influenced their CRC screening decisions. Patients described an average of 7.2 of these barriers each, in contrast to an average of 6.2 barriers cited by the 41 general internists participating in the study and an average of 10.9 barriers noted by the 25 participating family practitioners.
The factors most frequently mentioned by patients included personal well-being (96.7 percent), experiences of others and the screening process (both 86.7 percent), patient knowledge (83.3 percent), and physician recommendation (80.0 percent). The general internists under-reported all of the predisposing factors and some of the reinforcing factors and two enabling factors. Conversely, they over-reported most enabling factors and the influence of media as a reinforcer. Family practitioners under-reported only two of the predisposing factors: age and fear of cancer, and two of the reinforcing factors: assistance of others and experience of others. However, they over-reported the rest of the predisposing factors. The study was funded in part by the Agency for Healthcare Research and Quality (HS11845).
More details are in "Colorectal cancer screening: Patients' and physicians' perspectives on decision-making factors," by Yelena N. Tarasenko, M.P.H., M.P.A., Sarah B. Wackerbarth, Ph.D., Margaret M. Love, Ph.D., and others, in the Journal of Cancer Education 26(2), pp. 285-293, 2011.