Colorectal cancer screening discussions: Maybe 3As is enough?

Abstract

7 Background: We evaluate the association of the 5A steps as recommended by the US Preventive Services Task Force (i.e., assess, advise, agree, assist and arrange) with adherence to physician-recommended colorectal cancer (CRC) screening. Methods: Audio-recordings of periodic health exams (PHEs) were joined with electronic medical record data and pre-visit patient surveys. Association of the 5A steps, as coded from audio-recordings, with CRC screening use was assessed using generalized estimating equation approaches. Results: Physician participants (n=64) were salaried primary care physicians. Patient participants (n=444) were insured, aged 50-80 years and due for CRC screening. Virtually all visits (n=415) included a discussion of CRC screening. When CRC screening was discussed, patients almost always (99%) received a physician recommendation for screening (advise). Over half were given assistance in obtaining screening (assist, 59%) and told why they were eligible for screening (assess, 56%). Few negotiated a plan (agree, 16%) or discussed follow up (arrange, 3%). Just over half (56%) of patients adhered to physician screening recommendations. Multivariable model results illustrate the importance of the assess and assist steps combined (OR=1.92 [95%CI 1.03-3.57]) for patient adherence to recommended CRC screening. Other variables significantly associated with screening use included discussion of CRC screening during history taking, and decreasing patient age and body mass index. Conclusions: A relatively simple discussion at the time of a CRC screening recommendation (Advise)—one that both describes the patient’s eligibility for screening (Assess) and provides verbal help regarding how to obtain screening (Assist)—may lead to improved adherence to CRC screening.