Improving colorectal cancer screening by providing options.

Abstract

For adults with an average risk of developing colorectal cancer (CRC), providing screening options and considering patient preferences when helping them decide on which option may best suit them are important steps for improving CRC screening. This is the implication of a recent study published in Cancer Prevention Research, which found that most people at average risk of CRC prefer a stool-based screening test over a colonoscopy when they are educated on their screening options.1 Currently, clinical practice relies heavily on colonoscopy as the preferred screening tool. Improved screening is needed because approximately one-third of adults eligible for CRC screening in the United States have not completed screening, and there is a particular underuse of screening in various populations, including racial/ethnic minorities, certain age groups, and patients who are socioeconomically disadvantaged. In the study, investigators surveyed a sample of US adults from the general population aged 40 to 75 years and diverse in age, sex, race/ethnicity, and education on their preferred CRC screening method among 3 commonly used methods recommended by the US Preventive Services Task Force: fecal immunochemical test or guaiac-based fecal occult blood test (FIT/gFOBT); multitarget stool DNA (mt-sDNA); and colonoscopy. Of 5097 people surveyed, 1595 (31.3%) completed the survey. The survey found that most adult respondents favored stool-based screening over colonoscopy, with 65.4% preferring mt-sDNA and 61% preferring FIT/gFOBT over colonoscopy. More patients preferred mt-sDNA (66.9%) than FIT/gFOBT. Among the demographic factors correlating with a preference for stool-based screening over colonoscopy were insurance status (uninsured people were 2.5 times more likely to prefer this lessexpensive screening form), age (all age groups preferred mtsDNA over colonoscopy, although a larger proportion of adults aged 65 to 75 years preferred colonoscopy in comparison with those aged 45 to 54 years), race/ethnicity (50% of Hispanic and non-Hispanic Black respondents preferred mt-sDNA over FIT/gFOBT, although more non-Hispanic White adults preferred mt-sDNA in comparison with non-Hispanic Black and Hispanic adults), and CRC screening awareness and history (patients who previously had a stool-based test were 2.8 times more likely to choose FIT/gFOBT over colonoscopy, and those aware of stool-based methods were 2 times more likely to prefer mt-sDNA over FIT/gFOBT). “These findings underscore the importance of continuing to offer CRC screening options to patients and encourage health care providers to engage their patients in shared decision making to discuss various available CRC screening options in alignment with patient needs and preferences,” says the lead author of the study Xuan Zhu, PhD, senior health services analyst at the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery in Rochester, Minnesota. Potential strategies to improve CRC screening, she says, include patient education, use of shared decision making, and providing patient navigation support as needed throughout the CRC screening continuum.