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Community-based Preferences for Stool Cards versus Colonoscopy in Colorectal Cancer Screening

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Summary

Background

In the United States, compliance with colorectal cancer (CRC) screening recommendations remains suboptimal. Professional organizations advocate use of shared decision making in screening test discussions, but strategies to facilitate informed choice in CRC screening have not been well elucidated.

Objective

The objectives of the study were to determine screening test preference among colonoscopy-naïve adults after considering a detailed, written presentation of fecal occult blood testing (FOBT) and colonoscopy and to assess whether their preferences are associated with demographic characteristics, attitudes, and knowledge.

Design

The design of the study was a cross-sectional survey.

Participants

Colonoscopy-naïve supermarket shoppers age 40–79 in low- and middle-income, multiethnic neighborhoods in Denver, CO, reviewed a detailed, side-by-side description of FOBT and colonoscopy and answered questions about test preference, strength of preference, influence of physician recommendation, basic knowledge of CRC, and demographic characteristics.

Measurements and Main Results

Descriptive statistics characterized the sample, and bivariate and multivariable logistic regression analyses identified correlates of screening test preference. In a diverse sample of 323 colonoscopy-naïve adults, 53% preferred FOBT, and 47% preferred colonoscopy for CRC screening. Individuals of Latino ethnicity and those with lower educational attainment were more likely to prefer FOBT than non-Latino whites and those with at least some college. Almost half of the respondents felt “very strongly” about their preferences, and one third said they would adhere to their choice regardless of physician recommendation.

Conclusion

After considering a detailed, side-by-side comparison of the FOBT and colonoscopy, a large proportion of community-dwelling, colonoscopy-naïve adults prefer FOBT over colonoscopy for CRC screening. In light of professional guidelines and time-limited primary care visits, it is important to develop improved ways of facilitating informed patient decision making for CRC screening.

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Acknowledgments

This study was supported in part by an American Cancer Research Scholar Grant in Cancer Control: Psychosocial and Behavioral Research MRSG-06-081-01-CPPB (Denberg, PI). Connolly Butterfield provided assistance with survey collection.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Department of Medicine, University of Colorado at Denver School of Medicine, Aurora, CO, USA

    Ann C. DeBourcy MD, Scott Lichtenberger MD, Susanne Felton MA, Kiel T. Butterfield BS, Dennis J. Ahnen MD & Thomas D. Denberg MD, PhD

Authors
  1. Ann C. DeBourcy MD
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  2. Scott Lichtenberger MD
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  3. Susanne Felton MA
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  4. Kiel T. Butterfield BS
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  5. Dennis J. Ahnen MD
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  6. Thomas D. Denberg MD, PhD
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Corresponding author

Correspondence to Thomas D. Denberg MD, PhD.

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DeBourcy, A.C., Lichtenberger, S., Felton, S. et al. Community-based Preferences for Stool Cards versus Colonoscopy in Colorectal Cancer Screening. J GEN INTERN MED 23, 169–174 (2008). https://doi.org/10.1007/s11606-007-0480-1

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  • DOI: https://doi.org/10.1007/s11606-007-0480-1

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