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CAN GIVING PATIENTS WHAT THEY WANT INCREASE ADHERENCE TO COLORECTAL CANCER SCREENING?
MJ Sewitch, C Fournier
Purpose: To determine the relationship between patient preference for colorectal cancer (CRC) screening modality and patient adherence to physician CRC screening referral.
Methods: A prospective study was conducted of primary care physicians and their patients (aged 50-80 years, without past/current CRC). Patient preference for CRC screening modality was assessed by patient questionnaire at an index office visit. Physician CRC screening referral was assessed immediately after the index office visit by physician questionnaire. Matched on modality was defined as patients receiving a referral for either their screening modality of preference or having no modality preference. The outcome, patient adherence, was defined as undergoing the physician referral for fecal occult blood test (FOBT) within 6 months or for colonoscopy, double contrast barium enema (DCBE) or flexible sigmoidoscopy (FS), within 10 months.
Result: Participants included 43 primary care physicians and 605 of their patients. In total, 203 (34%) patients received a physician CRC screening referral (46% FOBT; 53% colonoscopy; 0.5% DCBE; 0.5% FS). Of these, 105 (52%) were adherent and 135 (67%) were matched on modality. A greater proportion of adherent patients were matched on modality compared to non-adherent patients (74% vs. 58%, p=0.0150). Multivariate analyses were stratified by gender because of a statistically significant interaction that was found between matched on modality and gender (p=0.0888). Men who were matched on modality were 3-times more likely to be adherent (OR= 3.49; 95%CI=1.28-9.56) compared to men who were not matched on modality. No association was found for women.
Conclusion: Giving men what they want in terms of CRC screening modality is associated with increased CRC screening adherence. Findings provide support for the role of ‘shared decision making’ in increasing patient adherence to CRC screening.