Informed Decision-Making

National guidelines recommend informed decision-making when it comes to choosing a colorectal cancer (CRC) screening modality,1-3 as evidence has shown that this strategy may improve screening adherence.4 With informed decision-making, healthcare providers offer options and describe their risks and benefits, and patients express their preferences and values.5 Informed decision-making is important for any age group, and guidelines emphasize informed decision-making related to screening in those older than 75 years.1-3,6 A healthcare provider’s recommendation for a specific CRC screening modality may improve screening adherence,7 assisting in early detection of CRC and potentially reducing CRC incidence and mortality.8

National screening guidelines recommend informed decision-making related to CRC screening1-3

Patient adherence to CRC screening increased by 31% when patients were given a choice of test compared with only offering colonoscopy4

“In some instances, the ‘best’ screening test can be considered the one that is acceptable to the patient and gets completed”3

Offering Patients a Choice of Screening Method May Improve Screening Rates4,a

Offering patients a choice of colorectal cancer screening method may improve screening rates. Figure shows screening rates of 67% in FOBT arm, 38% in colonoscopy arm, and 69% in patient choice arm. The patient choice arm resulted in a 31% absolute increase in patient adherence.
  • In a randomized clinical trial of racially/ethnically diverse adults aged 50-79 years at average risk of CRC (n=997), healthcare providers offered patients CRC screening with fecal occult blood testing (FOBT), colonoscopy, or patient choice for either and choice of screening modality resulted in a 31% absolute increase in patient adherence4
  • With increasing trends in CRC incidence and mortality in adults younger than 50 years (a 3% increase per year from 2010 to 2019),9 it is becoming more critical to detect CRC early

National Guidelines Recommend Informed Decision-Making To Improve Screening Adherence

US Preventive Services Task Force (USPSTF) 20211

"Several recommended screening tests are available. Clinicians and patients may consider a variety of factors in deciding which test may be best for each person."

"Discussion with patients may help better identify screening tests that are more likely to be completed by a given individual."

American Cancer Society (ACS) 20182 "The importance of offering a choice between structural or stool-based testing is included in this guideline in recognition of the role of patient values and preferences and as a practical implementation strategy to improve adherence."
American College of Gastroenterology (ACG) 20213 "The ‘ideal’ screening test should be noninvasive, have high sensitivity and specificity, be safe, readily available, convenient, and inexpensive. For CRC screening, there are multiple approved tests and strategies, each with its strengths and weaknesses. In some instances, the ‘best’ screening test can be considered the one that is acceptable to the patient and gets completed."

Footnotes

  1. This randomized clinical trial of competing CRC screening strategies in a racially/ethnically diverse population was conducted between April 2007 and March 2010 in the San Francisco Community Health Network. N=997, Age=50-75 years with average risk for CRC.

List of Definitions

ACG: American College of Gastroenterology; ACS: American Cancer Society; CRC: colorectal cancer; FOBT: fecal occult blood testing; US: United States; USPSTF: US Preventive Services Task Force.

References

  1. Davidson KW, Barry MJ, Mangione CM, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965-1977.
  2. Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250-281.
  3. Shaukat AK, Kahi CJ, Burke CA, et al. ACG clinical guidelines: colorectal cancer screening 2021. Am J Gastroenterol. 2021;116(3):458-479.
  4. Inadomi JM, Vijan S, Janz NK, et al. Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. Arch Intern Med. 2012;172(7):575-582.
  5. Barry MJ, Edgman-Levitan S. Shared decision making—pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780-781.
  6. Patel SG, May FP, Anderson JC, et al. Updates on age to start and stop colorectal cancer screening: recommendations from the U.S. Multi-Society Task Force on colorectal cancer. Gastroenterol. 2022;162(1):285-299.
  7. Laiyemo AO, Adebogun AO, Doubeni C, et al. Influence of provider discussion and specific recommendation on colorectal cancer screening uptake among U.S. adults. Prev Med. 2014;67:1-5.
  8. American Cancer Society. Colorectal Cancer Facts & Figures 2020-2022. Accessed July 13, 2023. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf
  9. Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023;73(3):233-254. doi:10.3322/caac.21772.