Despite the availability of several effective screening tests, colorectal cancer screening rates remain below national goals. Although colonoscopy is the most often recommended screening method, a new study has found that the preferences of primary care clinicians have shifted toward noninvasive options. This was particularly the case for patients who were unwilling to undergo invasive procedures, who were concerned about taking time off from work, who were unconvinced about the need for screening, or who refused other screening recommendations. The research, published by Rutten et al in Mayo Clinic Proceedings, suggests that although health-care providers prefer colonoscopy for screening, they recognize the need to tailor recommendations to the needs and preferences of patients.
"Nearly one-third of eligible adults in the United States are not up to date on colorectal cancer screening, and even lower rates have been observed among populations that are traditionally underserved," said Lila J. Finney Rutten, PhD, a health services researcher at Mayo Clinic and the study’s lead author.
Research has shown that the recommendations of primary care clinicians and gastroenterologists strongly influence whether patients are screened and what type of screening they choose: direct visualization, such as colonoscopy, or noninvasive options, such as stool-based screening. To better understand health-care providers’ preferences and practices with regard to colorectal cancer screening, the researchers developed a survey that was administered online in late 2019 and completed by 779 primary care clinicians and 159 gastroenterologists.
Survey Results
According to the survey, colonoscopy was the most frequently preferred option for average-risk patients, favored by 96.9% of gastroenterologists and 75.7% of primary care clinicians. “Interestingly, we found that nearly one-in-four primary care clinicians in our study selected a stool-based test as their preferred screening option, with multitarget stool DNA selected more frequently than either fecal immunochemical test or guaiac-based fecal occult blood test,” said Dr. Rutten.
The availability of multiple screening options with differing test attributes and patient acceptability highlights the need for health-care providers to share accurate information about all available options to support informed choice and shared decision-making, so that more patients initiate and follow through with their preferred colorectal cancer screening strategy.— Paul Limburg, MD
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Among primary care clinicians, 12.2% (95 of 779) preferred multitarget stool DNA, followed by fecal immunochemical test, (7.3%; 57 of 779) and guaiac-based fecal occult blood test (4.8%; 37 of 779).
Among primary care clinicians, preference for multitarget stool DNA over fecal immunochemical testing and guaiac-based fecal occult blood testing was less frequent in larger vs smaller clinical practices. Preference for multitarget stool DNA over fecal immunochemical testing was more likely among primary care clinicians with more years of clinical experience, higher patient volumes, and practice locations in suburban and rural settings vs urban settings.
"With the availability of multiple screening options with distinct benefits and drawbacks related to effectiveness, access, cost, risk, and patient acceptability, it is critical to encourage informed choice and shared decision-making between patients and their health-care providers," said Dr. Rutten.
"These findings suggest that primary care clinicians recognize the need to tailor their colorectal cancer screening recommendations to the preferences of their patients, especially with the emergence of new, less invasive options," added Paul Limburg, MD, a gastroenterologist at Mayo Clinic and the study’s senior author.
The study noted that previous research has demonstrated that the common practice of recommending screening with only colonoscopy may reduce the number of patients who undergo screening, particularly among racial and ethnic minorities, and that offering noninvasive screening options is associated with greater adherence to testing.
"The availability of multiple screening options with differing test attributes and patient acceptability highlights the need for health-care providers to share accurate information about all available options to support informed choice and shared decision-making, so that more patients initiate and follow through with their preferred colorectal cancer screening strategy," Dr. Limburg concluded.
Disclosure: The study was funded in part by Exact Sciences, based in Madison, Wisconsin, and by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. For full disclosures of the study authors, visit mayoclinicproceedings.org.
