Patient-physician colorectal cancer screening discussions: Delivery of the 5A's in practice

Jennifer Elston Lafata, Gregory S. Cooper, George Divine, Sue Flocke, Nancy Oja-Tebbe, Kurt C. Stange, Tracy Wunderlich

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: The U.S. Preventive Services Task Force advocates use of a 5A's framework (assess, advise, agree, assist, and arrange) for preventive health recommendations. Purpose: To describe 5A content of patientphysician colorectal cancer (CRC) screening discussions and physician-recommended screening modality and to test if these vary by whether patient previously received screening recommendation. Methods: Direct observation of periodic health examinations in 20072009 among average-risk primary care patients aged 5080 years due for screening. Qualitative content analyses conducted 20082010 used to code office visit audio-recordings for 5A and other discussion content. Results: Among study-eligible visits (N=415), 59% contained assistance (i.e., help scheduling colonoscopy or delivery of stool cards), but the assess, advise, and agree steps were rarely comprehensively provided (1%21%), and only 3% included the last step, arrange follow-up. Almost all physicians endorsed screening via colonoscopy (99%), either alone (69%) or in combination with other tests (30%). Patients nonadherent to a prior physician screening recommendation (31%) were less likely to have the reason(s) for screening discussed (37% vs 65%) or be told the endoscopy clinic would call them for scheduling (19% vs 27%), and more likely to have fecal occult blood testing (FOBT) alone (34% vs 25%) or FOBT and colonoscopy recommended (24% vs 14%), and a screening plan negotiated (21% vs 14%). Significance level is p<0.05 for all contrasts. Conclusions: Most patients due for CRC screening discuss screening with their physician, but with limited application of the 5A's approach. Opportunities to improve CRC screening decision-making are great, particularly among patients who are nonadherent to a prior recommendation from a physician.

Original languageEnglish (US)
Pages (from-to)480-486
Number of pages7
JournalAmerican journal of preventive medicine
Volume41
Issue number5
DOIs
StatePublished - Nov 1 2011
Externally publishedYes

Fingerprint

Early Detection of Cancer
Colorectal Neoplasms
Physicians
Colonoscopy
Occult Blood
Office Visits
Health
Advisory Committees
Endoscopy
Primary Health Care
Decision Making
Observation

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Epidemiology

Cite this

Patient-physician colorectal cancer screening discussions : Delivery of the 5A's in practice. / Lafata, Jennifer Elston; Cooper, Gregory S.; Divine, George; Flocke, Sue; Oja-Tebbe, Nancy; Stange, Kurt C.; Wunderlich, Tracy.

In: American journal of preventive medicine, Vol. 41, No. 5, 01.11.2011, p. 480-486.

Research output: Contribution to journalArticle

Lafata, Jennifer Elston ; Cooper, Gregory S. ; Divine, George ; Flocke, Sue ; Oja-Tebbe, Nancy ; Stange, Kurt C. ; Wunderlich, Tracy. / Patient-physician colorectal cancer screening discussions : Delivery of the 5A's in practice. In: American journal of preventive medicine. 2011 ; Vol. 41, No. 5. pp. 480-486.
@article{06236b48207b44c986dcfe46e28b8190,
title = "Patient-physician colorectal cancer screening discussions: Delivery of the 5A's in practice",
abstract = "Background: The U.S. Preventive Services Task Force advocates use of a 5A's framework (assess, advise, agree, assist, and arrange) for preventive health recommendations. Purpose: To describe 5A content of patientphysician colorectal cancer (CRC) screening discussions and physician-recommended screening modality and to test if these vary by whether patient previously received screening recommendation. Methods: Direct observation of periodic health examinations in 20072009 among average-risk primary care patients aged 5080 years due for screening. Qualitative content analyses conducted 20082010 used to code office visit audio-recordings for 5A and other discussion content. Results: Among study-eligible visits (N=415), 59{\%} contained assistance (i.e., help scheduling colonoscopy or delivery of stool cards), but the assess, advise, and agree steps were rarely comprehensively provided (1{\%}21{\%}), and only 3{\%} included the last step, arrange follow-up. Almost all physicians endorsed screening via colonoscopy (99{\%}), either alone (69{\%}) or in combination with other tests (30{\%}). Patients nonadherent to a prior physician screening recommendation (31{\%}) were less likely to have the reason(s) for screening discussed (37{\%} vs 65{\%}) or be told the endoscopy clinic would call them for scheduling (19{\%} vs 27{\%}), and more likely to have fecal occult blood testing (FOBT) alone (34{\%} vs 25{\%}) or FOBT and colonoscopy recommended (24{\%} vs 14{\%}), and a screening plan negotiated (21{\%} vs 14{\%}). Significance level is p<0.05 for all contrasts. Conclusions: Most patients due for CRC screening discuss screening with their physician, but with limited application of the 5A's approach. Opportunities to improve CRC screening decision-making are great, particularly among patients who are nonadherent to a prior recommendation from a physician.",
author = "Lafata, {Jennifer Elston} and Cooper, {Gregory S.} and George Divine and Sue Flocke and Nancy Oja-Tebbe and Stange, {Kurt C.} and Tracy Wunderlich",
year = "2011",
month = "11",
day = "1",
doi = "10.1016/j.amepre.2011.07.018",
language = "English (US)",
volume = "41",
pages = "480--486",
journal = "American Journal of Preventive Medicine",
issn = "0749-3797",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Patient-physician colorectal cancer screening discussions

T2 - Delivery of the 5A's in practice

AU - Lafata, Jennifer Elston

AU - Cooper, Gregory S.

AU - Divine, George

AU - Flocke, Sue

AU - Oja-Tebbe, Nancy

AU - Stange, Kurt C.

AU - Wunderlich, Tracy

PY - 2011/11/1

Y1 - 2011/11/1

N2 - Background: The U.S. Preventive Services Task Force advocates use of a 5A's framework (assess, advise, agree, assist, and arrange) for preventive health recommendations. Purpose: To describe 5A content of patientphysician colorectal cancer (CRC) screening discussions and physician-recommended screening modality and to test if these vary by whether patient previously received screening recommendation. Methods: Direct observation of periodic health examinations in 20072009 among average-risk primary care patients aged 5080 years due for screening. Qualitative content analyses conducted 20082010 used to code office visit audio-recordings for 5A and other discussion content. Results: Among study-eligible visits (N=415), 59% contained assistance (i.e., help scheduling colonoscopy or delivery of stool cards), but the assess, advise, and agree steps were rarely comprehensively provided (1%21%), and only 3% included the last step, arrange follow-up. Almost all physicians endorsed screening via colonoscopy (99%), either alone (69%) or in combination with other tests (30%). Patients nonadherent to a prior physician screening recommendation (31%) were less likely to have the reason(s) for screening discussed (37% vs 65%) or be told the endoscopy clinic would call them for scheduling (19% vs 27%), and more likely to have fecal occult blood testing (FOBT) alone (34% vs 25%) or FOBT and colonoscopy recommended (24% vs 14%), and a screening plan negotiated (21% vs 14%). Significance level is p<0.05 for all contrasts. Conclusions: Most patients due for CRC screening discuss screening with their physician, but with limited application of the 5A's approach. Opportunities to improve CRC screening decision-making are great, particularly among patients who are nonadherent to a prior recommendation from a physician.

AB - Background: The U.S. Preventive Services Task Force advocates use of a 5A's framework (assess, advise, agree, assist, and arrange) for preventive health recommendations. Purpose: To describe 5A content of patientphysician colorectal cancer (CRC) screening discussions and physician-recommended screening modality and to test if these vary by whether patient previously received screening recommendation. Methods: Direct observation of periodic health examinations in 20072009 among average-risk primary care patients aged 5080 years due for screening. Qualitative content analyses conducted 20082010 used to code office visit audio-recordings for 5A and other discussion content. Results: Among study-eligible visits (N=415), 59% contained assistance (i.e., help scheduling colonoscopy or delivery of stool cards), but the assess, advise, and agree steps were rarely comprehensively provided (1%21%), and only 3% included the last step, arrange follow-up. Almost all physicians endorsed screening via colonoscopy (99%), either alone (69%) or in combination with other tests (30%). Patients nonadherent to a prior physician screening recommendation (31%) were less likely to have the reason(s) for screening discussed (37% vs 65%) or be told the endoscopy clinic would call them for scheduling (19% vs 27%), and more likely to have fecal occult blood testing (FOBT) alone (34% vs 25%) or FOBT and colonoscopy recommended (24% vs 14%), and a screening plan negotiated (21% vs 14%). Significance level is p<0.05 for all contrasts. Conclusions: Most patients due for CRC screening discuss screening with their physician, but with limited application of the 5A's approach. Opportunities to improve CRC screening decision-making are great, particularly among patients who are nonadherent to a prior recommendation from a physician.

UR - http://www.scopus.com/inward/record.url?scp=80054764033&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80054764033&partnerID=8YFLogxK

U2 - 10.1016/j.amepre.2011.07.018

DO - 10.1016/j.amepre.2011.07.018

M3 - Article

C2 - 22011418

AN - SCOPUS:80054764033

VL - 41

SP - 480

EP - 486

JO - American Journal of Preventive Medicine

JF - American Journal of Preventive Medicine

SN - 0749-3797

IS - 5

ER -